We investigated the association between cardiac factors, spirometry, and exercise testing in patients with tetralogy of Fallot (TOF). Clinical data from patients with TOF performing a cardiopulmonary exercise test (CPET) was collected retrospectively over a 10-year period. 122 patients with TOF were identified, 52 excluded for incomplete exercise, spirometry, or cardiac data for 70 total patients included in the study. There was a male predominance 39 (56%), a mean age of 25 ± 12 years, with 28 (40%) < 18 years of age. The mean number of cardiac surgeries was 2.1 ± 1.2. Most, 46 (69%) had moderate to severe pulmonary valve insufficiency (PI) and 34 (51%) had moderate to severe right ventricular (RV) dilation. Mean forced vital capacity (FVC) was low at 81.8% predicted, and 32 (46%) with low FVC (< 80% predicted). Overall peak VO₂/kg was low with a mean of 58.2 ± 13.2 % predicted. Using multiple regression analysis, a higher number of cardiac surgeries was an independent predictor of lower FVC (p = 0.01). Lower FVC was itself an independent predictor of lower peak VO₂/kg and O₂ pulse (p < 0.05). Moderate or severe RV systolic dysfunction was an independent predictor of stroke volume response (p = 0.03). Higher body mass index (BMI) was an independent predictor of all exercise measures being worse (p < 0.05). Low FVC and reduced exercise capacity were common in our population of TOF patients. Low FVC was predictive of low exercise capacity while, of the cardiac measures only RV systolic dysfunction was significant and predictive of stroke volume response. Spirometry may be a valuable screening tool in evaluation of TOF patients.

The robot-based approach has been the most significant advancement in minimally invasive surgery over the past decade. Robotic coronary heart surgery represents half of the total cases of robotics-based cardiac surgery. Since 1998, it has emerged as a revolutionary approach to standard coronary surgery. However, despite its promising beginning, there has been a growing interest in the application of robotics in surgical fields other than cardiac surgery, such as urology and general surgery. In various waves of enthusiasm, single pioneers or visionary cardiac surgeons have tried to extend robotic surgery to different heart procedures, but they still struggled to practice it as a routine approach. Over the last 20 years, robotic platforms have gained importance in minimally invasive heart surgery, with proven safety and efficacy. However, despite its feasibility, safety, and efficacy, less than 0.5%–1.0% of coronary artery bypass grafting procedures are performed using a robot-assisted setup. We believe that in cardiac surgery, the time is ripe to open up new surgical strategies that are increasingly devoted to robotics, hybrid, and augmented-reality-based assistance. With this in mind, we wish to propose an excursus on the state of the art of coronary robotic surgery, its promising results, and its possible future perspectives, with a focus on the most recent achievements. This narrative minireview addresses, therefore, experiences and all aspects related to such a technique, with particular attention gained in robotic coronary revascularization, to the anaesthesiologic as well as surgical aspects, on the learning curve, patient outcome, and related costs, wishing to enlarge the portfolio of the younger generation of cardiac surgeons. In effect, according to the literature data, we are confident that robotic heart surgery is burgeoning, and the new generation of cardiac surgeons must face a gorgeous future if we invest in training and technology.

Introduction: Heart conditioning can be utilized as a healthy strategy in the reversion of disease and ageing. In this sense, heart conditioning may benefit the aortic stenosis patients. Case presentation: We describe the case of an 82-year-old man with moderate to severe aortic stenosis (aortic valve area 1.01 cm² with peak pressure gradient 56.7mmHg) who refused valvular intervention. He was treated conservatively with antianginal drugs, and remote ischemic preconditioning as a healthy strategy was delivered once daily. To our surprise, 27 months later, follow-up transthoracic echocardiography showed an aortic valve area of 1.41 cm². His symptoms were dramatically relieved. Conclusions: This case indicates that heart conditioning as a healthy regimen is a valuable safe and effective adjunctive treatment in aortic stenosis patients, which could affect cardiac reverse remodeling and recovery as well as quality of life.