A Cut Above: Cardiothoracic insights from EACTS

Understanding HOCM – Plenty of Patients, Shortage of Surgeons

What happens when hypertrophic cardiomyopathy stops responding to medication? In this episode of A Cut Above, Perry Elliott and Michael Grimm explore the evolving treatment of hypertrophic obstructive cardiomyopathy, from traditional medical therapy and new myosin inhibitors to septal myectomy and alcohol septal ablation. They discuss how anatomy, age and comorbidities shape treatment decisions, why multidisciplinary assessment is crucial, and how the emergence of myosin inhibitors is changing the role of surgery. Looking ahead, they consider the future of specialised surgical centres and the challenge that remains beyond obstruction: preventing the progression to heart failure.

Aortic surgery in revolution: full fix for all with FET?

As hybrid aortic surgery continues to advance, the frozen elephant trunk (FET) technique is playing an increasingly important role in treating complex aortic disease. Martin Czerny and Jennifer Chung discuss when to use FET, how to plan the procedure, and the key technical decisions that influence outcomes. Blending practical surgical tips with the latest evidence and guideline recommendations, this episode explores patient selection, operative strategy and the future of aortic arch repair, offering valuable insights for surgeons looking to adopt or refine this evolving technique.

The Tailor-Made Valve: Mastering the Ozaki Procedure

Can a surgeon build a new aortic valve from a patient's own tissue—and make it last? The Ozaki procedure has attracted passionate advocates and sceptics in equal measure, emerging as one of the most debated innovations in aortic valve surgery. In this episode, Dr. Pedro del Nido and Dr. Markus Krane discuss the technique's origins, technical challenges, durability, and role in both congenital and adult practice, exploring whether Ozaki represents a niche solution or a genuine advance in the lifelong management of aortic valve disease.

Rebuilding a destroyed heart: the Commando procedure

A pioneer of modern cardiac surgery, Tirone David, joins A Cut Above for a deep dive into one of the specialty's most feared and technically demanding operations: the Commando procedure. Also featuring Eduard Quintana, listen for discussions from radical reconstruction for infective endocarditis and massive annular calcification to the mindset required when "there is no other option". This episode explores the anatomy, precision, and surgical courage behind extraordinary cases — while offering invaluable lessons on innovation, operative judgement, and the future of complex valve surgery.

Valve Therapy in 2026: Is Surgery Losing Ground? A Debate with ESC/EACTS Guideline Co-Authors

In this episode, our hosts are joined by Michael Borger and Nikolaos Bonaros to break down the new valvular heart disease guidelines—what's changed, why it matters, and how the decisions were really made. They cut through the headlines to explain the thinking behind key recommendations, from TAVI thresholds and bicuspid valves to atrial functional MR, concomitant ablation, and the push for heart valve centres. Sharp, practical, and grounded in real-world decision-making, this episode gives you the essentials of modern valve therapy—and the questions that still need answering.

A Stitch That Changed Mitral Repair

How did a simple stitch transform mitral valve repair? In this episode, we spotlight the pioneers of cardiothoracic surgery, Ottavio Alfieri and Francesco Maisano - the minds behind the edge-to-edge repair. They revisit the early 1990s, when mitral repair was complex and inconsistent, and share how the now-famous Alfieri stitch—inspired by a congenital double-orifice valve—offered a simple, reliable solution. From early skepticism to global adoption and the rise of transcatheter therapies like MitraClip, this conversation traces how one elegant idea reshaped mitral valve treatment and continues to influence the future of structural heart therapy.

Between Hope and Hardware: LVAD Therapy in 2026

This episode focuses on long-term mechanical circulatory support and how durable LVAD therapy is shaping contemporary heart failure management. Joined by Gloria Färber and Daniel Zimpfer, we discuss key advances in device technology, the ongoing challenge of driveline complications, and the critical question of patient selection and timing. The conversation explores LVADs as destination therapy or bridge to transplant, managing right ventricular failure, and the role of temporary support. Looking ahead, the episode highlights emerging technologies and why mechanical circulatory support will remain central to advanced cardiac surgery.

Pushing the Boundaries of Thoracic Surgery with Robotics

In this episode, our hosts turn their focus to robotic thoracic surgery, exploring how robotics is reshaping everyday clinical practice. Joined by Virginia Litle (host of the Thoracic Surgery Clinics Podcast) and Vasileios Kouritas, the discussion examines where robotic approaches add clear value, where other techniques still have a role, and how surgeons decide which cases truly benefit from the technology. Topics include patient outcomes, operative precision, team dynamics in the operating room, managing intraoperative risk, and how experience influences safety and confidence. With reflections on complex resections, surgeon ergonomics, and future developments, the episode offers a clear-eyed view of why robotics has moved from novelty to necessity in modern thoracic surgery.

Prime the Pump: The Essentials of Perfusion in 2025

This episode examines the foundations of cardiopulmonary bypass, focusing on the 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery & the EBCP Expert consensus statement on basic qualifications and competencies for clinical perfusionists in Europe developed in collaboration with EACTS and EACTAIC. Joined by Alexander Wahba and Adrian Bauer, our hosts discuss what has evolved since the 2019 recommendations, where evidence has strengthened, and why practice still varies across Europe. The conversation covers pump technology, minimally invasive circuit strategies, key perfusion techniques, and the push to standardise perfusion education—highlighting how these documents aim to improve safety, consistency, and outcomes in everyday cardiac surgery.

President's Choice Abstracts from the Annual Meeting 2025

CABG Nightmares – Practical Solutions for Complex Cases

Recorded live at the EACTS Annual Meeting, this special episode explores the theme "Nightmares in CABG." Our hosts are joined by Faisal Bakaeen, Thomas Gudbjartsson, and Miguel Sousa Uva for an open and practical discussion on the challenges of coronary surgery. The panel shares their approaches to complex scenarios—from fragile conduits and calcified aortas to dissected mammaries and "full metal jacket" targets—offering insight into preparation, technique, and team communication. Emphasis is placed on patient assessment, intraoperative decision-making, and the humility required to learn from complications. The conversation closes with reflections on mentorship, transparency, and the value of honest debriefing in shaping safer surgical practice.

Scalpel to Startup: Turning Ideas into Impact

Our hosts are joined by Joseph Bavaria for a practical discussion on surgical innovation and industry collaboration. The conversation covers pathways from idea to device - patents, partnering with companies, and when a startup makes sense - along with funding from angel backing to venture rounds and the realities of regulatory approval. Bavaria reflects on advisory board work, managing conflicts of interest in clinical trials, and why surgeons should help shape product design while advocating for the broader platform rather than a single brand. He also offers guidance for early-career clinicians on finding mentors, protecting IP, and building the multidisciplinary ecosystem needed to bring ideas to patients.

From One Heart to Another: The Renaissance of Heart Valve Transplants

In this episode, we are joined by Dr. Emile Bacha to discuss the emerging field of partial heart transplantation. The conversation explores the history of the concept, its reintroduction in recent years, and how techniques such as domino procedures are being developed to expand donor availability. Dr. Bacha explains the practical challenges of regulation, organ procurement, and immunosuppression, as well as early outcomes seen in paediatric patients. With reflections on valve durability, patient growth, and the future potential of this approach, this episode offers a detailed look into a promising area of congenital cardiac surgery and beyond.

The Unplanned Plan B: SAVR After TAVR

In this episode, our hosts are joined by Sabine Bleiziffer and Augusto D'Onofrio to discuss SAVR after TAVR - exploring key decision-making factors, including valve selection, explantation techniques, and patient-specific risk profiles. The guests share experiences with challenging cases, technical tips, and thoughts on how procedural volume, planning, and shared decision-making can impact outcomes. We also consider the future of lifetime valve management and what young surgeons need to know as this field continues to evolve.

Dissection Roulette: How to Survive the Most Unforgiving Surgery

This month's episode focuses on the complex management of acute aortic dissection. Our hosts are joined by Florian Schoenhoff and Chris Malaisrie to discuss current strategies in surgical planning and intraoperative decision-making. Topics include CT-based assessment, cannulation techniques, malperfusion management, and valve preservation. The conversation also considers how to optimise outcomes, the role of conservative management in select cases, and the potential future impact of endovascular approaches. Listen for a practical overview of key considerations in this complex procedure.

Double-valve trouble or life-time solution: mastering the Ross procedure

Recorded at the AATS annual meeting in Seattle, our hosts are joined by Dr. El-Hamamsy & Dr. Ouzounian to explore the resurgence of the Ross procedure. The discussion covers the evolving evidence base, training requirements, and technical considerations surrounding this increasingly prevalent operation. Dr. El-Hamamsy and Dr. Ouzounian share their own learning curves, views on centralising care, and the importance of surgical volume for patient outcomes. Listeners will also hear about best practices in patient selection, graft support strategies, and the future of Ross—including potential innovations to expand access globally.

Surgical Leadership: Democracy or Dictatorship

In this thought-provoking discussion, our hosts explore the multifaceted world of leadership in cardiac surgery. Joined by Shirin Bemelmans-Lalezari and Volkmar Falk, we delve into how leadership styles evolve, the balance between authority and empathy, and the importance of team dynamics. Learn of the real-life challenges in managing surgical teams and navigating hierarchy. With insights from both clinical and coaching perspectives, this episode offers valuable reflections for anyone considering or currently in a leadership role within cardiothoracic surgery.

Pulse Check – Key Papers at a Glance: Infective Endocarditis

We are pleased to announce the first of a new series of upcoming episodes, titled 'Pulse Check – Key Papers at a Glance'. Our host Can discuss two recent and impactful EJCTS articles on infective endocarditis. Joined by the renowned, Michael Borger and Torsten Doenst, we explore firstly the implications of preoperative septic cerebral embolism for patients undergoing valve surgery. Then followed by an exploration into the use of haemoadsorption therapy, addressing the key issue of controlling inflammation during cardiac surgery for endocarditis. Listen to gain rapid insight into the associated articles: Effect of haemoadsorption during cardiac surgery for Staphylococcus aureus endocarditis: a REMOVE trial post hoc analysis Outcomes following heart valve surgery in patients with infective endocarditis and preoperative septic cerebral embolism: insights from the CAMPAIGN study group'

Expanding aortic roots and surgical horizons

Are you curious about the origins and future of aortic root enlargement surgery? In this episode, our hosts discuss the surgical horizons of this underutilised technique. Featuring the well-respected Bo Yang, Can Gollmann-Tepeköylü and Miia L Lehtinen explore the creation of this innovative technique, as well as its reputation and utility in the surgical community. Listeners can expect to hear firsthand how Dr Yang discovered his esteemed procedure, as well as detailed comparisons to similar interventions and how patient suitability is assessed.

Guidelines: Perioperative Medication

Are you looking to deepen your understanding of perioperative medication? Join us for the first episode of 2025, where we offer listeners an author insight into the recently published '2024 EACTS Guidelines on perioperative medication in adult cardiac surgery'. With working group members Anders Jeppsson and Emma Hansson, our host Miia L Lehtinen explores the fundamental intricacies considered to ensure these diverse guidelines are current and clinically applicable. Discussions include how the varied specialities of clinical intervention contribute to individual patient needs, including indication specific medication schedules, and the nuanced effects these bring to patients. We also encourage our listeners to view the recently published perioperative guidelines here: https://academic.oup.com/ejcts/advance-article/doi/10.1093/ejcts/ezae355/7815986?searchresult=1&login=false