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

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.

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.

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.

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.

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.

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.

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.

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.

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.