What is Cardiac Surgery?
Cardiac surgery is a specialized surgical field that involves invasive procedures on the heart and great vessels to treat severe coronary, valvular, or myocardial disease, providing definitive therapy for patients with these conditions. 1
Types of Cardiac Surgical Procedures
Coronary Artery Bypass Grafting (CABG): A procedure that provides mortality benefit in defined populations by restoring blood flow to the heart muscle. More than 300,000 patients undergo CABG annually in the United States, with approximately 50% of these patients being older than 65 years with multiple comorbidities. 1
Valve Surgery: Procedures to repair or replace damaged heart valves (mitral, aortic, tricuspid, pulmonary) that have resulted in improved survival and quality of life for patients with end-stage heart disease from obstructed or leaking native heart valves. 1
Heart Transplantation: Once considered experimental, heart transplantation has now been established as standard care for end-stage heart failure. 1
Mechanical Circulatory Support: Implementation of complex implantable pumps that provide effective short-term treatment for the failing heart, with long-term mechanical support for severe heart failure becoming increasingly feasible. 1
Pediatric Heart Surgery: Significant advances have been made in this field, including lifesaving procedures such as definitive repair of hypoplastic left heart syndrome. 1
Evolution and Technological Advances
Cardiopulmonary Bypass: The introduction of the heart-lung machine enabled direct surgery on the heart by maintaining circulation while the heart is stopped. 2
Minimally Invasive Techniques: New developments include:
Biotechnology and Cell-Based Therapy: Emerging approaches include:
Outcomes and Quality Measures
Mortality and Morbidity: Despite advances, cardiac surgical procedures remain among the most invasive and expensive therapeutic techniques in modern medicine, with significant risks. 1
Quality of Life: Enhanced postoperative quality of life and functional capacity are key indicators of surgical success following cardiac procedures. 5
Cardiac Rehabilitation: This plays a pivotal role in enhancing patient function, reducing frailty, and improving long-term quality of life after cardiac surgery. 5
Challenges and Future Directions
Aging Population: An increasing percentage of cardiac surgery patients are older with multiple comorbidities related to generalized atherosclerosis. 1
Novel Cardioprotective Strategies: Approaches such as remote ischemic conditioning and pharmacological interventions are being developed to reduce perioperative myocardial injury. 4
Implementation of New Technologies: Novel imaging technologies and training methods will be necessary for implementing advanced minimally invasive cardiac surgical techniques. 4
Financial Constraints: The major drawback for the achievement of this amazing progress is the financial cost, requiring an open debate between all parties concerned in healthcare. 3
Common Pitfalls and Caveats
Patient Selection: The indications for coronary intervention should not be redefined simply because a patient requires a major noncardiac procedure. The long-term implications of severe coronary disease remain significant regardless of other surgical needs. 1
Perioperative Risk Assessment: Cardiovascular morbidity and mortality vary not only among procedures but also among institutions for the same procedure, requiring individualized risk assessment. 1
Translating Experimental Findings: Multiple cardioprotective therapies that showed promise in laboratory settings have failed to demonstrate benefits in clinical trials, highlighting the need for rigorous clinical testing. 4