The influence of new surgical techniques on the development of cardiac surgery

Background. During the last decade new strategies and equipment have gained popularity in the clinical and experimental setting of cardiac surgery. Little is known about the real impact of these new approaches on the development of heart surgery. The present paper aimed to characterize, through a multicenter evaluation, the state of the art in Italy. Methods. A survey of all active heart surgery centers in Italy (both public and private institutions) was conducted through a questionnaire. Diffusion, effectiveness and future perspective of these new surgical techniques were asked. Off-pump coronary artery-surgery, myocardial revascularization in patients with low left ventricular ejection fraction, left ventricular surgical remodeling, mitral valve reconstruction, ministernotomic approach in aortic surgery and the use of laser, robots, heart port-access and endoscopy were the strategies under investigation. Results. The use of laser, heart port-access and endoscopy were considered to have a poor impact due to proved ineffectiveness and/or technical complexity. Indications and long-term outcomes of off-pump coronary artery surgery are still under active debate. The introduction of new prosthetic materials has resulted in the widespread diffusion of mitral valve reconstruction approaches with concomitant widening of the indications. Similarly there is wide consensus on myocardial revascularization in patients with low ejection fraction. Ministernotomic strategies and ventricular remodeling are slowly but progressively gaining acceptance. Conclusions. Cardiac surgery in Italy is characterized by a great effort on new research field. Traditional approaches are still preferred unless new techniques have proved effective after strict scientific evaluation.