Advances in cardiac surgery and therapeutics

Over the years, novel surgeries and therapeutics has made the treatment of congenital heart disease, coronary artery diseases, valve disease and atrial fibrillation, possible. In addition, robotics has gained acceptance in cardiac surgery field.

1. Congenital Heart Disease (CHD)

CHD is a structure defect of the heart and great vessels at birth. It is the leading cause of birth defect-related deaths. Thus complex congenital heart defects have to be treated actively with medication or surgery. Following techniques have provided a solution to this problem:

  1. Anatomical repair for Ebstein’s anomaly
  2. Septation of single ventricle with double-patch procedure
  3. Surgical treatment of double-outlet right ventricle with pulmonary artery hypertension
  4. Advanced repair materials

 2. Coronary Artery Disease

Coronary artery disease remains the leading cause of death nowadays. Coronary Artery Bypass Grafting (CABG) is the conventional surgical treatment with good results. Some of the novel methods are listed below:

  1. Minimally invasive direct coronary artery bypass grafting
  2. Percutaneous coronary intervention (PCI)
  3. Hybrid MIDCAB approach

3. Aortic Stenosis

Aortic stenosis is associated with a high death rate if no action taken. Surgical Aortic Valve Replacement (SAVR) is the conventional golden treatment for patients with aortic stenosis. However, unfortunately, many patients are not eligible for surgery due to advanced age, poor left ventricular function or other complications. Some of the alternative options are given below:

  1. Implantation techniques of Transcatheter Aortic Valve Replacement (TAVR)
  2. Novel aortic valve prosthesis

4. Mitral Regurgitation

Mitral Valve Regurgitation (MR) is the most common valvular heart disease and often associated with worsening of symptoms and reduced survival. Surgical intervention is usually recommended for symptomatic severe MR or asymptomatic severe MR with left ventricular dysfunction or enlargement. Latest treatment methods include:

  1. Leaflet procedures
  2. Annuloplasty procedures
  3. Paravalvular leak closure
  4. Mitral valve implantation

5. Atrial Fibrillation

As we all know, Atrial Fibrillation (AF) is the most common arrhythmia disease, especially with an increasing incidence in the aging population. And the morbidity associated with AF is significant without pharmacologic intervention. Novel procedures are mentioned below:

  1. Percutaneous transcatheter ablation
  2. Hybrid surgery
  3. Surgical treatment

6. Procedures Assisted by Robotics

Robotic cardiac operations evolved from minimally invasive operations. As minimally invasive cardiac operations gained favor, developments in tele-manipulation technology and optics fostered the evolution of robotic-assisted cardiac surgery. Nowadays, robotic systems have been utilized successfully to perform complex mitral valve repairs, coronary revascularization, atrial fibrillation ablation, intracardiac tumor resections, atrial septal defect closures, and left ventricular lead implantation. In the future, robotic systems will likely incorporate strain sensors to the instruments arms, allowing for haptic feedback and precise control of force.

In short, any surgery and any therapeutic have better to be patient tailored and the curative effect should be considered in long-term. With advanced development of technology, cardiac surgery trends will be minimally invasive, safe and efficacy, close cooperation between surgeons and physicians.

Source: Advances in Cardiac Surgery and Therapeutics by Ji Jingjing and Wu Qingyu

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