Rapidly Changing World of Cardiac Surgery

Cardiac surgery developed rapidly in the seventies and eighties of the last century, followed by a period of stabilisation and finally a numerical decline in 21st century. Coronary bypass surgery has been largely supplanted by percutaneous interventions, arrhythmia surgery has been replaced by percutaneous ablation and implantable defibrillators, correction of simpler congenital anomalies is also accomplished by catheter techniques, and we are now observing the emergence of transcatheter aortic valve replacement, which is rapidly overtaking surgical valve repair. On the horizon are mitral and tricuspid repairs; even some short-term circulatory assistance devices are being employed by transcutaneous approach. This development has important consequences for cardiosurgical training: minimally invasive procedures are becoming standard of care, catheter training in a heart laboratory (“wire skills”) is becoming essential, education in interpretation of advanced imagining techniques: magnetic resonance imaging, angio- and multislice computed tomography, and 2D and 3D echo must be introduced, and surgeons must be also trained in endoscopic and robotic surgery for advanced minimally invasive interventions.