Further questions

In addition to the Top 10 priorities, a number of further research questions were identified:

Quality of life

  • What is the best tool to assess Quality of Life (QOL) in specific cardiac surgery disease?
  • What modifiable factors can be targeted to improve QOL?
  • Are there important QOL benefits in elderly patients who undergo cardiac surgery?
  • What is the long-term comparison in terms of QOL between surgical and interventional approach?

Frailty, chronic conditions and prehabilitation

  • Can we identify specific frailty phenotypes that do not derive benefits from surgery versus other treatments?
  • Are there specific pre-surgery interventions that can be targeted to patients with chronic conditions or frailty
  • Do specific surgical techniques (e.g. minimally invasive surgery), or percutaneous approaches improve outcomes in populations with chronic diseases?
  • Are pre-surgery interventions feasible in non-elective surgery?
  • Does prehabilitation improve outcomes in frail patients?
  • What are the best nutritional strategies for prehabilitation?
  • Does prehabilitation have long-term benefits?
  • Should we design prehabilitation programs specific to patient groups and type of cardiac surgery?

Heart valve intervention

  • Can B-type natriuretic peptide (BNP) levels guide the timing for intervention on the aortic valve?
  • Is aortic flow peak velocity an adequate criterion to plan surgery on asymptomatic patients?
  • Does mid-wall myocardial fibrosis findings at cardiac magnetic resonance (CMR) have a role in the timing of surgery in asymptomatic patients with severe aortic valve disease?
  • Does longitudinal strain measurement have a role in the timing of surgery in asymptomatic mitral valve regurgitation?

Minimally invasive surgery

  • Is minimally invasive surgery clinically or cost effective?
  • What is the optimal communication strategy to present the choice between minimally invasive and traditional surgery to the patients?
  • What are the requirements for the provision of specialised minimally invasive cardiac surgery services?
  • Is there a difference in long-term QOL between minimally invasive and traditional surgery?

Minimising organ damage

  • Does pre-surgery optimisation of chronic kidney, lung, or metabolic diseases reduce post-surgery lung and kidney injury or infection?
  • Do personalised perioperative treatment algorithms based on enhanced monitoring of tissue oxygenation or vascular function during surgery prevent organ injury?
  • Are there pharmacological strategies or other interventions (fluid restriction, enhanced recovery, extracorporeal circuit modification) that attenuate the effects of surgery on organ function?
  • Can novel myocardial protection strategies improve clinical outcomes?
  • Which perfusion strategy should we adopt for aortic dissection?

Preventing and treating post-operative atrial fibrillation

  • Do preoperative lifestyle interventions such as weight loss or exercise have a role in postoperative atrial fibrillation prevention?
  • Does attenuating the inflammatory response to surgery reduce post-operative atrial fibrillation?
  • Is rhythm control or rate control the optimal management strategy in every patient subgroup?
  • Is surgical ablation safe and effective in longstanding persistent atrial fibrillation?
  • Is hybrid (endocardial + epicardial) atrial fibrillation ablation superior to surgical and transcatheter interventions?
  • What is the optimal management of post-operative atrial fibrillation in heart failure patients?

Managing infection after surgery

  • How effective is preoperative skin antisepsis in preventing surgical infection?
  • What is the optimal ventilation management to prevent postoperative pneumonia?
  • How do we manage steroid therapy in the perioperative period to avoid complication on wound healing?
  • Do microbial sealants prevent surgical site infection?
  • Which interventions should be part of a care bundle to prevent surgical site infection in cardiac surgery?
  • What is the optimal surgical antibiotic prophylaxis and duration?
  • Are interventions to prevent infection applicable to hybrid cardiac surgery procedures?