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?