Invasiveness in cardiac surgery: a question of age

A survey was conducted among 1644 cardiac surgeons on the surgical strategy regarding the invasiveness of the procedure they would prefer as a patient in a number of simple clinical scenarios. A total of 380 (23%) replies were received. Only in the case of aortic valve surgery, a notable preference of minimally invasive strategy was registered, as transcatheter aortic valve implantation was indicated by 49% of the respondents. Regarding the size of the incision for mitral valve surgery, there was a substantial equality between preferences of standard surgery and minimally invasive option (port access: 42%; standard surgery with full sternotomy: 40%). With regard to the use of extracorporeal circulation for coronary surgery, the traditional option received more preferences than the less-invasive one (on-pump CABG: 42%; off-pump CABG: 31%). When respondents' age was taken into account, surgeons aged<50 years preferred mini-thoracotomy (P=0.03) and transcathether approaches (P=0.008) to have their mitral and aortic valve surgeries performed, whereas more senior ones would choose more traditional techniques. In conclusion, the findings of this survey suggest that the surgeon's age may play an important role in the preference for less-invasive techniques.