[A decade of changes in cardiac surgery: an Italian geographical and gender analysis]

Numerous speculations have been made in recent years about the future of cardiac surgery, seen by some as an "obsolete" discipline and reserved for complex/emerging cases.

From the central database of the private-affiliated group GVM Care & Research with the National Health System, data from 2014 to 2023 relating to elective cardiac surgery (57 736 patients) were extracted from 12 cardiac surgery centers located throughout the country, with specific reference to isolated coronary and valvular surgery.

The number of elective interventions performed from 2014 to 2023 has progressively increased with a slowdown in 2020 caused by the COVID-19 pandemic. The increase in the number of interventions is mainly linked to an increase in interventions in central-southern Italy which, starting from 2016, has led to equalizing the data in the two geographical areas. Women, throughout the country, have a higher average age at surgery than men and a higher surgical risk than men, especially if operated in northern Italy. Coronary artery bypass grafting has increased especially in southern Italy, and remains more frequent in males throughout the country. As for isolated valve interventions, there has been an increase in the total number, more significant in central and southern Italy, and a significant increase in the use of biological prostheses. Thirty-day mortality has not undergone significant changes in the last 10 years.

Our results demonstrate that cardiac surgery is a specialty that has not reduced its activity over the years in the elective field despite a significant transformation of the branch with a shift towards transcatheter approaches. The observation of a possible diagnostic delay (and consequently of intervention) in the female sex remains, with an increase in the predicted risk in women.