Future developments in cardiac surgery need to focus mainly on four areas. First, it is necessary to develop the techniques of minimal access; second, to perform cardiac surgery without the need for CPB; and third, to reduce the need for heparin or to find its alternatives. There have been significant advances in the first area, and today cardiac surgery can be performed with smaller incisions (MIDCAB) or with the help of robots, as shown in Figs. 5 and 6 (ENDO ACAB, or complete robotic mitral valve repairs or coronary artery surgery).
Fig. 6 Robotic coronary artery bypass surgery.
With smaller incisions there are less sources of potential bleeding. In addition, surgery is performed without the need for CPB (OPCAB), either through conventional incisions or through the smaller incisions. The major advantage of OPCAB is avoidance of the inflammatory response to the CPB and the blood injury that goes with it. Heart-port is a method of going on CPB via femoral cannulations, with the help of specifically made cannulae. The surgery is performed through smaller incisions. The third area is to develop techniques where the need for heparin is reduced (heparin coated pump circuits) and to develop heparin substitutes that can be used in patients with heparin allergy or with HIT. This area is still under development and needs future research. The final area concerns the development and the use of fully artificial blood.
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