Innovations in cardio-thoracic surgery: Predicting and optimising outcome with state of the heart technology

Cardio-thoracic surgery envelops surgery of the heart, lungs, mediastinum, large intrathoracic vessels, diaphragm and the thoracic wall. Many operative techniques introduced from 1950 to 1980 are still used today. However, a perceived drawback is its invasiveness and procedural complications. As a result, the number of surgeries is dropping and innovations are mainly focused and funded for less invasive approaches like interventional cardiology.

To further improve clinical outcomes of cardiac surgery, several themes can be defined to make cardiac surgery sustainable for the future.
This thesis focuses on minimally invasive cardiac surgery, technological innovations and multidisciplinary approaches to improve surgical outcome for patients. The hypothesis is that cardiac surgery remains a first time right strategy for patients when these themes are adopted in clinical practice.

Part I: The first part of this thesis focuses on minimally invasive cardiac surgery. By reducing the impact of the heart-lung machine outcomes for large groups of patients will improve. Other patient groups can profit from off-pump surgery even when inoperable for cardiac surgery with a heart-lung machine.

Part II: Besides minimal invasive surgery, technological innovations in cardio-thoracic surgery such as improved biomaterials and devices are necessary to further improve surgical outcome.

Part III: A multidisciplinary approach with teamwork and shared decision making from patients, (technical) medical specialists, nurses, physiotherapists and other professionals will optimise treatments in cardio-thoracic surgery. Good professional behaviour starts with proper training in a simulated environment.

The three themes stated in this thesis should enable combination of good outcomes and reduce drawbacks. Several aspects that improve cardiac surgery were covered in this thesis. However this thesis was not designed in a way to prove that the overall outcome is better than alternative choices or leads to an increase in surgical volume.