Cardiovascular Medicine & Surgery - Global Trends & Challenges

This article by "Samir Redzepagic, MD, Public Health Officer, Monash Public Health" will explore the future directions in cardiac surgery, novel surgical techniques, and treatments, but also emerging diagnostic approaches such as microRNAs and epigenomics. It will also discuss the challenges and opportunities to improve cardiovascular health in developing countries, including the role of digital health and the need for sustainable financing. Specific regional issues were considered, with an emphasis on cultural sensitivity and prioritization. Overall, the essay will suggest a need for continued investment and innovation to address the global burden of cardiovascular disease.

Cardiac surgery is a rapidly advancing field that is constantly improving with new techniques, technologies, and approaches. In this essay, I will discuss some of the latest trends and advancements in cardiac surgery and the potential future directions for the field.

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Timely and accurate diagnosis is critical for the effective management of CVD. In recent years, significant advances have been made in the development of new and emerging diagnostic approaches in cardiovascular medicine and cardiac surgery. These approaches range from the identification of novel blood biomarkers, such as microRNAs, to the use of epigenomics, gene detection, and DNA methylation. In this essay, we will explore these emerging diagnostic approaches and their potential applications in cardiovascular medicine and cardiac surgery.

However, there are several challenges associated with the use of these emerging diagnostic and treatment approaches in clinical practice. First, the use of these biomarkers requires specialized laboratory equipment and expertise, which may not be available in all healthcare settings. Second, the interpretation of these biomarkers can be complex, and there is a need for standardized protocols for their measurement and interpretation. Third, the cost of these biomarkers may be a barrier to their widespread use in clinical practice.

Despite these challenges, there is great enthusiasm for the use of these emerging diagnostic approaches in clinical practice. The development of point-of-care diagnostic tests that can be used in primary care settings could help overcome some of the challenges associated with the use of these biomarkers. Moreover, advances in machine learning and artificial intelligence could help improve the interpretation of these biomarkers, leading to more accurate and reliable diagnoses.

The development of new and emerging diagnostic approaches in cardiovascular medicine and cardiac surgery has the potential to revolutionize the diagnosis and management of CVD. These diagnostic approaches hold great promise for the early and accurate diagnosis of CVD, allowing for early intervention and prevention. While there are several challenges associated with the use of these biomarkers and other diagnostic modalities in clinical practice, there is great enthusiasm for their use, and ongoing research is focused on overcoming these challenges.

Discussion:

Recent advances and future trends in cardiac surgery

Minimally Invasive Cardiac Surgery:

One of the biggest trends in cardiac surgery and cardiovascular medicine over the last two decades is the move towards minimally invasive procedures. This involves performing surgery through small incisions instead of the large incisions traditionally used in open-heart surgery. Minimally invasive surgery offers many benefits, including reduced blood loss, reduced pain, shorter hospital stays, and faster recovery times. Advances in technology and techniques have made it possible to perform many heart surgeries using minimally invasive techniques, including aortic valve replacement, mitral valve repair, and bypass surgery. The future of cardiac surgery is likely to see even more minimally invasive procedures as technology continues to advance.

Robotic cardiac surgery:

Another area of development in cardiac surgery is the use of robotic surgery. Robotic surgery involves the use of robotic arms controlled by a surgeon to perform the surgery. The robotic arms can make very precise movements and can access hard-to-reach areas, which can lead to better outcomes for patients. In addition, robotic surgery is less invasive than traditional open-heart surgery, which can lead to faster recovery times and less pain for patients. While robotic surgery is still in its early stages, it has the potential to revolutionize cardiac surgery in the future.

Tissue Engineering and Regenerative Medicine:

Tissue engineering and regenerative medicine are two areas of research that have the potential to transform cardiac surgery in the future. Tissue engineering involves growing new tissue in the laboratory and using it to replace damaged or diseased tissue in the body. This could be used to create new heart valves or even entire hearts. Regenerative medicine involves using the body's own cells to regenerate damaged or diseased tissue. This could be used to repair damaged heart tissue or to create new blood vessels. While tissue engineering and regenerative medicine are still in the early stages of development, they have the potential to revolutionize the treatment of heart disease in the future.

Transcatheter Aortic Valve Replacement (TAVR):

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that is used to replace a diseased aortic valve. TAVR involves inserting a new valve through a small incision in the leg and guiding it up to the heart using a catheter. TAVR is less invasive than traditional open-heart surgery and has been shown to be just as effective in treating aortic valve disease. In the future, TAVR is likely to become even more common as the technology and techniques used in the procedure continue to improve.

Artificial Intelligence (AI) applications in Cardiovascular Medicine:

It is a rapidly advancing technology that has the potential to transform many fields, including cardiac surgery and cardiovascular medicine in general. AI can be used to analyse large amounts of data and help surgeons make better decisions. For example, AI can be used to analyse imaging data and help surgeons identify the best approach for a particular patient. AI can also be used to help surgeons plan surgeries and simulate the outcome of different surgical approaches. While AI is still in its early stages in the field of cardiac surgery, it has the potential to improve outcomes for patients in the future. More>> "CARDIOVASCULAR AI RISK SCORE PROGRAMME"

Personalized Medicine:

With the advent of predictive, preventive, and personalised (3P) medicine that is increasingly becoming important to reduce cardiovascular events and increase life expectation worldwide we are moving into the new era of treating cardiovascular diseases. That involves tailoring medical treatment to an individual patient based on their unique characteristics, such as their genetics or their medical history. In cardiac surgery, personalized medicine could be used to identify patients who are at higher risk for complications during surgery and develop tailored treatment plans to minimize those risks. Personalized medicine could also be used to develop targeted therapies for specific types of heart disease. While personalized medicine is still in the early stages of development, it has the potential to improve outcomes for patients in the future.

Hybrid Approaches:

In cardiovascular medicine they involve combining multiple procedures, such as open-heart surgery and catheter-based interventions, into a single surgery (procedure). This can lead to faster recovery times and better outcomes for patients. Hybrid approaches are particularly useful for patients with complex heart conditions, such as those with both coronary artery disease and structural heart disease. Over the recent decade, hybrid coronary revascularisation has received considerable attention as being the most suitable revascularization strategy for patients with multi vessel coronary disease. In the future, hybrid approaches are likely to become even more common as the technology and techniques used in the procedures continue to improve. More>> "CARDIOVASCULAR INTERVENTION"

Telemedicine:

Involves using technology to provide medical care remotely. In cardiac surgery, telemedicine can be used to provide follow-up care and monitor patients after surgery. This can be particularly useful for patients who live in rural areas or who have limited mobility. Telemedicine can also be used to provide virtual consultations with specialists, which can be helpful for patients who live far away from a specialized cardiac surgery centre. While telemedicine is still in its early stages in the field of cardiac surgery, it has the potential to improve access to care and reduce healthcare costs in the future.

Quality Improvements:

Initiatives Quality improvement initiatives are efforts to improve the quality of care provided to patients. In cardiac surgery, quality improvement initiatives can involve tracking outcomes, identifying areas for improvement, and implementing changes to improve patient care. Quality improvement initiatives can also involve implementing best practices, such as using checklists during surgery to reduce errors. An example of such an initiative is EuroHeart which is an international collaboration that aims to improve the quality of cardiovascular care and facilitate observation and randomized research through continuous and longitudinal capture of individual patient data. By focusing on improving the quality of care provided to patients, quality improvement initiatives have the potential to improve outcomes and reduce complications in the future. It’s just one of the forgotten areas where we can make the current use of the emerging technologies being implemented to improve the quality of care.

Patient Centred Care:

It involves focusing on the needs and preferences of the patient in the delivery of care. In cardiovascular medicine and surgery, patient centred care can involve providing information to patients about their condition and treatment options, involving patients in the decision-making process, and providing emotional support to patients and their families. By focusing on the needs and preferences of the patient, patient centred care has the potential to improve patient satisfaction and outcomes in the future. The most recent Covid-19 pandemic has put into challenge this unique connection distancing the patient from the healthcare professionals and arising risks for the quality of patient care. The new reality has evolved into a revolutionary acceleration of adopting innovative and novel technologies in every domain of daily life from social interactions and entertainment to delivering medical services in broader context of the healthcare globally. More>> "Patient-Centered Cardiovascular Diagnostics"

The field of cardiovascular medicine and surgery is constantly evolving and improving with new techniques, technologies, and approaches. The future of cardiac surgery is likely to see even more minimally invasive procedures, robotic surgery, tissue engineering and regenerative medicine, transcatheter aortic valve replacement, artificial intelligence, personalized medicine, hybrid approaches, telemedicine, quality improvement initiatives, and patient centred care. By continuing to focus on improving patient outcomes and reducing complications, the field of cardiac surgery has the potential to continue to improve and provide better care to patients in the future. The new and less invasive emerging treatments along personalised medical care are gaining more attention and acceptance and they will ultimately become the routine practice in medical care.

Emerging diagnostic approaches in cardiovascular medicine and cardiac surgery.

MicroRNAs:

mRNAs (miRNAs) are small non-coding RNA molecules that play an important role in the regulation of gene expression. miRNAs have been shown to be involved in the development and progression of CVD, and are thus promising biomarkers for the early diagnosis of CVD. Recent studies have demonstrated that the expression of specific miRNAs in the blood is altered in patients with CVD. For example, miR-208a and miR-499 are elevated in patients with acute myocardial infarction (AMI), while miR-1 and miR-133a are elevated in patients with heart failure. hese miRNAs have the potential to be used as diagnostic biomarkers for the early detection of CVD, as they are released within the body fluids (i.e., peripheral blood [PB], serum and plasma), they could be attractive as non-invasive biomarkers to monitor cardiovascular diseases and, as a future direction, possible therapeutic approaches for CVD treatments like heart failure (HR) and atrial fibrillation (AF).

Epigenomics:

It refers to the study of changes in gene expression that are not caused by changes in the DNA sequence. Epigenetic modifications, such as DNA methylation and histone modifications, have been shown to play a role in the development and progression of CVD. For example, DNA methylation of the ACE gene has been linked to the risk of hypertension and stroke.? Similarly, histone modifications have been shown to be involved in the regulation of cardiac gene expression. Epigenetic modifications have the potential to be used as diagnostic biomarkers for CVD.

Gene Detection:

Genetic testing has been used for the diagnosis of inherited cardiac diseases, such as hypertrophic cardiomyopathy and long QT syndrome. Advances in next-generation sequencing (NGS) have made it possible to sequence multiple genes simultaneously, allowing for the rapid and cost-effective diagnosis of inherited cardiac diseases. In addition, genetic testing can be used to identify patients who are at increased risk of developing CVD, allowing for early intervention and prevention.

DNA Methylation:

This potential diagnostic model is a type of epigenetic modification that involves the addition of a methyl group to the cytosine residue of DNA. DNA methylation has been shown to play a role in the development and progression of CVD. For example, hypermethylation of the PPARα promoter has been linked to an increased risk of atherosclerosis. Similarly, hypomethylation of the KLF4 promoter has been shown to be involved in the development of atherosclerosis. DNA methylation has the potential to be used as a diagnostic biomarker for CVD.

Other Biomarkers:

Other emerging biomarkers for the diagnosis of CVD include high-sensitivity C-reactive protein (hs-CRP), growth differentiation factor-15 (GDF-15), and B-type natriuretic peptide (BNP). hs-CRP is a marker of systemic inflammation and has been shown to be associated with an increased risk of CVD. GDF-15 is a marker of cellular stress and has been shown to be associated with an increased risk of heart failure. BNP is a hormone that is released by the heart in response to stress and has been shown to be a marker of heart failure.

Advanced imaging techniques:

Advanced imaging techniques in cardiovascular medicine, such as MRI, CT, and PET, are becoming increasingly important in the diagnosis and treatment of CVD. These techniques enable non-invasive visualization of the heart and blood vessels, allowing for earlier diagnosis and more targeted treatment. Advances in imaging technology are also enabling the development of new minimally invasive surgical techniques.

Development of new and emerging diagnostic approaches in cardiovascular medicine and cardiac surgery holds great promise for the early and accurate diagnosis of CVD. Advances in the identification of novel blood biomarkers, such as microRNAs, epigenomics, gene detection, and DNA methylation, have the potential to revolutionize the diagnosis and management of CVD. These diagnostic approaches can help identify patients who are at high risk of developing CVD, allowing for early intervention and prevention. Moreover, these diagnostic approaches can help guide treatment decisions, allowing for more personalized and targeted therapy.

First, the use of these biomarkers requires specialized laboratory equipment and expertise, which may not be available in all healthcare settings. Second, the interpretation of these biomarkers can be complex, and there is a need for standardized protocols for their measurement and interpretation. Third, the cost of these biomarkers may be a barrier to their widespread use in clinical practice.

Despite these challenges, there is great enthusiasm for the use of these emerging diagnostic approaches in clinical practice. The development of point-of-care diagnostic tests that can be used in primary care settings could help overcome some of the challenges associated with the use of these biomarkers. Moreover, advances in machine learning and artificial intelligence could help improve the interpretation of these biomarkers, leading to more accurate and reliable diagnoses.

Future challenges in Cardiovascular Medicine and Surgery

There are several challenges and obstacles associated with the future directions in cardiovascular medicine and surgery that I would like to address in this review.

Increasing costs

Many of the new technologies and approaches in cardiac surgery are expensive, which can limit their availability and impact. One potential solution is to focus on developing cost effective alternatives that can be used in resource limited settings. For example, point-of-care diagnostic tests can be developed that are affordable and easy to use, even in remote or underserved areas.

The cost of new technologies and approaches in cardiac surgery can be a major barrier to access, particularly in low- and middle-income countries. Patients in these settings may not be able to afford the latest treatments, which can lead to delays in diagnosis and treatment, and poorer outcomes. To address this challenge, it is important to focus on developing cost-effective alternatives that can be used in resource limited settings, especially in developing countries.

Access to quality healthcare services

Access to high-quality cardiac care can be a challenge for many patients, particularly those living in rural or remote areas. Telemedicine and remote monitoring technologies can help address this challenge, enabling patients to receive high-quality care without needing to travel long distances.

Complex regulatory approvals

Many new technologies and approaches in cardiovascular medicine and surgery require regulatory approval before they can be used in clinical practice. This process can be slow and complex, which can delay the availability of new treatments. One solution is to streamline the regulatory process for these technologies, while ensuring that safety and efficacy are not compromised.

Interdisciplinary collaboration

Cardiovascular medicine and surgery are highly specialized fields, and there is often a lack of interdisciplinary collaboration between different other related specialties. To address this challenge, it is important to foster greater collaboration and communication between different disciplines, including cardiology, radiology, genetics, and engineering. This can help drive innovation and improve patient outcomes.

Important ethical considerations

As new technologies and approaches are developed, there are often ethical considerations that need to be taken into account. For example, the use of gene editing technologies raises questions about the potential risks and benefits, and how to ensure that these technologies are used in an ethical and responsible way. To address these challenges, it is important to engage in open and transparent discussions about the potential risks and benefits of new technologies, and to develop guidelines and regulations that ensure that they are used in an ethical and responsible way, not only on the local level but globally in particular.

Overall, while there are significant challenges associated with the future directions in cardiovascular medicine and surgery, there is also great promise for improving patient outcomes and quality of life. By focusing on developing cost-effective and accessible technologies, streamlining regulatory processes, fostering greater collaboration between different disciplines, and addressing ethical considerations, we can overcome these challenges and continue to drive innovation in the field of cardiac surgery.? That can have a significant impact on patient care in developing countries and regions, particularly in areas with limited resources and infrastructure.? By doing so, we can help ensure that all patients, regardless of where they live, have access to high-quality cardiac care.

Conclusion:

In conclusion of this review, advancements in cardiovascular medicine and cardiac surgery have led to significant improvements in patient outcomes and overall healthcare. New and emerging technologies such as minimally invasive techniques, digital health, and the use of novel biomarkers have paved the way for more efficient and effective diagnosis and treatment of cardiovascular disease. However, these developments are not without their challenges, particularly in low-income and developing countries where limited resources and infrastructure often hinder the delivery of quality care.

Numerous obstacles faced by these countries can be addressed through a combination of strategies, including improved funding mechanisms, greater collaboration between governments and the private sector, and the deployment of innovative technologies and approaches that can deliver better care at lower cost. Efforts must also be made to address social and cultural barriers that may prevent individuals from seeking appropriate care or adhering to prescribed treatments.

Looking to the future, continued innovation in cardiovascular medicine and cardiac surgery will undoubtedly lead to further improvements in patient care and outcomes. The development of new technologies and techniques such as regenerative medicine, gene therapy, and tissue engineering hold great promise for the field. Digital health will continue to play an increasingly important role in the delivery of cardiovascular care, particularly in remote and underserved areas.

Despite the many challenges that lie ahead, it is clear that the future of cardiovascular medicine and cardiac surgery is bright. By embracing new technologies and approaches, and working to overcome barriers to care, we can ensure that patients around the world receive the high-quality, effective care they need to live healthy, productive lives. However, it is important that these advancements are made accessible to everyone, regardless of income or location, to ensure that no one is left behind in the quest for improved cardiovascular health.

New generations of highly trained professionals are already changing the global landscape. It is reasonable to expect that they will address these issues better, as they will have access to improved education, training, and technological advancements. With the increasing emphasis on global health and equity, medical schools and training programs are placing greater emphasis on cultural competency, community engagement, and social determinants of health. As younger generations of healthcare professionals enter the field with a greater understanding of these issues, they will be better equipped to provide high-quality care that addresses the unique needs and challenges of patients in poor and developing countries.

The field of cardiovascular medicine and cardiac surgery is rapidly evolving, driven by new technologies, approaches, and research. While there remain significant challenges to be addressed, particularly in low-income and developing countries, the future looks bright, with the promise of further improvements in patient care and outcomes. By continuing to invest in innovative technologies and approaches, and by working to overcome social, economic, and cultural barriers, we can ensure that everyone has access to the high-quality cardiovascular care they need to live long and healthy lives. The unpredictability of the current global political and socio-economic context will definitely shape the future of healthcare and well-being of every individual on our planet.