The performance of coronary artery bypass grafting (CABG) has improved with the development of percutaneous coronary intervention (PCI), while being compared with that of PCI. Recent randomized trials have reported the superiority of CABG over PCI in patients with diabetes and multi-vessel disease. CABG tends to involve minimally-invasive surgery, such as off-pump CABG, minimally-invasive direct coronary artery bypass, hybrid CABG and robotic-assisted CABG. The treatment of ischemic heart disease requires careful selection of the treatment method, in close cooperation with cardiologists and cardiac surgeons, and in consideration of the patient background and the coronary artery lesion.

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The number of patients with aortic valve stenosis has increased with the aging of the population. Until recently, aortic valve replacement surgery has not been performed for high-risk cases. However, the technology for transcatheter aortic valve implantation (TAVI) has been developed and the treatment range of aortic valve stenosis has also increased. Thus, although the number of cases treated with TAVI has increased rapidly, the number of aortic valve replacement surgeries has not decreased significantly to date. Hereafter, surgical aortic valve replacement (SAVR) is expected to evolve using minimally-invasive cardiac surgery (MICS) technology, including TAVI for younger patients.

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In patients with degenerative mitral regurgitation disease, mitral valve plasty (MVP) is the generally accepted “gold standard” treatment, as it has demonstrated superiority over mitral valve replacement (MVR). However, the role of MVP in the treatment of functional mitral regurgitation remains controversial. Although minimally invasive cardiac surgery (MICS) via right minithoracotomy has attracted attention in Japan in recent years, transcatheter mitral valve intervention has emerged as an effective treatment for mitral regurgitation in patients who are at high risk for surgery. We describe the current status of surgical and transcatheter intervention for mitral regurgitation and our treatment strategy for this disease.

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It is inevitable that patients with abdominal aortic aneurysms (AAA) will face life-threatening crises if they do not undergo surgical treatment. In 1995, the first synthetic graft implantation for an AAA patient was performed by Dr. Arthur Voorhees. The knitted Dacron® fabric graft, a polyester polymer, was developed by Dr. Michael DeBakey and associates in Houston and has been an almost ideal graft material to this day. From the 1960s to 1990s, Dacron® and Teflon® grafts have been implanted in AAA patients with a 95% success rate. In 1991, Parodi reported the first successful endovascular AAA repair. The stent graft system is an innovative device designed to be a minimally-invasive treatment option for high risk AAA patients. In the 2000s, endovascular aneurysm repair (EVAR) has been developed as a standard procedure for AAA. Some randomized controlled trials have reported that EVAR had an early survival advantage compared with open repair, however, in long-term outcomes, up to 10 years, there were no advantages of EVAR for aneurysm-related and total mortality compared with open repair. We evaluated the long-term survival and aneurysm related complications for patients who underwent EVAR in our institute.

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In recent years, the era of catheter intervention, cardiac surgery has necessitated the construction of a heart team, as the “back shield” of PCI and MICS. In the absence of the Heart Team, no new PCI devices could be provided. The treatment strategy for heart disease must be decided by the heart team. Thus, in hospitals that provide this highly-advanced medical care, construction of a heart team is essential.

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