[Surgical therapy of coronary artery disease in the Italian cardiac surgery centers]. / Studi osservazionali trattamento della cardiopatia ischemica nei centri cardiochirurgici italiani. Risultati di una indagine conoscitiva.

ABSTRACT

BACKGROUND: We conducted a national survey on surgical therapy for coronary artery disease and its complications, with the aim to eventually identify differences in the processes of care adopted in the Italian cardiac surgery centers. METHODS: Eighty-seven Italian cardiac surgery units received a questionnaire about their general activity profile and the following interest areas (a) surgical myocardial revascularization techniques; (b) ischemic mitral regurgitation treatment; (c) left ventricular reconstruction procedures; (d) mechanical circulatory support and heart transplantation in ischemic cardiomyopathy. RESULTS: Forty-one Centers (47.1%) returned a completely filled questionnaire. The analysis of the answers showed differences in the therapeutic approaches adopted in the various centers regarding choice of surgical technique and grafts for myocardial revascularization; propensity to treat moderate ischemic mitral regurgitation in the setting of severe left ventricular dysfunction; propensity to treat extended myocardial scars; treatment options in ischemic cardiomyopathy with advanced heart failure. The specific center profile (volume of activity, availability of heart transplantation) seems to influence the choice among the different treatment options. CONCLUSIONS: This study may contribute to show and analyze existing differences in clinical practice between different centers. Diagnostic and therapeutic approaches (processes of care) should be frequently monitored in order to promptly single out critical areas necessitating review or further researches, to standardize decision making criteria, and to improve care appropriateness.