Future directions in cardiac surgery.

The future of cardiac surgery is interesting, challenging, and changing. In coronary artery disease, operations are becoming more difficult due to previous stent placement and population aging, but there is a sense that volume is increasing, especially in centers that perform operations for diffuse disease and those that can perform truly minimally invasive procedures with robotic takedown of mammary arteries and perform anastomoses thoracoscopically. In valve disease, there will be increasing numbers of elderly patients requiring surgery, especially for aortic valve disease; a combination of minimally invasive surgery, hybrid procedures, and perhaps percutaneous valve placement in the truly high risk will be required. Mitral valve repair will become increasingly used as well as some percutaneous valve devices. In 5 years, most thoracic aneurysms will be treated by endovascular stenting and adults with congenital disease will be a small but growing population of patients.