Genomic Drivers in Cardiac Surgical Decision Making: From Molecular Mechanisms to Precision Operative Interventions
June 2026
The integration of genomic medicine into cardiac surgery represents a paradigm shift from traditional, size-based population metrics to patient-specific, gene-driven therapeutic strategies. Pathogenic variations in structural, contractile, and metabolic genes fundamentally dictate the natural history of cardiovascular diseases, altering vascular wall integrity, myocardial stress tolerances, and perioperative pharmacdynamics. This article reviews the transition from basic monogenic associations to advanced multi-omic risk stratification in cardiac surgery. We detail the molecular mechanics of heritable thoracic aortopathies (e.g., FBN1, TGFBR1/2, ACTA2), genetic cardiomyopathies (MYH7, MYBPC3, LMNA), and congenital structural anomalies (e.g., 22q11.2 deletion). Furthermore, we examine the critical role of perioperative pharmacogenomics (CYP2C19, VKORC1) in mitigating graft failure and thromboembolic events. Finally, we explore future innovations, including machine learning-integrated "digital twins," in vivo CRISPRCas9 therapeutic genome editing, and transcriptomic profiling for post-operative management, establishing a comprehensive architecture for contemporary precision cardiac surgery.
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