Future of cardiac surgery, introducing the interventional surgeon

Abstract

Background The swift advances in interventional cardiology combined with the increasing risk of cardiac surgical procedures resulted in diminishing volume of coronary and valvular surgery and affected the future of cardiac surgery service and training. Application to cardiac surgery training programs have steadily declined. This cross‐sectional study aimed at identifying main weakness facing cardiac surgery and advocating some recommendations to improve the status of current and future of cardiac surgery. Methods Cross‐sectional study was authorized by the institutional review board of King Abdulaziz University and performed among cardiac surgeons and cardiologists in the Kingdom of Saudi Arabia, from May to June 2021. Data were collected by sending questionnaires through email to cardiac surgeons and cardiologists in different cardiac centers all over Saudi Arabia. Out of 200 emails sent to our participants only 55 who responded. Results A total of 55 doctors who participated in the study have completed the self‐administered questionnaire by electronic mail. Seventy‐six percent of the respondents are cardiac surgeons and 24% are cardiologists. Most of the respondents (72.7%, 63.6%) think that the volume of coronary and valvular cardiac surgery patients nowadays is less than before compared to invasive cardiology patients. Most of the respondents (91%) think that coronary cardiac surgery is better than invasive cardiology in left main disease and complex lesions but carries higher risk. Sixty‐nine percent of the respondents think that one cardiac center in each city according to the population will provide better cardiac health services compared to small cardiac units. Conclusion In the recommendations to improve the future of cardiac surgery, 83% of the respondents agree that residents training in cardiac surgery should be modified to add at least one extra year of training in the Catheterization Laboratory (Cath lab) procedures including coronary, valvular, aortic and arrhythmia, thus introducing the interventional surgeon.

Impact of percutaneous valve intervention on mechanical valves selection

“…2 Recently, the advent of transcatheter procedures on aortic, mitral, and tricuspid valve, repair, and implantation really opened the door widely for the interventional cardiologist to play a major role in all valve procedures and affecting the volume and future of cardiac surgery practice and resident training. 3 Transcatheter valve-in-valve implantation within dysfunctional surgical bioprosthesis has become an alternative to high-risk redo open-heart surgery. 4 This will change dramatically the trade-offs between mechanical and bioprosthetic valve selection and may affect the future of mechanical valves.…”

Prognostic value of combined preoperative phase angle and handgrip strength in cardiac surgery

“…Predicting post-procedural morbidity and mortality remains challenging despite the development of many scoring systems and prognostic algorithms in cardiac surgery [ 1 , 2 ]. Hence, the assessment of novel biomarkers capable of guiding the modern physician in choosing the optimal, individualized, treatment for patients based on clinical prediction is of outmost importance [ 3 ].…”

The trade‐offs in the making of the interventional heart surgeon

“…TAVI has only been demonstrated to be not inferior to SAVR in high-and intermediate-risk patients at follow-up extending to 5 years. 1 The conformity to this recommendation would imply leaving without surgical treatment thousands of patients worldwide, owing to the financial constraints on the healthcare budget limitation. A growing concern is the economic impact of expanding recommendations elsewhere, where countries with inadequate healthcare budgets and expenditure comprise a far different setting.…”

“…The provocative paper from Al‐Ebrahim et al 1 addresses growing consternation experienced by part of the current generation of heart surgeons, where the introduction of the so‐called disruptive transcatheter procedures seemingly threatens the stability and even existence of contemporary cardiovascular surgery.…”

“…The current ESC/EACTS Guidelines have disregarded the option of SAVR in patients with high risk for surgery and this may represent a serious omission once we consider the global implications of such a recommendation. TAVI has only been demonstrated to be not inferior to SAVR in high‐ and intermediate‐risk patients at follow‐up extending to 5 years 1 . The conformity to this recommendation would imply leaving without surgical treatment thousands of patients worldwide, owing to the financial constraints on the healthcare budget limitation.…”