Transcatheter procedures in structural heart disease: The surgeon stepping‐in

Abstract

The seismic impact of transcatheter interventions is rocking the spectrum of structural heart disease (SHD) treatment, with the compelling and attractive appeal of minimally invasive procedures and fast-track discharge. The trend is relentless and continual innovation comes to our doors nearly on a daily basis. Litwinowicz and colleagues How to cite this article: Hossne NA, Gomes WJ.

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

“…Furthermore, the trend towards referring patients in need of cardiac procedures to centers of excellence, a policy aimed at achieving better outcomes and cost reduction, will add elements favoring the insertion and role of the surgeon in this multidisciplinary program. 20 But now and forever, surgeons should strive to keep their surgical skills; the downfall of surgery is not anticipated and as revealed, will hold its ground for the foreseeable future.…”

The ascending aorta and arch in the sights of transcatheter therapy: A time for reappraisal

“…The further trend toward referring patients with aorta diseases to centers of excellence, a policy aimed at achieving better outcomes and cost reduction, will add elements favoring the role of the surgeon in this multidisciplinary program. A pending issue is to determine which patient could most benefit from the emerging assorted array of therapeutic options, from surgical delay or permanent deferral of surgery to interventional transcatheter procedures with transfer to specialized centers 16,17 . Given the complexity of designing a randomized controlled trial in a disease with a multivariate presentation like type A AAD, a scoring system derived from a large dedicated database would be effective to predict the 30‐day mortality rate for patients undergoing surgery for type A AAD and provide recommendation for procedure selection 18 …”

“…Transcatheter procedures and open surgery will coexist side by side and be regarded as complementary rather than competing. In this way, the role of the cardiovascular surgery societies worldwide, partnering with medical device companies and establishing ongoing educational and training programs, with certification for heart surgeons who complete training, should support the prospect of acquiring these ground‐breaking and complementary new skills 16,17 …”

Commentary: The ascending aorta and arch in the sights of transcatheter therapy. A time for reappraisal.

“…The further trend towards referring patients with aorta diseases to centers of excellence, a policy aimed at achieving better outcomes and cost reduction, will add elements favoring the insertion and role of the surgeon in this multidisciplinary program. A pending issue is to determine which patient could most benefit from the emerging assorted array of therapeutic options, from surgical delay or permanent deferral of surgery to interventional transcatheter procedures with transfer to specialized centers [16,17]. Given the complexity of designing a randomized controlled trial in a disease with a multivariate presentation like the type A AAD, a scoring system derived from a large dedicated database would be effective to predict the 30-day mortality rate for patients undergoing surgery for type A AAD and provide recommendation for procedure selection [18].…”

“…Transcatheter procedures and open surgery are to coexist side by side and to be regarded as complementary rather than competing. In this way, the role of the Cardiovascular Surgery Societies worldwide, partnering with medical device companies, and establishing ongoing educational and training programs, with certification for heart surgeons who complete training, should support the prospect of acquiring these ground-breaking and complementary new skills [16,17]. Substantial more refinement and technological innovation will be necessary before endovascular repair of type A AAD comes to widespread use, the ideal timespan for cardiovascular surgeons to be involved, and prepared to take on the challenges of leading this new enterprise.…”