Percutaneous valve technology: an historical opportunity for cardiac surgeons

The future of cardiothoracic surgery faces a lofty challenge with the advancement of percutaneous technology and minimally invasive approaches. Coronary artery bypass grafting (CABG) surgery, once a lucrative operation and the driving force of our specialty, faces challenges with competitive stenting and poor reimbursements, contributing to a drop in applicants to our specialty that is further fueled by the negative information that members of other specialties impart to trainees. In the current era of explosive technological progress, the great diversity of our field should be viewed as a source of excitement, rather than confusion, for the upcoming generation. The ideal future cardiac surgeon must be a "surgeon-innovator," a reincarnation of the pioneering cardiac surgeons of the "golden age" of medicine. Equipped with the right skills, new graduates will land high-quality jobs that will help them to mature and excel. Mentorship is a key component at all stages of cardiothoracic training and career development. We review the main challenges facing our specialty�length of training, long hours, financial hardship, and uncertainty about the future, mentorship, and jobs�and we present individual perspectives from both residents and faculty members.

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Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.2008 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Polimeni

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Primary Endpoint ◽

Cardiovascular Death ◽

Volume Index ◽

Valve Repair ◽

Percutaneous Valve Repair ◽

Percutaneous Valve

Abstract Background Percutaneous mitral valve repairs has been increasingly performed worldwide. The MITRA-UMG registry provides a snapshot of a real-world clinical data and outcomes. Purpose We sought to investigate predictors of clinical outcomes in patients with mitral regurgitation undergoing percutaneous valve repair. Methods The MITRA-UMG registry retrospectively collected data from consecutive patients with symptomatic moderate-to-severe or severe MR underwent MitraClip implantation. The primary endpoint of interest was the composite of cardiovascular death or rehospitalization for HF. Results Between March 2012 and July 2018, a total of 133 consecutive patients admitted to our institution were included. Acute procedural success was obtained in 95.4% of patients, with no intraprocedural death. The composite primary endpoint of cardiovascular death or rehospitalization for heart failure was met in 50 patients (38%) with cumulative incidences of 7%, 25%, at 30 days and 1 year, respectively. In the Cox multivariate model, NYHA functional class IV, left ventricular end-diastolic volume index (LVEDVi), Euroscore II, independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan-Meier analysis, a LVEDVi >92 ml/m2 was associated with an increased incidence of the primary endpoint. Conclusions In searching the ideal phenotype of patients who benefit most of percutaneous mitral valve repair, those presenting with severely dilated ventricles (LVEDVi >92 ml/m2), high operative risk (EUROSCORE II >7%) or advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis at long-term. Funding Acknowledgement Type of funding source: None

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Commentary: Are Cardiac Surgeons Treating Patients of Lower Socioeconomic Status Differently?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2020.09.009 ◽

2020 ◽

Author(s):

Richard Lee ◽

Neal Weintraub

Keyword(s):

Socioeconomic Status ◽

Lower Socioeconomic Status ◽

Lower Socioeconomic ◽

Cardiac Surgeons

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Cardiac surgeons' concerns, perceptions, and responses during the COVID‐19 pandemic

Journal of Cardiac Surgery ◽

10.1111/jocs.15681 ◽

2021 ◽

Author(s):

Jessica G.Y. Luc ◽

Niv Ad ◽

Tom C. Nguyen ◽

Rakesh C. Arora ◽

Husam H. Balkhy ◽

...

Keyword(s):

Cardiac Surgeons

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Consultant staffing in UK congenital cardiac services: a 10-year survey of leavers and joiners

Open Heart ◽

10.1136/openhrt-2021-001723 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001723

Author(s):

David Steven Crossland ◽

Richard Ferguson ◽

Alan Magee ◽

Petra Jenkins ◽

Frances A Bulock ◽

...

Keyword(s):

Turnover Rate ◽

Adult Congenital Heart Disease ◽

Staff Retention ◽

High Turnover ◽

National Review ◽

Adult Congenital ◽

Level 1 ◽

The Uk ◽

Cardiac Surgeons ◽

Work Abroad

ObjectivesTo report the numbers of consultant congenital cardiac surgeons and cardiologists who have joined and left UK practice over the last 10 years and explore the reasons for leaving.MethodsRetrospective observational questionnaire study completed between 11 June 2019 and 1 July 2020 by UK level 1 congenital cardiac centres of 10-year consultant staff movement and reasons suggested for leaving UK practice.ResultsAt survey completion there were 218 (202 whole time equivalent (WTE)) consultant cardiologists and surgeons working within level 1 centres made up of 39 (38 WTE) surgeons, 137 (128.5 WTE) paediatric cardiologists, 42 (35.5 WTE) adult congenital heart disease (ACHD) cardiologists. 161 (74%) consultants joined in the last 10 years of whom 103 (64%) were UK trained. There were 91 leavers giving a staff turnover rate 42% (surgeons 56%, paediatric cardiologists 42%, ACHD cardiologists 29%). Of those, leaving 43% moved to work abroad (surgeons 55%, paediatric cardiologists 40%, ACHD cardiologists 67%). Among the 65 reported reasons for leaving 16 were financial, 9 for work life balance, 6 to working conditions within the National Health Service (NHS) and 12 related to the profession in the UK including six specifically highlighting the national review process.ConclusionsThere has been a high turnover rate of consultant staff within UK congenital cardiac services over the last 10 years with almost half of those leaving moving to work overseas. Financial reasons and pressures relating to working in the NHS or the specialty in the UK were commonly reported themes for leaving. This has major implications for future planning and staff retention within this specialised service.

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