This is very interesting that you mentioned the combination of skills of a cardiac surgeon and interventional cardiologist. I had a very interesting conversation in Boston at Brigham and Women’s Hospital with Professor Tsuyoshi Kaneko about Dr. Michael Davidson Fellowship. It was established in the memory of Dr. Michael Davidson, who focused on both interventional cardiology and cardiac surgery. So that a physician understands the best approach to that particular patient rather than going from a particular surgical or interventionalist technique, and it’s something that you mentioned before. ‘It’s not how we do things. It’s how we make the right decision.’ And I think that it is very something that you highlight in your own professional career,
You point to a very important aspect of our profession. I think we often focus on what we do rather than the objective of what we are doing. The objective is to save lives, improve quality of life. This is a very simple background of any intervention. And there are many ways to obtain this objective. And probably there is no single solution, which is perfect for every patient. There is always a compromise. And having the full spectrum of treatment options creates an environment that is safer for the patient. And if it is well-adopted, if it is well-organized, this approach to treatment can probably provide better outcomes. I still believe we need to learn a lot. I mean, we are still in a transition phase where we have different treatment options. And still, there is a lot of controversies. Don’t forget cardiac surgery was established in the 1950s. And we have very long-term experience. Maybe the collection of data has not been so highly scientific. Because initially, there were no alternatives. So there was no reason to make comparison studies [between cardiac surgery and alternative options of treatment]. And after many years, cardiac surgical procedures became such a standard practice that there was no need to test it again against anything.
As new technologies become available, now we start to have this discussion. Let us make an example of transcatheter aortic valve replacement. It is called TAVI in Europe or TAVR in the United States. TAVI is an alternative to surgical aortic valve replacement. And there was no such study on surgical aortic valve replacement as of today before TAVI became available. So we didn’t study TAVI with core lab-adjudicated outcomes before the challenge of new technology. So, in general, I really believe the new technology is bringing new light, new opportunities, improving even cardiac surgery. Me personally, in my personal experience, I have a very special viewpoint because I started cardiac endovascular procedures after I was fully trained as a cardiac surgeon. And I found that, on the one hand, it was pretty simple for me to learn the endovascular procedures. At the same time, I applied a lot of knowledge from the endovascular cardiology field. It is very useful in the open surgical field and in minimally invasive cardiac surgery.
So, in general, from my viewpoint, I see the advantage of the confluence of the two fields into one field. [Cardiac surgery and interventional cardiology] need to cross-fertilize. Every year it happens more and more. We need to ensure that what we learn in the two areas – [cardiac surgery and interventional cardiology] – becomes a common understanding. We must find the right solutions for our patients. We also must find the right way to train the surgeons and interventional cardiologists of the future because this is now becoming the question. Who is going to do this? What is going to be the educational pathway to provide the new generations of doctors with the best educational package? What is the job description [for a properly trained cardiovascular doctor]? This is already a question today.
All that’s very important because clearly breaking silos in medicine is a very important task. And I think your career clearly illustrates the importance of that for the benefit of the patient, which is an ultimate goal.
Absolutely. Absolutely. And this is one of the biggest challenges for academic institutions – to provide modern educational pathways. Because we all need to change the way we teach our profession. And we all need to understand that the pace of changes in the job descriptions is so fast that we need to be flexible enough to be able to change direction even in the next two or three years. Because things are changing so fast that you cannot anymore do your profession the way you learned at school. My father went to school, became a surgeon, and he was able to do almost the same operations for all his life. Only at the very end of his career, I remember, he was telling me that he needed to learn how to do endoscopic, laparoscopic gallbladder resection. This was a little challenge for him. Imagine today. Today we have one procedure, which I learned in cardiac surgery. It is closing the ASD [Atrial Septal Defect]. Today it is something that I cannot use for my fellows [surgeons-in-training]. So we need to really be flexible there. But the good news is that all this flexibility at the end improves patient outcomes. It is creating new opportunities. And overall, if you look at the data, the mortality risk of mitral valve interventions, for instance, in the United States, has been shown over time to decrease every year. And the introduction of less invasive cardiac procedures has been decreasing mortality for my patients. It is true not only in those patients who undergo endovascular procedures but also in open surgical treatment. Because overall, it’s a kind of competition to do better and better, to be less and less invasive, to become safer and safer. And when you have different treatment options, you may also offer less invasive options for those patients who are more fragile. You can do procedures that are more tested by time for those patients who can afford a more invasive and more durable procedure.