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Surgery without interventions?
1CGF-Millard Fillmore Division, Department of Thoracic and Cardiovascular Surgery, Buffalo, New York 14209, USA. gguiraud@mfhs.edu
Insights
Cardiac surgeons must evolve beyond solely performing procedures. Embracing a broader role in cardiology and focusing on less invasive, target-specific therapies is crucial for the future of cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Historically, cardiac surgeons dominated invasive cardiac procedures.
- The rise of catheter-based interventions has shifted procedural control to cardiologists.
- This shift has raised concerns among cardiac surgeons regarding their identity and role.
Purpose of the Study:
- To analyze the current landscape of cardiac interventions and roles.
- To re-evaluate fundamental concepts like surgery, intervention, and therapeutic philosophy.
- To propose a future direction for cardiac surgery emphasizing minimal invasiveness and broader engagement.
Main Methods:
- Conceptual analysis of therapeutic strategies in cardiology.
- Review of the historical division of labor between cardiologists and surgeons.
- Examination of the components of therapeutic plans: target, agent, and delivery method.
Main Results:
- Cardiac surgery has been historically viewed as a delivery method with significant potential for collateral damage (morbidity).
- Current trends show a shift towards interventional cardiology, with surgeons potentially losing procedural domain.
- There's a need to redefine surgical rationale towards target-specific therapies with minimal harm.
Conclusions:
- Cardiac surgeons should broaden their scope beyond the 'delivery end' of interventions.
- Future cardiac surgery requires a return to being 'Renaissance Men' involved in all of cardiology.
- Adopting a philosophy of minimal invasiveness and target-specific therapy is essential for the evolution of cardiac surgery.
Abstract:
Cardiac surgeons took to the heart and claimed an exclusive privilege to intervene. The task of cardiologists was to identify "candidates" and feed the Great Surgical Machine. Recently catheter surgery has developed and fell into the hands of cardiologists, who became interventionists. Cardiac surgeons are concerned about losing interventions and their identify. The analysis of the current situation implies a revisitation of old concepts: surgery, intervention, therapy, patients, invasiveness etc ... etc ... and a review of our therapeutic philosophy. Therapeutic plans comprise three interrelated components: the target, the bullet (therapeutic agent), and the gun (the way of delivering the bullet on target). This description characterizes surgery as a way of delivering. If side effects are effects that do not affect the target, surgical procedures are mostly side effects, with significant morbidity. Future surgical rationales should reconcile target-specific therapy and minimal collateral damages: Minimal Surgery! or to use a new buzz, less invasiveness. Cardiac surgery has focused too much on surgical practice and neglected the rest of cardiology, missing opportunities for new researches, new rationales, and new techniques. Surgeons must become again Renaissance Men, involved in the entire field of cardiology, with a special skill in surgical techniques. Cardiac surgeons should no longer confine their practice to the delivering end. This end does not, any more, justify the means.