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Eur J Cardiothorac Surg 2004;26:S19-S24
© 2004 Elsevier Science NL

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Cardiac Surgery Division, Medtronic, Inc., Minneapolis, MN, USA

^* Corresponding author. (Email: robert.guezuraga{at}medtronic.com).

The transformation of the cardiothoracic specialty requires a complete mind-set and skill-set change such that the specialty repositions itself in this era of complex cardiac disease, increased competition, technology innovation, financial constraints, rationed access to technology and increased scrutiny on clinical outcomes. The future offers a variety of surgical treatment options for patients suffering from disease states that have traditionally not been treated by cardiothoracic surgeons such as ablation for atrial fibrillation and cell therapy for heart failure. In addition, patient expectations for prolonged and quality-improved years are higher as they educate themselves on options that are less invasive. Failure to build a new repertoire of skills will mean diminished access to patients because referrals will be made to those cardiothoracic surgeons who are seen as innovators. Time is of the essence, as market dynamics are taking their toll. Cardiothoracic surgery today is still one of the most profitable specialties within the hospital and therefore, hospitals should be willing to support and differentiate their heart programs through new technology adoption. But cardiothoracic surgeons need to be open to explore new methods for treating cardiac disease and to work with industry in proving the efficacy and patient benefits of new procedures. At a higher level, pan-European approaches to new technology adoption need to focus on increased governmental spending on healthcare and on reimbursement strategies that make this possible. The medical device industry continues to invest heavily in new techniques and technologies and should be viewed as a strategic partner by individual surgeons as well as by the surgical societies. As industry continues to focus on areas such as research, product development, market development, professional and resident education, reimbursement, and patient access issues, it is imperative for surgeons to work collaboratively with industry to drive change for the cardiothoracic specialty and to maximize the resources that each offers to the other. Though not always understood, a common unity of purpose does exist and constructive methods to dealing with change can be developed together. Frost & Sullivan predicts a medical device industry compound annual growth rate of 8% in the next 12 years. Achieving that same level of growth specifically across cardiothoracic surgery would be tremendous.

Key Words: Technology innovation • Revascularization • Valves • Atrial fibrillation • Heart failure • Minimally invasive