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Eur J Cardiothorac Surg 2004;26:S76-S77
© 2004 Elsevier Science NL
Working group report |
University College London, The Heart Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK
* Tel.: +44 20 7573 8888; fax: +44 207 573 8888. (Email: bruce.keogh{at}uhb.nhs.uk).
Abstract
Cardiac surgeons have varied practices generally covering revascularisation, and valve surgery with other subspeciality interests. Coronary surgery represents about 75% of cardiac surgical practice. Percutaneous interventions are reducing the referral rate for coronary surgery. The cardiologist who refers patients for surgery has a potential conflict of interest because he offers a treatment himself. Furthermore, cardiologists cannot deal with the major complications of the treatment they offer. This raised the issue of how best to integrate cardiological and surgical treatments. The options considered were: 1. The development of integrated clinics or multidisciplinary meetings for review of data on all patients prior to a decision on intervention. 2. Training of a new breed of surgical interventionist capable of performing all required interventions for a specific condition, e.g. coronary surgery and percutaneous coronary interventions. The development of integrated review of all patients prior to a decision on treatment was deemed problematic given that in the interests of the patient PCI should be performed, where possible, at the same time as the diagnostic angiography. The group dismissed the option of a single interventionist capable of performing both surgical and percutaneous interventions, with the single exception of aortic surgery and stenting procedures. The development of integrated review of all patients prior to a decision on treatment was deemed problematic given that in the interests of the patient PCI should be performed, where possible, at the same time as the diagnostic angiography. The group felt that EACTS should actively engage and collaborate with other organisations, such as the European Society of Cardiology, which were engaged in developing cardiovascular science or therapies, including industry.
Key Words: Cardiology • Cardiac surgery • Vascular surgery
The open Discussion following the ‘Cardiology/cardiac surgery/vascular surgery—evolution to one speciality?’ workshop went on as follows:
Appendix
Conference discussion
Mr Keogh : Do we think it is reasonable at an EACTS level to start to engage the cardiologists, perhaps at a leadership level through the European Society of Cardiology? Do people feel that this would be a good way forward? And we could do that on a number of issues, whether it be training, research, guidelines, so on and so forth?
Dr D. Birnbaum (Regensburg, Germany): We have some experience on a national basis with the cooperation on the cardiological level. A constructive way is, to our experience, mainly personal linked, it therefore is a question how the heads of the Societies will join.
To do this on the basis of the annual meeting would not help: cardiologists would not join sessions and surgeons do not visit cardiologist's congresses unless they are invited to give key lectures, etc. It is a question how a Society behaves at its top, whether they start to get into a cordial associative contact or not. I think we need to like to associate with cardiologists, which is a good future approach. Then possible training programs could be established, because the European Society of Cardiology has certainly such a positive attitude for this kind of common programs too. Why not advertising such as a business in Bergamo?
Mr Keogh : So that is a vote of support for engaging the European Society of Cardiology at a Council type level.
Dr L. Menicanti (Milan, Italy): Speaking about the relationship between cardiologists and cardiac surgery and the cooperation, and speaking about randomized studies and about knowledge, I have an idea, probably naive, but there are some studies that are ready, for example, the STICH trial, in which there is a strict collaboration of cardiologists and cardiac surgery. Very often the PI is a surgeon and the coordinator is a cardiologist, or vice-versa. So this is a good model to go on. And I am thinking, and I would like your advice, why the Society cannot enter in this randomized study, the STICH trial, for example?
Dr L. Bockeria (Moscow, Russia): I don't think that this experience is very important, but I would like to say a few words about what we have at Bakoulev Institution. We have 375 residents at the moment: surgeons, cardiologists, intensive care physicians, perfusionists. They all are for the first year on the same schedule for training. They go for cardiology, for surgery, different departments, and this gives another philosophy for these people. We started this several years ago inside each specialty, congenital, adult, coronary, arrhythmia, therapeutic departments, cardiological departments.
And I should say that the philosophy of these cardiologists is very different from the regular cardiologists because they treat the patient the best way they see, and they are more on the surgical side than regular cardiologists. So maybe this experience might be used in some way.
Mr Keogh : Thanks, Leo (Leo Bockeria). So that is another kind of vote of support for trying to take that forward.
In terms of the business module at Bergamo, do people feel that that is an idea worth taking forward, trying to introduce trainees to the basic concepts of finance, accounting, business? Any votes against? You are the director of education at Bergamo, Pieter (Pieter Kappetein).
Dr A. Kappetein (Rotterdam, Netherlands): This is a perfect idea. What we also discussed in our working group, is that is not only a good idea for the residents but perhaps also for, consultants, because this has never been part of our training.
Mr Keogh : But a good way to start is to try with the trainees; if they like it, then maybe we can think about expanding it.
And what do people feel about introducing a session which allows people to submit abstracts that address professional and administrative type of affairs for the annual general meeting? It probably would mean that we would either have to run an additional parallel session or chop out something else from adult cardiac, congenital, or what have you. Is it a good idea in principle?
Dr R. Dion (Leiden, Netherlands): Well, Bruce (Bruce Keogh), I think the problem will be that you will need to reduce the number of abstracts that you can accept in the scientific field. I think that the subject is important, but I would see it as an apart session, a short one, with an introductory lecture and a panel discussion: indeed, if you open it to free papers, you will have to accept at least between 5 and 10 of them to be somewhat exhaustive. It will take a long time, and I am not sure about the meaningful character of the ‘take-home’ message.
Mr Keogh : I agree with you entirely, Robert (Robert Dion). So what I sense you are saying is you agree with the principle of introducing this kind of discussion into the annual meeting but you don't want to do it at the price of excluding the sort of high quality scientific papers which we see at the moment and that you are worried that if we introduce that as a category for abstract submission there may not be enough abstracts, so then it may not be good enough, so we might well need to supplement it with some expert giving us a didactic lecture.
Dr Dion : That is it, yes.
Mr Keogh : So in principle we are agreed?
No? Some objections?
Dr F. Beyersdorf (Freiburg, Germany): Well, Bruce, I agree to it, and I agree because this forms a part of our daily activity anyway, and the annual meeting should reflect what surgeons are doing during their daily activity.
One of the problems we have sometimes is that some of our co-workers, and maybe some of the chairmen, are not very good at professional and administrative affairs and therefore are losing ground. So to speak about this during the annual meeting I think is very good, however, it should be done either as a sixth session or outside the meeting. I mean, however one is doing that, that is a different point, but it should not reduce the scientific part, but it should be included.
Mr Keogh : So you are with Robert Dion on this. You like the principle but not at any price.
Dr A. Haverich (Hannover, Germany): The same thing. I could imagine having it in the postgraduate course, for instance, because there it would not interfere with many other interests, I would believe. But that would be one suggestion, only.
Dr T. Wahlers (Jena, Germany): I would like to support both, and I would ask you to first outline a little bit more what topics you summarize under this point specifically or what has been discussed in your working group?
Mr Keogh : We didn't go into the topics in great detail. It was fairly conceptual. Juan Comas, you had trouble working out where to submit one of your abstracts at the last meeting. There are issues relating to auditing, for example, that don't necessarily fit into our standard categories.
Dr J. Comas (Madrid, Spain): It is true. I had it was an idea, and I sent an abstract about it this year. In my unit we have been working worked on quality for about the last six years, and the last year we applied an European model of quality management to know what was our level of efficiency. And I wrote an abstract, and I looked at a category for it to fit in to fill it. It was not congenital, it was not surgical. And then, yes, I contacted Torkel (Torkel Aberg), saying that probably it was a good idea to have a professional for a category inside the meeting, because this is what some of us in the Association are working on, a thing that we are doing, Sam (Sam Nashef) is doing something like that also too in quality, and I think it is a thing that needs to be included involved.
I think one of the things that we have to evaluate in the future is that we have to do surgical procedures things, but we also have to increase our value. Our value that means to have more power or influence somewhere. Maybe our classic if we have these kinds of scientific papers are this is very good, but the power against administrations and policies all the things could be related to with other aspects kinds of things, because the administration doesn't know anything about if the coronary cases or whether the valve cases have this mortalities, but they want to know about the money, how much it costs, what is your quality, what are your standards? And this is the point I was thinking about.
Mr Keogh : Well, I think then my sense is that it is reasonable giving it a try. If we only get an abstract from you and Sam, then we will need to think of somewhere else to put them. If we get enough abstracts which are of reasonable quality, we will ask the program committee to consider adding in a session, and the other thing that they might want to consider is some kind of lecture, and that would be up to I guess a combination of the program committee and the council, if people feel that is appropriate.
Dr L. von Segesser (Lausanne, Switzerland): I would favor rather the post graduate course solution, even if we have an abstract category from which we can pick some and put it in. But I think we could have one year a session on communication with experts to teach us something about it, another year about valuing our products and things like that, or how we should do fund-raising. I think these things would be attended by quite some people. But we need experts, and we are not experts in these fields.
Footnotes
Presented at the EACTS Symposium for the Future of Cardiac Surgery, Frankfurt, Germany, July 1–2, 2004.
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