A friend and I (MS2s) were talking about some of the procedures we had learned about in our Cards block and realized that we didn't really know which ones were considered difficult. Are there procedures that take years of practice to become proficient, akin to surgery, and not worth doing yourself if you haven't been doing them? For example, are there instances where interventional cardiologist A would refer a patient to interventional cardiologist B, because B was more skilled at that type of procedure than A (maybe peripheral stuff)?
What are Some of the More Difficult Procedures?
- Thread starter Coast
- Start date
- Joined
- Jul 25, 2001
- Messages
- 9,319
- Reaction score
- 121
Yes. There are many interventionalists who are not comfortable doing any number of procedures which fall within that realm (e.g. TandemHeart, alcohol septal ablation, unprotected left main PCI) not to mention the whole new realm of TAVI and mitral clip procedures, which are, if not exactly "difficult", at least more cumbersome and time-consuming than most bread-and-butter community interventionalists are accustomed to. A good bulk of the stuff we see in our cath lab are cases referred to us by community interventional cardiologists who don't have the ability, interest, patience, or financial incentive to pursue these things.
- Joined
- May 15, 2008
- Messages
- 5,089
- Reaction score
- 55
Yes, see above...in private practice, it's not practical for a lot of people to do this complex stuff like complicated PCI/stenting in a vessel with weird anatomy, atrial septal defect closure, etc. The risk/benefit and money/time ratio is not in their favor.
Thanks. I hadn't realized how complicated some of these procedures can be...just makes it more interesting though! Will some of the new things, like TandemHeart or TAVI, hit private practice soon? Or will they forever be in the realm of academics due to financial or difficulty reasons? The complex and difficult procedures are what excites me the most, as a med student.
- Joined
- Jul 25, 2001
- Messages
- 9,319
- Reaction score
- 121
I believe that the percutaneous valve interventions will make their way into the community at some point, once the delivery systems have been refined. The Sapien valve, for example, is bulky, can't be recovered once deployed (so you get one shot), creates shadowing on echo so TEE guidance is spotty sometimes... nobody in the community is going to want to deal with this thing as it is.
There are some procedures that are never going to be performed in bread-and-butter community practice because they, by definition, involve critically ill patients who are going to land in a referral center. If you're an interventionalist in a small city, working in a lab that does elective PCIs and a couple STEMIs a week, you will never do a TandemHeart.
I will also say that virtually everybody, as a medical student, is drawn to the craziest, newest, most complicated procedures. It's exciting stuff, it's cool. Gradually, however, a large portion of us will remain casually interested in this stuff but become more and more interested in practical notions like lifestyle, job opportunities, etc. So the vast majority of interventionalists who will never do a TandemHeart are perfectly happy with that notion.
- Joined
- Jun 22, 2003
- Messages
- 1,787
- Reaction score
- 26
Mostly see this with structural heart disease. Percutaneous valves, ASD closures etc. They usually get referred to a tertiary facility, or if there's faculty in-house who want a stab at it they'll talk to the device rep to have them send an MD who's done a lot of them to supervise.
Within a group you might have some inverventionalists who don't do legs, renals, carotids, AV fistulas etc., those would also get referred to someone else within or outside the group who did do them.
I don't know that any of it is because of difficulty necessarily. Mostly it's because people are unfamiliar with the procedure or just don't have a desire to do them.
-The Trifling Jester
Within a group you might have some inverventionalists who don't do legs, renals, carotids, AV fistulas etc., those would also get referred to someone else within or outside the group who did do them.
I don't know that any of it is because of difficulty necessarily. Mostly it's because people are unfamiliar with the procedure or just don't have a desire to do them.
-The Trifling Jester
Similar threads
