Interventional Cardiology vs. Cardiac Surgery: The Rise of Cardiac Surgeons

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khash08

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Hi folks,

I know that the cardiac surgeons are in pretty bad shape now since almost all the procedures they used to do (especially bypass surgery) can now be done by interventional cardiologists with minimally invasive procedures.

However, I read some articles stipulating that research points to the fact that stenting can have long term consequences, in which case cardiac surgery might be the preferable procedure.

Many are already talking about a prominent rise and comeback of cardiac surgeons. Personally, I think that the future belongs to interventional cards. What do you guys think?

References (interesting articles about the subject):

Code:
[URL="http://www.nytimes.com/2007/02/25/health/25bypass.html?_r=1&em&ex=1172552400&en=8ecfb79a03cdc6a3&ei=5087%0A"]http://www.nytimes.com/2007/02/25/health/25bypass.html?_r=1&em&ex=1172552400&en=8ecfb79a03cdc6a3&ei=5087%0A[/URL]
 
I think we will still need cardiothoracic surgeons, but they will never rise to the heights of the 1980's, when they were doing a ton of CABG surgeries in the pre-coronary stent era. Cardiothoracic surgeons are super important. Nobody can predict the future, but I know that in recent years some CT surgery trainees were having trouble finding jobs...it seems the CT surgeons started training fewer surgeons which should help with that. Also, the CT surgeons started doing more minimally invasive procedures, etc. so that they could offer patients more options, and potentially compete with interventional cards in some areas.
 
The SYNTAX study looked at complete revascularization via stenting vs surgery for 3vd and left main disease - areas that have traditionally been thought of as soley the domain of CABG - long term "major adverse cardiac events" were slightley higher w/ stents than surgery - but this was driven by increased rates of repeat revascularization in the stent group. There was no mortality difference or difference in repeat MI. Also while the stent group had higher revascularization, the CABG group had sig higher rates of stroke. Granted that the primary end point was major adverse events, but its hard to really see this as CABG being superior to complete revascularization via stents - if it were me I'd rather have to go back to the cath lab than have a stroke. Of course the groups may diverge over time so we'll have to see the followup data.

On top of this most of what we do - CABG or Stenting, is for symptom relief - and a large majority of patients have anatomy for which stenting is non-inferior to CABG.

Add to this percutaneous mitral valve repair procedures, new percutaneous aortic valve replacement procedures which are in trials but for which the data looks very promising, PFO/VSD repair, percutaneous LVADS, and the next generation of stents including resorbable stents - and its pretty clear that IC will continue to grow for the foreseeable future. If anything, IC will be put out of business by improved medical therapy/ ? stem cells, but not by cardiac surgery.

Of course there's no debate that cardiac surgeons will always be needed, that they have a hard job, and that what they do is very valuable. Its just a question of supply and demand and right now in cardiac surgery from what I'm seeing and hearing supply > demand.... but this will change over time as fewer CT surgeons are being trained.
 
...and let me say that I've never seen a more life-deprived group of people than the cardiac surgeons at my institution. They're there...ALL the time. I see this one guy consistently working 6am to 10pm, every single day, including weekends, and he must be sixty-five and the angriest, most pissed-off intolerant man I've ever met. His fellow is inches from killing herself, I think, complaining that the average operation takes about 9 hours and she spends the remaining hours of her 7-day workweek in the SICU, watching PA pressures and praying nobody will code within the next hour or two.

I walked away from my CT rotation thinking I'd TOTALLY give up ALL ideas regarding going into any type of surgery, even though I loved my general and neurosurgery rotations. I just didn't want to see another OR for a while. I'm over it now but my point: I think if anybody reading this is even THINKING about doing cards instead....you'd do well to run in that direction, turf wars aside.

As for me, I'm between vascular surg and cards. Those maniacs made vascular look like a party.
 
...and let me say that I've never seen a more life-deprived group of people than the cardiac surgeons at my institution. They're there...ALL the time. I see this one guy consistently working 6am to 10pm, every single day, including weekends, and he must be sixty-five and the angriest, most pissed-off intolerant man I've ever met. His fellow is inches from killing herself, I think, complaining that the average operation takes about 9 hours and she spends the remaining hours of her 7-day workweek in the SICU, watching PA pressures and praying nobody will code within the next hour or two.

I walked away from my CT rotation thinking I'd TOTALLY give up ALL ideas regarding going into any type of surgery, even though I loved my general and neurosurgery rotations. I just didn't want to see another OR for a while. I'm over it now but my point: I think if anybody reading this is even THINKING about doing cards instead....you'd do well to run in that direction, turf wars aside.

As for me, I'm between vascular surg and cards. Those maniacs made vascular look like a party.


If you really like OR and procedures, but don't like 8 hours marathon cases, have you considered urology? Most of their procedures aren't too long (with some exceptions like transplant, ileal conduit, etc). But you wouldn't have to do those long procedures after residency and could just stick to the simple stuff like cystoscopy, biopsies, laparascopy, etc.
 
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