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Bringing the medics and surgeons back together

ESC Congress News 2016 - Rome, Italy

Cardiovascular Pharmacotherapy
Cardiovascular Nursing

  A symposium will today explore the interaction between cardiologists and cardiac surgeons on heart teams - and highlight the need for improvement.

Multidisciplinary team-working in cardiology is already widely adopted in TAVI, revascularisation and HF. Now well established in oncology, this heart team approach involves specialists - including surgeons, consultants, nurses and anaesthetists - sharing knowledge and expertise on the best way forward for patients without an obvious treatment pathway.

Surgeons on TAVI and revascularisation teams will be involved throughout. However, adult intensive care specialist Susanna Price says this is not the case with HF teams where surgeons are only visible at the initial and end stages. This mind-set, however, needs to change, says Price, a consultant cardiologist and intensivist at the Royal Brompton and Harefield NHS Foundation Trust in London. ‘I’m concerned that this  is far removed from what a multidisciplinary team should be,’ she adds. ‘We’re missing a trick because it’s the surgeons who are developing all these new therapies based on robotics and extracorporeal circuits. They’re very innovative but don’t have a role [on HF teams] - it’s a missed opportunity.’ 

In addition, Price believes that surgeons are vital in specialist teams set up to treat cardiogenic shock. Apart from in isolated centres, she says, ‘very little’ is being done to improve mortality rates for this condition, which are currently around 50%. They could be reversed though if institutions deployed ‘shock’ teams dedicated to delivering early intervention to patients - for example, extracorporeal membrane oxygenation (ECMO). These teams would bring together cardiac surgeons, interventional cardiologists, perfusionists, imaging specialists, cardiac anaesthetists as well as nurses. Says Price: ’It would be like having a cardiac arrest team but with an added surgeon and identifying patients immediately. The 2015 resuscitation guidelines acknowledged that ECMO might be used in cardiopulmonary resuscitation, so using ECMO earlier could become a thing of the future.’    

The degree of co-operation between cardiologists and surgeons is an issue too in the interventional treatment of valvular disease. Hendrik Treede will acknowledge in today’s Symposium that TAVI has become the perfect example of successful collaboration between cardiologists, cardiac surgeons and imaging specialists. However, he will also highlight how the extent of collaboration varies, not only between centres but also between countries.

‘In many countries interventional treatment of heart valve disease is often in the hands of cardiologists alone and surgeons are not involved,’ says Treede from the Comprehensive Heart Center, University Hospital Halle, Germany. ‘The consequence is that indications and treatments are no longer discussed, choice of access routes is limited and additional risks may be taken.’

In some centres, a situation even exists where two TAVI teams work in parallel. The impact is that they are not profiting from the wealth of skills which exists among the respective specialists. Treede believes an ‘everybody does everything’ policy is necessary to improve the interaction between cardiologists and surgeons. His vision is for them to be cross trained in all relevant skillsets, for financial budgets to be shared and for all interventional heart valve therapies to be done together. He adds: ‘What’s also required are regular heart team sessions and decision-making for every patient where different treatment options are available.’

Don’t miss: The heart-team based practice in 2016: space for improvement in the interaction between cardiologists and cardiac surgeons?

30 August  14:00-15:30  Sarajevo - Village 2


Click here to read other scientific highlights in the full edition of the Congress news.