Cardiac and Vascular Surgeons Can Learn From Each Other

More and more often, cardiac and vascular surgeons are seeing the same patients and dealing with similar challenges, making a collaborative approach essential to optimizing outcomes.

SVS @ STS: Sharing Common Ground for Cardiovascular Problems

Monday

1:15 p.m. – 3:15 p.m.

Room 31C

“Cardiac surgeons and vascular surgeons have very different training and tools in their armamentariums,” said Keith B. Allen, MD, of St. Luke’s Mid America Heart Institute in Kansas City, MO. “It’s important for both types of specialists to expand their horizons and understand what strategies the other uses.” 

Dr. Allen will co-moderate today’s session planned by STS and the Society for Vascular Surgery, which will outline common areas where surgeons should approach patient care collaboratively, considering all options at their disposal. 

Keith B. Allen, MD

Keith B. Allen, MD

One example is vascular access. The use of transcatheter procedures has increased with expanding indications for endovascular devices. The size of some of these devices adds to the challenge of vascular access. 

“The devices are getting smaller, but cardiac surgeons must be creative and think outside the box when femoral access is not available,” Dr. Allen said. “There is a continued need for alternate options for individuals with inadequate iliofemoral vessels.”

Historically, alternate options have included transapical and direct aortic approaches, but Dr. Allen noted that these choices have lost ground to minimally invasive strategies. He recommends that both cardiac and vascular surgeons have a working knowledge of less invasive approaches such as carotid, transcaval, axillary, and subclavian access.

Pulmonary embolism (PE) is another area in which the perspectives of both specialties are necessary. Acute PE is the third-leading cause of cardiovascular death in the United States, with an estimated 100,000 deaths each year. Among the challenges of PE are that it is often difficult to diagnose, clinical trial data are inadequate for evidence-based recommendations, and guidelines offer different risk stratification classifications. 

Many clinicians need a greater understanding of guidelines for management of PE, Dr. Allen noted, and many institutions have yet to establish a PE team. 

“In some institutions, care is provided in a piecemeal manner. There is no team or plan, or clinicians do not understand the distinctions among submassive, massive, and minor PE,” said Dr. Allen. “Clinicians should know how to diagnose different types of PE and understand the potential therapies—catheter-based procedures, surgery, and medical therapy. The most important point is to have a team and implement it.” 

This session will outline how to organize a PE team, triage according to type of PE, and select appropriate therapy in individual cases. 

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