Re-imagining Thoracic Surgery

It was 2011 and incoming STS President Michael J. Mack, MD warned members that it was time to get on the train to treat structural heart disease or lose out. Eight years later, Tom C. Nguyen, MD, of The University of Texas Health Science Center in Houston, expanded Dr. Mack’s admonition. He said that it is time to re-envision the future of cardiothoracic surgery or lose it.

Tom C. Nguyen, MD

Tom C. Nguyen, MD

Dr. Nguyen explained that there are two ways to conceive surgery—in terms of the tools used to treat disease or in terms of the diseases surgeons treat. Most cardiothoracic surgeons, societies, and equipment manufacturers think of our subspecialty in terms of the tools we use or develop.

The reality is that tools change—and at an increasing pace. More than 300,000 transcatheter valve replacements (TAVRs) have been performed worldwide since 2002 and now outnumber surgical AVRs. He noted that he believes cardiothoracic surgeons who define their work in terms of SAVR procedures are a dying breed.  He predicts that surgeons who think of themselves as TAVR experts will be similarly displaced by the next wave of valve repair technologies.

The solution, Dr. Nguyen said, is to re-imagine cardiothoracic surgery in terms of the conditions we treat. Tools are nothing more than tools, sufficient for now and expected to be replaced by improved technologies.

Re-imaging thoracic surgery means developing a new training paradigm that focuses on the condition, not the tool, to capture the future. As a result, Dr. Nguyen called on his colleagues to look beyond specific technologies and create a new, standardized curriculum for subspecialty training. Cardiothoracic surgeons must become proactively involved in the creation, development, and implementation of new technologies as a matter of policy, practice, and survival, he said.