What’s the future of cardiac surgery?

How it will impact your CV program

Haley David, Technology Insights

The Society of Thoracic Surgeons’ (STS) 50th Annual Meeting took place January 25th in Orlando, Fla. With continued focus on interventional technologies and procedures, many are asking, “What role will cardiac surgery play in the future?” Here are five key takeaways from this year’s conference:

1. Collaboration is essential

With recent innovations, the interventional and surgical lines continue to blur. Many CV surgeries are minimally invasive, and many new interventional procedures—like transcatheter aortic valve replacement (TAVR)—require a surgical cut-down. As a result, cardiac surgeons and interventionalists must work together to perform and offer these growing and differentiating services.

In fact, surgical collaboration is required beyond the OR walls. For TAVR, surgeons are a crucial part of patient selection, device evaluation, and follow-up care. For ventricular assist devices (VADs), surgeons and HF specialists collaborate to discern appropriate VAD patients and the patient’s treatment pathway. As a result, STS expert panelists emphasized the multidisciplinary heart team as a mainstay for both TAVR and VAD programs in the future.

Plus, without a surgeon, programs cannot get reimbursed for these expensive technologies, making an already challenging financial landscape insurmountable. CMS’s National Coverage Decisions (NCD) for TAVR and, more recently, for VADs mandate a team approach with a surgeon’s involvement in order to receive reimbursement.

As a result, strategic planners must consider the needs of both surgeons and interventionalists and facilitate multidisciplinary care to prepare for future growth.

2. As devices shrink, turf wars likely to ensue

From TAVR devices and new VADs, the technologies highlighted at this year’s STS/AATS Tech-Con made one thing abundantly clear: devices are only getting smaller. Next generation TAVR devices are as small as 14 French, and even for the most advanced technologies—such as total artificial hearts (TAH)—surgeons are striving for pumps that fit entirely within the pericardial space.

Related: Operational Considerations for Building a TAVR Program

As advanced devices such as VADs and TAH continue to shrink, the procedures will likely shift to our interventional colleagues. Thus, hospital leaders must prepare for physician turf wars in both the interventional and surgical spaces as both specialties vie for these new devices.

3. Cardiac surgeons may need to expand skill sets

To further complicate matters, future cardiac surgeons may require both interventional and surgical skills. One STS panelist urged surgical members to strive for “equipoise” including interventional transfemoral, transradial, subclavian, and open surgical skills.

Related: You've decided to launch a TAVR program...now what?

By broadening their skillsets, surgeons can offer patients a wide variety of procedures while mitigating the risk of diminishing volumes. Much like endovascular surgeons have done, cardiac surgeons may respond to these technology trends by becoming trained in both open and percutaneous skills.

It’s no surprised then that integrated residencies and teaching programs for cardiac surgeons continue to grow. Hospital leaders must stay abreast of changing physician skills and tailor their recruitment strategies accordingly.

4. Patients want options

As the cardiac surgery business changes, CV teams must consider patient preference. Patients want a wide-variety of treatment options, including interventional and surgical procedures. By offering a host of CV procedures, CV programs can differentiate themselves as patient-centric or a “one-stop shop.”  

From our blog: FDA approves Medtronic’s CoreValve

Thus, offering both interventional and surgical treatment options will serve as an essential marketing tool. It will be important to showcase these alternatives to referring physicians to build referrals. 

5. Surgery remains critical

Ultimately, surgery will remain a critical component of the CV business. As a major contributor to a CV program’s bottom line, surgery represents a staple for program viability. For the foreseeable future, there remains a significant portion of patients that will require and even excel with surgical procedures.

Hospital leaders must defend these revenue-intensive businesses and work with physicians to discern the appropriate surgical patient selection criteria. 

A sink-or-swim moment for cardiac surgery

As the surgical landscape continues to evolve, CV surgery programs striving to stay relevant must adjust to this changing environment. Strategic planners must anticipate these changes by facilitating multidisciplinary collaboration, recruiting highly-skilled surgeons, protecting margins, and emphasizing treatment options in marketing campaigns.

For more information on our latest conference coverage, check out The Pipeline or follow us on Twitter. And, if you are interested in a cardiac surgery or TAVR assessment, please contact your Dedicated Advisor today.

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