con la Cardiología intervencionista tiene que tender a desaparecen la cirugía cardíaca, tan agresiva y una aceleración de aterosclerosis coronaria. El peligro de la vida e incluso para al salud de la cirugía pasará a ser algo obsoleto yfalta de lógica, psará a se un pasado sin repetición, será algo que nadie va a querer repetir. Todo operaado tiene siempre una couta de pago de salud en el futuro mientrás la mayoría tratado por la cardiología intervencionista necesitan menos medicamentos, menos citas con su cardiólogo y prácticamente todos se reincorporan a sus actividades familiares, sociales y laoborales habituales de forma normal, sin limitaciones. La cirugía cardíaca pasa a ser una nueva enfermedad, tanto vlavular, como vascular coronaria, como la cirugia en conénitos, todos pasan a ser unos ser otro tipo de enfermo con muchos medicamentos, anticuagulación que en un verdadero problema, consultas repetidas y la agresividad de está cirugía se repite igual que se repite sus efectos secundarios delétereos de las mismas. La cardiología Intervencinista tiene un futuro alentador y luminoso mientrás que la cirugía cardíca psa a ser una agresividad y unos resultados cuestionables en cuanto a calidad de vida y pronostico de vida, es una mutilación para tratar de resolver un problema de salud cardíaca de forma parcial????!!!

Cardiac surgery patient volume has certainly come down during the last two decades. Mitral stenosis, ASD and PDA are almost entirely done by interventional cardiologists. TAVI is emerging as a very good option for aortic stenosis even in patients with only moderately high risk for surgical AVR. Expanding indications even include cases of AR. Complex coronary cases including main stem, bifurcations, chronic total occlusions and calcified lesions are now routinely performed by interventional cardiologists. Only the very complex cases are referred to surgeons for CABG. At the same time, the quality of cases done by cardiac surgeons have changed. Now more complex and complicated cases are being undertaken with excellent outcome.

In the USA there are a few places that do amazing interventional work and can fix blocked arteries from 1974 who have failed 2 bypasses since - they work with such ease for recovery. Sadly due to insurance control of the healthcare system in the US some people die while they are waiting for the AVR to be completed as an outpatient, when 10 years ago they would have had the surgery during the same hospital stay - but pressures on the hospital owned doctors (and also from insurance company owned hospitals) takes away the accuracy of going to the OR for open AVR, waiting for outpatient TAVR - some people do not make it.

Dr koshy has nicely explained. Add to the list of diseases managed by Interventional cardiologist by percutaneus intervention are..

VSD closure

RSOV closure

Management of paravalvular leak

Closure of coronary and pulmonary AV fistula

Mitaclip

Percutaneus mitral valve replacement

Percutaneus tricuspid valve and pulmonary valve replacement

Alcohol sepal ablation in HCM

Etc... Thanks

Cardiac surgeon will soon restrict themselve into transplant and LVAD cases.

Though lot of structural heart diseases are effectively managed by interventional cardiologists, several complex cases do require the help of cardiac surgeons. Complex pediatric cardiac procedures continue to be the domain of cardiac surgeons. If a proper "heart team" approach is followed, many multi vessel CAD patients especially with diabetes qualify for CABG rather than PCI.

I follow answers

best regards

I agree with Allen Orehek

I think cardiac surgeons have to to be more involved in the cath lab especially with the coming new procedures i.e TAVI otherwise they will face dificult future full of high risk procedures with substantial risk and marginal benefit

Es preciso que los cirujanos se den cuenta del desarrolo y tomen pare de él. ya la situación y avances del siglo XXI el que no se incorporé al proceso tendrá que marginarse en un pasado oscuro y lleno de complicaciones sin efectividad alguna.

I agree with dr koshy first comment except the last two words

I think a change in cardiac surgery training programs has to be made to involve residents in the cath lab new interventions , PCI,TAVI and others

I agree with dr pande

Es así ,no hay dudas. el decir lo contrario es absurdo. Hay que aceptar la relalidad, los laboratorios o departamentos de hemodinamias son cada vez más avanzados con técnicas novedosas y eficaces. Usted escucha a los pacientes decir ¨ojalá que no tenga que operarme¨, ya ellos conocen que los procederes hemodinámicos son menos agresivos, con menos secuelas, y por supuesto no siendo tan traumaticos dan una mejor calidad de vida y un pronostico de vida muy superior a la cirugía cardiovascular. hay que recordar que la cirugía cardiovascular viene a traer una nueva enfermedad donde acelera el proceso aterosclerotico o tienen que consumir más medicamentos incluyendo los anticualgulantes que son tan peligrosos y requieren de tantos controles que el enfermo se convierte en un nuevo enfermo pendiente y dependiente de tiempo de Protombina INR y consultas y reconsultas con gatos economicos y molestias que no veo que sufren los pacientes que resuelven con técnicas hemodinámicas muy avanzadas y cada vez menos deletéreas para el paciente. La Homodinámia sustituye los procesos agresivos de la ciruugía cardiovascular y ésto es progresivo y rápido, muy rápido. Hacer una encuesta a los médicos y pacientes y todos prefieren y conocen las ventajas de la hemodinámia, aunque no sea criterio cientifico pero que coincide honestamente!!!...Diso los Bendiga en cada decisión hermanos colegas!!!...

Dr Candelario can I have breifing in english please thanks

Cardiac surgery is evolving and changing, not diminishing. Cardiac surgeons now manage the more complex cases (of which there is a high volume of cases to undertake given the large global burden of severe cardiovascular disease) and achieve very good outcomes. And indeed the efficacy of many open cardiac surgical procedures far surpasses percutaneous methods in multiple patient groups in the current literature. However, with the likely improvement in efficacy of percutaneous interventions over time, the indication for PCI/TAVI etc. will inevitably expand and start to encroach on the current caseload of cardiac surgeons. So there is a need in my opinion for catheter-based skills to be included in cardiac surgical training programmes so that the next generation of wannabe cardiac surgeons (like myself) can safely undertake any cardiac intervention (open, minimally-invasive or percutaneous) for all patients (young, old, low-risk and higher-risk) and so continue to maintain and even expand our caseload. The great specialty of cardiac surgery is here to stay, but may need to adapt somewhat.

I do agree with above comments. Interventional Cardiologist are doing more simple and complex procedures. Previously cardiac surgeons used to do these all cases when we did not have PCI facility.

nada es discutible las respuestas anteiores. siendo cardiólogo pienso, solamente, en crear cirujanos cardiovaculares más competentes y conocedores, auqnue nos quiten pacientes jajaja... No quitamos importancia a la Cirugía Cardivascular lo que queremos es resaltar la importnacia de concoer sobre técnicas avanzadas de Homodinamia, técnicas sin lugar a dudas mucho menos invasivas y agresivas y con resultados muy alentadores. Que lo tome quien quiera. Me retiro de este camino trillado!!!...

this problem is perhaps real in countries with high volume of cardiac surgery, but that is not the case for low and medium income countries which are far from responding to all the needs even in cardiology and in cardiac surgery.

Yes, Is very important. Okey.

Not that I say that to him; precisely the combination of both things is necessary. The Hemodinamia is absolutely less aggressive and with advances many more quickly than the cardiac surgery and provided that you may do resolutions with Hemodynamics the sick person cardiacs must not be operated on. It is clear that both are important for the solution of problems but never must they exist join once the other one was separated from as going by is in many centers of worldly cardiology. They are close-knit thanks to God at my country and they take very reliable decisions for the well-being of the sick. There are no geris between Surgery Cardiovascular and resolution for Hemodinamia they are at peace and unit, without stopping to think if I join or the other one is better. Solos and cardiovascular thinks about the best form to solve the problem of sick person all that may decide in favor of Hemodinamia does not put itself in risk in a Surgery cardiovascular unnecessary. Also we have a system of free health for the sick person that makes the union easy and it eliminates the contradiction!!!...

thank you very much Dr Candelario

Khaled Alebrahim Yes to a certain extent in adults especially in patients with coronary artery disease. However, the total number of coronary surgeries has not declined but remains constant in the recent years. We are now seeing cases of in-stent thrombosis presenting for CABG after repeated angioplasties. The numbers of these cases will rise in the coming years.

As mentioned in other replies, the CABGs are now complex cases with low EF and comorbidities. The outcomes have improved. Things may change towards surgery if future report will show the benefits of internal mammary grafts when compared to stents.

In congenital cardiac surgery, we almost do not get to do secundum ASDs now. Our cardiologists have started doing simple VSDs as well. However, the complex congenitals are still there and will remain with the surgical team.

In valvular cases, the interventions have added a lot of value but the mainstay of treatment is still surgery. Ascending aorta and aortic arch surgeries also add a big volume to the surgical team.

No puedes negar que la Hemodinamia y las tecnicas no quirurgicas avanzan mucho más en cantidad y calidad,. No se divcorcie la cirugia cardivascular del cateterismo y el tratamiento por angioplastia y Stens resuelve mucho y es mucho menos agresivo. Tampoco, jamás hace el daño la hemodinamia como la cirugía revascularizadora sobre todo acelera el poceso de aterosclerosis coronaria. Mulpliquemos y sumemos no div

@idamos ni restemos. La unión es la fuerza y la mejor atención al enfermo cardiovascular

yes

Es un camino trillado. Es claro que sí.... No en estadística de una semana o de un mes. Hace años que ocuure. Un abrazo cordial. feliz año 2019.