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Cardiac Surgery in the Modern Hospital

  • Steven L. LansmanEmail author
  • Joshua B. Goldberg
  • Masashi Kai
  • Ramin Malekan
  • David Spielvogel
Chapter

Abstract

This chapter discusses three things that characterize the modern hospital and cardiac services: the incorporation of enabling technologies, the adoption of databases, and the coalescence of institutions into networks. Each of these has impacted current cardiac surgical programs, as they matured from coronary bypass franchises to “full service stations.” Technological advances have given rise to entirely new treatment modalities, such as mechanical assist devices for heart failure, minimally invasive cardiac surgery, and endovascular approaches to structural heart disease. Internal and national cardiac surgical databases have been adopted that monitor, analyze, and disperse outcome data, to provide transparency and improve results. The coalescence of institutions into networks has given rise to efficiencies, allowing more support for primary care physicians in the community and the centralization of high-risk, resource-intense services, such as cardiac surgery.

Keywords

Transcatheter TAVR ECMO Heart failure Cardiac surgery Databases Registries Network 

Abbreviations

ECMO

Extracorporeal membrane oxygenation

VAD

Ventricular assist device

References

  1. 1.
    Vetrovec GW, Anderson M, Schreiber T, et al. The cVAD registry for percutaneous temporary hemodynamic support: a prospective registry of Impella mechanical circulatory support use in high-risk PCI, cardiogenic shock, and decompensated heart failure. Am Heart J. 2018;199:115–21.  https://doi.org/10.1016/j.ahj.2017.09.007.CrossRefPubMedGoogle Scholar
  2. 2.
    Tang GHL, Malekan R, Kai M, et al. Peripheral venoarterial extracorporeal membrane oxygenation improves survival in myocardial infarction with cardiogenic shock. J Thorac Cardiovasc Surg. 2013;145:e32–3.  https://doi.org/10.1016/j.jtcvs.2012.12.038.CrossRefPubMedGoogle Scholar
  3. 3.
    Mehra MR, Goldstein DJ, Uriel N, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med. 2018;378:1386.  https://doi.org/10.1056/NEJMoa1800866.CrossRefPubMedGoogle Scholar
  4. 4.
    Wahlers TCW, Haverich A, Borger MA, et al. Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve. J Thorac Cardiovasc Surg. 2016;151:1639–47.  https://doi.org/10.1016/j.jtcvs.2015.12.058.CrossRefPubMedGoogle Scholar
  5. 5.
    Meuris B, Flameng WJ, Laborde F, et al. Five-year results of the pilot trial of a sutureless valve. J Thorac Cardiovasc Surg. 2015;150:84–8.  https://doi.org/10.1016/j.jtcvs.2015.03.040.CrossRefPubMedGoogle Scholar
  6. 6.
    Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.  https://doi.org/10.1056/NEJMoa1103510.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20.  https://doi.org/10.1056/NEJMoa1514616.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hannan EL, Cozzens K, King SB 3rd, et al. The New York State cardiac registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes. J Am Coll Cardiol. 2012;59:2309–16. 2012/06/16.  https://doi.org/10.1016/j.jacc.2011.12.051.CrossRefPubMedGoogle Scholar
  9. 9.
    Ferguson TB Jr, Dziuban SW Jr, Edwards FH, et al. The STS National Database: current changes and challenges for the new millennium. Ann Thorac Surg. 2000;69:680–91.  https://doi.org/10.1016/S0003-4975(99)01538-6.CrossRefPubMedGoogle Scholar
  10. 10.
    Vassileva CM, Aranki S, Brennan JM, et al. Evaluation of the Society of Thoracic Surgeons online risk calculator for assessment of risk in patients presenting for aortic valve replacement after prior coronary artery bypass graft: an analysis using the STS adult cardiac surgery database. Ann Thorac Surg. 2015;100:2109–16.  https://doi.org/10.1016/j.athoracsur.2015.04.149.CrossRefPubMedGoogle Scholar
  11. 11.
    Latifi R, Olldashi F, Dogjani A, et al. Telemedicine for Neurotrauma in Albania: initial results from case series of 146 patients. World Neurosurg. 2018;112:e747–53.CrossRefGoogle Scholar
  12. 12.
    Health NYSDo. Adult Cardiac Surgery in New York State Reports. Source: New York State Department of Health WebsiteGoogle Scholar
  13. 13.
    Griffith BP, Anderson MB, Samuels LE, et al. The RECOVER I: a multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support. J Thorac Cardiovasc Surg. 2013;145:548–54.CrossRefGoogle Scholar
  14. 14.
    Baughman KL, Jarcho JA. Bridge to life — cardiac mechanical support. N Engl J Med. 2007;357:846–9.CrossRefGoogle Scholar
  15. 15.
    Mehra MR, Naka Y, Uriel N, et al. A fully magnetically levitated circulatory pump for advanced heart failure. N Eng J Med. 2017;376:440–50.CrossRefGoogle Scholar
  16. 16.
    Eudailey KW, Borger MA. Intuity Elite Valve Implantation Technique. Oper Tech Thorac Cardiovasc Surg. 2016;21:306–21.CrossRefGoogle Scholar
  17. 17.
    Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. 2014;63:1972–81.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Steven L. Lansman
    • 1
    Email author
  • Joshua B. Goldberg
    • 1
  • Masashi Kai
    • 1
  • Ramin Malekan
    • 1
  • David Spielvogel
    • 2
  1. 1.Department of SurgeryWestchester Medical CenterValhallaUSA
  2. 2.Department of RadiologyWestchester Medical CenterValhallaUSA

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