Views from Cross-Trained Cardiac Surgeons (Part 1)

A session at the 2010 Transcatheter Cardiovascular Therapeutics conference co-sponsored by TCT, the American Association for Thoracic Surgery, and the Society of Thoracic Surgeons centered on integrating cardiac surgery and interventional cardiology.

With such a shift being discussed, it is useful to consider the perspectives of two “early adopters" of this way of thinking - Dr. Mathew Williams at New York Presbyterian Hospital-Columbia and Dr. Michael Davidson at the Brigham and Women's Hospital. Both completed cardiac surgery training and then went on to pursue training in interventional cardiology. Each currently practices using a blend of techniques from both disciplines.

At the time they pursued interventional cardiology training, no formalized training programs for cardiac surgeons interested in interventional techniques existed. But both had observed the emergence of transcatheter valves.

“I've always had a strong interest in valves," said Dr. Davidson, “and it was very clear to me that transcatheter valve techniques would play an incredibly large role and that it was highly likely during my career that these would take a high-profile role. To be a full participant, I couldn't just have cardiac surgical skills but would also need interventional skills, and not just for 'cardiac surgical backup' or providing femoral access, but to really be a full participant - to understand the technology and how to utilize it."

Dr. Williams and Dr. Davidson each approached interventional cardiologists at their respective institutions to set up their training. Dr. Williams worked with Dr. Martin Leon, a prominent interventional cardiologist at Columbia and eventually completed a year-long traditional interventional cardiology fellowship, “I did everything the interventional cardiology fellows did, except I also spent a day a week in the OR as well to keep up those skills," Dr. Williams said.

Dr. Davidson worked with Dr. Donald Baim, a pioneer in interventional cardiology then at the Brigham, and did a year-long fellowship from 2005 to 2006. “I spent about 3 days a week in the cath lab and 2 days a week in the OR so I could keep up my surgical skills. I did a lot of diagnostic catheterizations and assisted in PCI cases. Because of my interest in valves, I was also involved any time there was a structural heart case such as mitral/aortic valvuloplasties. I also made a point of being involved in cases done by vascular surgeons (aortic, peripheral, renal, and carotid work) and spent some time in the electrophysiology lab to gain experience in trans-septal perforations."

The interventional cardiologists involved, Dr. Leon and Dr. Baim, were both described as very enthusiastic about this innovative training pathway. “It was something that Marty [Leon] had always thought was a great concept and had never really happened before then," Dr. Williams said. Similarly, “Dr. Baim loved the idea; it really meshed well with his world view of how the specialties were changing," said Dr. Davidson, who added that “having that kind of high-altitude backup was important and allowed me the air cover to pursue this sort of training."

After their interventional cardiology fellowships, both men joined the staff at their respective training institutions. Dr. Williams is on staff at Columbia in both interventional cardiology and cardiac surgery. “I do a reasonable amount of independent PCI and perform the full scope of interventional procedures - I've joined that group and take acute MI call. Our cardiologists have really embraced this and are fantastic. I am in the hybrid OR 4 days/week - not all of the cases I do in this room are hybrids, but I do completion angiograms on almost every CABG that I do. I do hybrid coronary revascularization with PCI and surgery in a single setting. However, the majority of my work is valvular - including 4-8 trans-catheter valves per month (either transapical or transfemoral). I also spend time in the cath lab - I do the routine, catheter-only based procedures there."

Dr. Davidson is on staff in cardiac surgery at the Brigham and does not perform coronary interventions. “I'm spending the majority of my time doing cardiac surgery with the emphasis being on valves, but I am also a full participant in any structural heart disease cases going on in interventional cardiology (e.g. transcatheter aortic valve). I also do my own cardiac catheterizations and so any given week, I have patients who come in for hybrid procedures. For instance a patient may come in with mitral valve prolapse and I will schedule them for cardiac catherization, possible stent and minimally invasive MVP in a single setting. I spend about one day a week doing catheter-based procedures and several days a week doing traditional surgery. Another thing that has occurred here is that we've had a programmatic approach to this integrated practice. We have a joint advanced valve and structural heart disease clinic that I started with one of my interventional colleagues that has now branched out to involve more cardiologists and more surgeons. In this clinic, cardiac surgeons and interventional cardiologists see patients jointly."

Dr. Davidson notes some of the benefits of cross-training: “It allows me to be a greater participant in my patient's care. For instance, I have patients sent to me who have very complicated valve disease and we may put them through a full workup including catheterization to figure out what component of their symptoms is the valve disease and what component may be from other pathologies. It makes me more involved in disease management, not just doing the surgeries as they come."

(Part 2 of this article follows next month).

A session at the 2010 Transcatheter Cardiovascular Therapeutics conference co-sponsored by TCT, the American Association for Thoracic Surgery, and the Society of Thoracic Surgeons centered on integrating cardiac surgery and interventional cardiology.

With such a shift being discussed, it is useful to consider the perspectives of two “early adopters" of this way of thinking - Dr. Mathew Williams at New York Presbyterian Hospital-Columbia and Dr. Michael Davidson at the Brigham and Women's Hospital. Both completed cardiac surgery training and then went on to pursue training in interventional cardiology. Each currently practices using a blend of techniques from both disciplines.

At the time they pursued interventional cardiology training, no formalized training programs for cardiac surgeons interested in interventional techniques existed. But both had observed the emergence of transcatheter valves.

“I've always had a strong interest in valves," said Dr. Davidson, “and it was very clear to me that transcatheter valve techniques would play an incredibly large role and that it was highly likely during my career that these would take a high-profile role. To be a full participant, I couldn't just have cardiac surgical skills but would also need interventional skills, and not just for 'cardiac surgical backup' or providing femoral access, but to really be a full participant - to understand the technology and how to utilize it."

Dr. Williams and Dr. Davidson each approached interventional cardiologists at their respective institutions to set up their training. Dr. Williams worked with Dr. Martin Leon, a prominent interventional cardiologist at Columbia and eventually completed a year-long traditional interventional cardiology fellowship, “I did everything the interventional cardiology fellows did, except I also spent a day a week in the OR as well to keep up those skills," Dr. Williams said.

Dr. Davidson worked with Dr. Donald Baim, a pioneer in interventional cardiology then at the Brigham, and did a year-long fellowship from 2005 to 2006. “I spent about 3 days a week in the cath lab and 2 days a week in the OR so I could keep up my surgical skills. I did a lot of diagnostic catheterizations and assisted in PCI cases. Because of my interest in valves, I was also involved any time there was a structural heart case such as mitral/aortic valvuloplasties. I also made a point of being involved in cases done by vascular surgeons (aortic, peripheral, renal, and carotid work) and spent some time in the electrophysiology lab to gain experience in trans-septal perforations."

The interventional cardiologists involved, Dr. Leon and Dr. Baim, were both described as very enthusiastic about this innovative training pathway. “It was something that Marty [Leon] had always thought was a great concept and had never really happened before then," Dr. Williams said. Similarly, “Dr. Baim loved the idea; it really meshed well with his world view of how the specialties were changing," said Dr. Davidson, who added that “having that kind of high-altitude backup was important and allowed me the air cover to pursue this sort of training."

After their interventional cardiology fellowships, both men joined the staff at their respective training institutions. Dr. Williams is on staff at Columbia in both interventional cardiology and cardiac surgery. “I do a reasonable amount of independent PCI and perform the full scope of interventional procedures - I've joined that group and take acute MI call. Our cardiologists have really embraced this and are fantastic. I am in the hybrid OR 4 days/week - not all of the cases I do in this room are hybrids, but I do completion angiograms on almost every CABG that I do. I do hybrid coronary revascularization with PCI and surgery in a single setting. However, the majority of my work is valvular - including 4-8 trans-catheter valves per month (either transapical or transfemoral). I also spend time in the cath lab - I do the routine, catheter-only based procedures there."

Dr. Davidson is on staff in cardiac surgery at the Brigham and does not perform coronary interventions. “I'm spending the majority of my time doing cardiac surgery with the emphasis being on valves, but I am also a full participant in any structural heart disease cases going on in interventional cardiology (e.g. transcatheter aortic valve). I also do my own cardiac catheterizations and so any given week, I have patients who come in for hybrid procedures. For instance a patient may come in with mitral valve prolapse and I will schedule them for cardiac catherization, possible stent and minimally invasive MVP in a single setting. I spend about one day a week doing catheter-based procedures and several days a week doing traditional surgery. Another thing that has occurred here is that we've had a programmatic approach to this integrated practice. We have a joint advanced valve and structural heart disease clinic that I started with one of my interventional colleagues that has now branched out to involve more cardiologists and more surgeons. In this clinic, cardiac surgeons and interventional cardiologists see patients jointly."

Dr. Davidson notes some of the benefits of cross-training: “It allows me to be a greater participant in my patient's care. For instance, I have patients sent to me who have very complicated valve disease and we may put them through a full workup including catheterization to figure out what component of their symptoms is the valve disease and what component may be from other pathologies. It makes me more involved in disease management, not just doing the surgeries as they come."

(Part 2 of this article follows next month).

A session at the 2010 Transcatheter Cardiovascular Therapeutics conference co-sponsored by TCT, the American Association for Thoracic Surgery, and the Society of Thoracic Surgeons centered on integrating cardiac surgery and interventional cardiology.

With such a shift being discussed, it is useful to consider the perspectives of two “early adopters" of this way of thinking - Dr. Mathew Williams at New York Presbyterian Hospital-Columbia and Dr. Michael Davidson at the Brigham and Women's Hospital. Both completed cardiac surgery training and then went on to pursue training in interventional cardiology. Each currently practices using a blend of techniques from both disciplines.

At the time they pursued interventional cardiology training, no formalized training programs for cardiac surgeons interested in interventional techniques existed. But both had observed the emergence of transcatheter valves.

“I've always had a strong interest in valves," said Dr. Davidson, “and it was very clear to me that transcatheter valve techniques would play an incredibly large role and that it was highly likely during my career that these would take a high-profile role. To be a full participant, I couldn't just have cardiac surgical skills but would also need interventional skills, and not just for 'cardiac surgical backup' or providing femoral access, but to really be a full participant - to understand the technology and how to utilize it."

Dr. Williams and Dr. Davidson each approached interventional cardiologists at their respective institutions to set up their training. Dr. Williams worked with Dr. Martin Leon, a prominent interventional cardiologist at Columbia and eventually completed a year-long traditional interventional cardiology fellowship, “I did everything the interventional cardiology fellows did, except I also spent a day a week in the OR as well to keep up those skills," Dr. Williams said.

Dr. Davidson worked with Dr. Donald Baim, a pioneer in interventional cardiology then at the Brigham, and did a year-long fellowship from 2005 to 2006. “I spent about 3 days a week in the cath lab and 2 days a week in the OR so I could keep up my surgical skills. I did a lot of diagnostic catheterizations and assisted in PCI cases. Because of my interest in valves, I was also involved any time there was a structural heart case such as mitral/aortic valvuloplasties. I also made a point of being involved in cases done by vascular surgeons (aortic, peripheral, renal, and carotid work) and spent some time in the electrophysiology lab to gain experience in trans-septal perforations."

The interventional cardiologists involved, Dr. Leon and Dr. Baim, were both described as very enthusiastic about this innovative training pathway. “It was something that Marty [Leon] had always thought was a great concept and had never really happened before then," Dr. Williams said. Similarly, “Dr. Baim loved the idea; it really meshed well with his world view of how the specialties were changing," said Dr. Davidson, who added that “having that kind of high-altitude backup was important and allowed me the air cover to pursue this sort of training."

After their interventional cardiology fellowships, both men joined the staff at their respective training institutions. Dr. Williams is on staff at Columbia in both interventional cardiology and cardiac surgery. “I do a reasonable amount of independent PCI and perform the full scope of interventional procedures - I've joined that group and take acute MI call. Our cardiologists have really embraced this and are fantastic. I am in the hybrid OR 4 days/week - not all of the cases I do in this room are hybrids, but I do completion angiograms on almost every CABG that I do. I do hybrid coronary revascularization with PCI and surgery in a single setting. However, the majority of my work is valvular - including 4-8 trans-catheter valves per month (either transapical or transfemoral). I also spend time in the cath lab - I do the routine, catheter-only based procedures there."

Dr. Davidson is on staff in cardiac surgery at the Brigham and does not perform coronary interventions. “I'm spending the majority of my time doing cardiac surgery with the emphasis being on valves, but I am also a full participant in any structural heart disease cases going on in interventional cardiology (e.g. transcatheter aortic valve). I also do my own cardiac catheterizations and so any given week, I have patients who come in for hybrid procedures. For instance a patient may come in with mitral valve prolapse and I will schedule them for cardiac catherization, possible stent and minimally invasive MVP in a single setting. I spend about one day a week doing catheter-based procedures and several days a week doing traditional surgery. Another thing that has occurred here is that we've had a programmatic approach to this integrated practice. We have a joint advanced valve and structural heart disease clinic that I started with one of my interventional colleagues that has now branched out to involve more cardiologists and more surgeons. In this clinic, cardiac surgeons and interventional cardiologists see patients jointly."

Dr. Davidson notes some of the benefits of cross-training: “It allows me to be a greater participant in my patient's care. For instance, I have patients sent to me who have very complicated valve disease and we may put them through a full workup including catheterization to figure out what component of their symptoms is the valve disease and what component may be from other pathologies. It makes me more involved in disease management, not just doing the surgeries as they come."

(Part 2 of this article follows next month).