CT transplant vs transcatheter/minimally invasive

[Medstart108]

In an academic center, anyone able to comment on the relative differences in working hours between a cardiac surgeon involved in transplant/VAD vs someone who is focused on TAVR/mitraclip/minimally invasive?

Transplant would obviously entail more emergency operations, transplants happen at all times in the night which means a worse lifestyle, but at the same time, most centers do maybe 30-50 hearts a year and 50 or so lungs a year and most surgeons would likely do 20-30 since surgeries a year. My question though is are there a lot more operations associated with transplants and VADs like takebacks, centrimags etc. that would add to the workload/burden?

I'm interested in transplant mainly because of the research potential, it appears to be a field that is still dormant waiting to explode. At the same time, there is certainly an appeal to doing transcatheter and have more safe procedures/controllable hours etc.

How do academic ct transplant surgeons with basic science/translational labs do it? It seems like doing both would be 90+ hours a week. Is that an accurate assessment? What would it be like as an academic transcatheter/interventional surgeon doing clinical research? Would that be closer to 60-75 hours a week or would that also be closer to 80 hours a week.

I've done some research and asked around, but i definitely feel like its hard to broach this topic with my staff for fear of looking less committed.

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[dodolol21]

Have no insight to offer as a first-year medical student but am interested in a career in adult CTS with a focus on TAVR/MitraClip/minimally invasive approaches. Would also appreciate any insights others might have. Might ask some people myself and if get anything useful will be sure to post!

 

[AsianPersuasion]

I have no large experience to back this up, but from my very little time so far with CV guys, it's seems that the patient gets referred to cardio for work up, if they need interventional procedure, cardio takes a hack at them, if cardio F**k it up, CT / VS comes in to bail them out. The only one time I saw interventional cardio referred a procedure to CT was because the patient had severe structural disease....I would think that it's very difficult to take interventional MIS from cardio because those guys and gals get first dibs on the patient and if they're too sick, they're sending them to CT. So I imagine that you'll get patients but they're going to be train-wrecks...That's just my opinion as a lowly PGY-1.

 

[deleted745951]

@Asian

I have no large experience to back this up, but from my very little time so far with CV guys, it's seems that the patient gets referred to cardio for work up, if they need interventional procedure, cardio takes a hack at them, if cardio F**k it up, CT / VS comes in to bail them out. The only one time I saw interventional cardio referred a procedure to CT was because the patient had severe structural disease....I would think that it's very difficult to take the TAVR/MC/MIS from cardio because those guys and gals get first dibs on the patient and if they're too sick, they're sending them to CT. So I imagine that you'll get patients but they're going to be train-wrecks...That's just my opinion as a lowly PGY-1.

What are common things vascular gets consulted for if something goes wrong with cardio, other than femoral pseudoaneurysms and oh ****, why won’t it stop bleeding?

Any other things y’all get consulted for that you did not expect prior to getting into residency?

 

[AsianPersuasion]

@Asian


What are common things vascular gets consulted for if something goes wrong with cardio, other than femoral pseudoaneurysms and oh ****, why won’t it stop bleeding?

Any other things y’all get consulted for that you did not expect prior to getting into residency?

I'm at a heavy aortic center, so we co-pilot with CT on those cases. I just started so I'm not doing any of those anytime soon. Right now I'm just trying to learn how to put colace in the new EMR.

 

[Jolie South]

@Asian


What are common things vascular gets consulted for if something goes wrong with cardio, other than femoral pseudoaneurysms and oh ****, why won’t it stop bleeding?

Any other things y’all get consulted for that you did not expect prior to getting into residency?

I have seen them rupture an aorta with the delivery system. When 3 vascular surgeons got called in to fix it and heckle the cardiologist, it was simply amazing. We were able to fix it with an endograft limb.

I have also seen them dissect the femoral artery and effectively perclose it shut. These last two circumstances required open cut downs.

 

[cards67]

I trained at a place that did 30+ tx/yr and high volume of tavr, etc. At our hospital, CTsurg was involved in all tavr cases but this may vary by hospital and of course cards controls the patients, so procedures/jobs may be iffy. Otherwise, most the cases are scheduled, rarely any complications nor exceptionally long days. I was interested in HF and spent a lot of time on HF service, of course the surgeons were always on call in case a heart came available but they rotated call. True this only happened 30+ times a year, but these guys also did lvads and other surgeries, which are more scheduled but have their potential emergencies and complications. They didn't do lung tx. Thing about transplants is that there's somewhat a lot going around it; big money, big surgery/risk, very public outcomes data, etc. and it can be a "dirty" business sometimes. I think you need a certain personality to deal with that. I'm curious what about tx you think is about to explode?

 

[Medstart108]

I trained at a place that did 30+ tx/yr and high volume of tavr, etc. At our hospital, CTsurg was involved in all tavr cases but this may vary by hospital and of course cards controls the patients, so procedures/jobs may be iffy. Otherwise, most the cases are scheduled, rarely any complications nor exceptionally long days. I was interested in HF and spent a lot of time on HF service, of course the surgeons were always on call in case a heart came available but they rotated call. True this only happened 30+ times a year, but these guys also did lvads and other surgeries, which are more scheduled but have their potential emergencies and complications. They didn't do lung tx. Thing about transplants is that there's somewhat a lot going around it; big money, big surgery/risk, very public outcomes data, etc. and it can be a "dirty" business sometimes. I think you need a certain personality to deal with that. I'm curious what about tx you think is about to explode?

I don't think tx is going to explode for sure, but i do hope that VADs will grow in the next 20 years or so. I think though overall the heart failure area is probably the one area that has potential growth, CABG, Valves, Aortic work is all going to remain the same or fall most likely from a CT perspective. Whereas heart failure is still an area where patients die of heart failure before getting a VAD currently mostly because VADs are complex and have many side effects/complications, but if these are reduced, there may be potential for their indications to expand and volumes to grow.

 

[cards67]

I agree with lvads, I have heard of some smaller hospitals interested in starting lvad programs. However, recently tx has spiked too, supposedly due to opioid deaths, lots of tx programs have increased their volume quite a bit the past few years. However, listing/waitlist criteria changes recently may damper that growth. Another interesting development may be the TAH as well.

 

[LebronManning]

I don't think tx is going to explode for sure, but i do hope that VADs will grow in the next 20 years or so. I think though overall the heart failure area is probably the one area that has potential growth, CABG, Valves, Aortic work is all going to remain the same or fall most likely from a CT perspective. Whereas heart failure is still an area where patients die of heart failure before getting a VAD currently mostly because VADs are complex and have many side effects/complications, but if these are reduced, there may be potential for their indications to expand and volumes to grow.

I agree with you in that VADs are going to be the next area for growth in cardiac care, but consider that these may in fact be percutaneous VADs similar to impella. I think that would be the logical push as everything is going minimally invasive. If this is the case, Interventional Cards will certainly dominate this as with most other things.