National Consolidation of Heart Programs: A New Paradigm?

With the announcement of Cleveland Clinic offering cardiothoracic surgery services to Charlotte, North Carolina after their collaboration with Central Dupage Hospital in Illinois, a new cardiovascular surgery paradigm is taking shape:

The Novant-Cleveland Clinic affiliation is not the first such collaboration for a Charlotte-area hospital. In 2010, CaroMont Health, which operates Gaston Memorial Hospital, announced a partnership with Columbia HeartSource, part of New York Presbyterian Hospital/Columbia University Medical Center. CaroMont doctors visit the N.Y. hospital, and N.Y. doctors have scrubbed in on surgeries at Gaston Memorial. Doctors confer about patient cases weekly, and CaroMont offers procedures that weren't available before.

"This is really a new paradigm in medicine," said Dr. Paul Kurlansky, a cardiac surgeon with Columbia HeartSource. It's a way for top-tier academic medical programs to share what they know with community hospitals and begin to reduce disparities in medical care across the U.S., Kurlansky said. "You will start seeing this increasingly throughout the country."

This is all about the race to tertiary care access which is increasingly being restricted. The hospital system that offers continued access to advanced therapies will hold a competetive (not to mention) financial advantage.

-Wes

Clevand Clinic In Chicago?

All I can say is, best of luck:

In a move likely to shake up the market for heart care in the Chicago area, the well-known Cleveland Clinic’s cardiac surgery program said Thursday that it has signed an affiliation agreement with Central DuPage Hospital in the western Chicago suburbs.

The internationally known Cleveland Clinic draws patients from more than 85 countries around the world for everything from open-heart surgery and valve replacement to heart transplants. Its deal with Central DuPage, in Winfield, is designed to enhance the heart care provided at the 313-bed community hospital and potentially bring Cleveland Clinic patient referrals at a time heart surgeries are less needed than they were a decade ago.

This won't shake up the market in Chicago. After all, when you have a bunch of Cadillac's in garage, why go after a Ford?

Unless, of course, it costs a whole lot less to buy a Ford.

-Wes

Wide Awake Open Heart Surgery

Click image to enlarge

Why someone would want to do this, I haven't a clue.

Swaroup Anand, 23, from Bangalore, is fully conscious as he undergoes open-heart surgery. An epidural to the neck, administered at the city’s Wockhardt Hospital, has numbed his body. Dr Vivek Jawali pioneered the technique ten years ago and has recently released a tutorial on DVD which gives a step-by-step guide to the procedure – sorry, but you can only get a copy if you’re a surgeon or an anaesthetist.

Seems there would be considerable risk of respiratory compromise is the epidural went too high. But according to this video, over 400 cases have been performed, including a bypass with aortic valve replacement!

I don't know... I'm not sure I could stomach the sound of the bone saw or, worse, if the surgeon said "Oh, crap..."

-Wes

h/t: Slashdot

Reference:
Chakravarthy MR, Jawali V, Patil TA, Srinivasan KN, Manohar M, Khan J, Jayaprakash K, Das JK, Mahajan V. "High thoracic epidural anaesthesia as the sole anaesthetic technique for minimally invasive direct coronary artery bypass in a high-risk patient." Ann Card Anaesth. 2003 Jan;6(1):62-4.

Robin Williams Discusses his Aortic Valve Replacement

He's an exerpt from a candid video where Robin Williams discusses his rationale for choosing the type of valve replacement he received:

"... here are your choices:

• pig valve, which is great, you can find truffles,
• mechanical valve, which clicks and you know, weird, (eds note: that also requires chronic anticoagulation)
• and bovine - great, 'I'll go bovine, Bob, for 20!'"

The video provides a very real (and, yes, humorous) glimpse into the emotional and physical impact of aortic valve surgery as only Robin Williams can portray.

-Wes

You Get What You Don't Pay For

Like fewer cardiothoracic surgeons:

"The reasons for this declining interest appear to be multiple," according to the investigators. For one thing, they note, the number of coronary artery bypass graft operations, in which surgeons reroute blood flow around block arteries that supply the heart, and which account for a large part of the surgeons' income, fell by 28 percent between 1997 and 2004. Many of these operations were replaced by stents -- mesh tubes that prop blocked arteries open -- inserted by cardiologists, not heart surgeons.

Furthermore, Medicare reimbursements for bypass surgery have fallen by 38 percent. Finally, newly trained cardiothoracic surgeons have had trouble finding jobs.

For the supply of cardiothoracic surgeons to be adequate in the coming decade would require elimination of coronary artery bypass operations, and numbers of young surgeons entering the field must be as high as in the 1990s. Since these are both highly unlikely, the researchers continue, the number of surgeons entering training in cardiothoracic surgery will probably be "inadequate to care for the US population in the coming decades."

But then, this is what proponents of cutting specialists' income want: fewer costly specialists, all in the name of "cost savings."

-Wes

Reference: "Shortage of Cardiothoracic Surgeons Is Likely by 2020" Circulation Published online before print July 27, 2009, doi: 10.1161/CIRCULATIONAHA.108.776278.