Technology doesn't hold a monopoly on innovation. Innovation can arise in the form of new processes or even in new ways of thinking. Our cover story focuses on complex coronary disease and two options for treating left main disease and multivessel disease. Technological and procedural advances in CABG and PCI have led to treatment options that didn't exist a decade ago.
Drug-eluting stents. Off-pump surgery. Intravascular ultrasound. Fractional flow reserve. These technologies and techniques have moved cardiac care forward by improving diagnostic capabilities and patient outcomes.
They also may have helped pave the way for another innovation, another change in delivering care for complex coronary disease and, in the future, possibly for other conditions: that is, the heart team approach. Michael J. Mack, MD, medical director of cardiovascular surgery at Baylor Health Care System in Dallas, explains that cardiac surgeons and interventional cardiologists working in teams can offer more nuanced care for patients whose disease is far from straightforward. The discussions are not contentious, he says, but rather a collaborative review of options and strategies.
The SYNTAX trial, which compared PCI with CABG and gave credence to the heart team approach, influenced the design of the PARTNER trial. One legacy of SYNTAX may be the development of the heart team approach while PARTNER may get credit for its clinical implementation, Mack says.
This shift from staying in specialty siloes to working in multidisciplinary teams has the potential to open up new avenues of care in cardiology and beyond. It will be interesting to see if and how this collaborative model influences hospital culture in general. Will we eventually see kidney teams or neurology teams, or even, for instance, kidney-heart teams?
Innovation is contagious. Has the heart team idea changed how you go about your work? Are there other innovations percolating in your office, cath lab, operating room, board room or elsewhere? If so, please send me a note.