Invited Commentary

Abstract

The article by Ikonomidis and colleagues [1Ikonomidis J.S. Ad N. Aldea G.S. et al.Vascular operations performed by cardiothoracic surgeons: The Society of Thoracic Surgeons survey.Ann Thorac Surg. 2016; 102: 589-592Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar] is a contemporary snapshot of thoracic surgeons performing peripheral vascular surgery and their perceived need for vascular surgery to be part of the formal cardiothoracic surgery training. This is an important and timely survey as our specialty continues to adapt and evolve to the growing number of minimally invasive approaches, catheter-based therapies, and endovascular procedures for cardiovascular diseases. In addition, the roots of cardiothoracic and vascular surgery have largely been intertwined. Historically, because of pioneering cardiovascular surgeons such as Drs DeBakey, Cooley, Crawford, and Spencer, who were major contributors to peripheral vascular surgery, vascular operations were commonly taught in thoracic training programs well into the late 1980s. Importantly, the American Board of Thoracic Surgery decided in the late 1970s not to examine candidates in vascular surgery primarily because of the growth of coronary bypass procedures. In 1982, a Certificate for Special Competence in Vascular Surgery was administered by the American Board of Surgery (ABS) to thoracic surgeons performing vascular surgery. In 1986, the vascular certificate was replaced with an ABS written and oral exam. Thoracic surgeons with at least150 peripheral cases per year were able to sit for the exam. By 1998, board certification was limited to residents formally finishing vascular surgery training programs. Thereafter, thoracic surgeons performing vascular surgery declined. Although this survey is limited by the number of respondents, 395 of 5,271 members responding (7.5%), and may have a bias toward those who practice vascular surgery, it does provide the best assessment of our member’s current involvement in vascular surgery. The survey found that 44% of thoracic surgeons are taking routine vascular call and performing a wide breadth of vascular procedures, both open and endovascular, including thoracoabdominal aneurysms, abdominal aneurysms, aortoiliac disease, peripheral vascular disease, dialysis access, and vascular trauma. Interestingly, only 11% of respondents are board certified in vascular surgery, but 43% would like to have vascular surgery boards. In addition, 81% of respondents would like to see vascular surgery as a part of the formal cardiothoracic curriculum and 90% believe that a cardiovascular track should be offered as a part of the cardiothoracic surgery education. To answer this growing need for vascular training within our specialty, the Allegheny General program has an integrated curriculum with our 0-5 vascular residency and with our thoracic surgery residency program, providing 6 months of cardiac surgery in the fourth year. Residents are also encouraged to finish the 2-year thoracic surgery residency 0-5-2. With dual certification in both vascular surgery and cardiothoracic surgery, residents have both a strong open and endovascular skill set. Thought leaders in both fields should study the Allegheny model. [2Magovern G. Simpson K. Curriculum innovation: the key to recruiting the best and brightest.J Thorac Cardiovasc Surg. 2011; 141: 1114-1115Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] Because the 2 fields are highly differentiated, it is unrealistic to consider a fully integrated 7-year curriculum. Efforts to integrate both fields make sense to primary care physicians, the general public, and to hospital-based cardiovascular institutes, all of whom are looking for multidisciplinary teams to augment quality, safety, and value. Vascular Operations Performed by Cardiothoracic Surgeons: The Society of Thoracic Surgeons SurveyThe Annals of Thoracic SurgeryVol. 102Issue 2PreviewMany cardiothoracic surgeons supplement their case volume through the performance of vascular surgical procedures. Information regarding this practice is not well defined. Full-Text PDF