Zembala, Marian

Via Medica Journals

www.kardiologiapolska.plNasze forum — kardiolodzy i kardiochirurdzy razem/Cardiac surgery and cardiology Kardiologia Polska2011; 69, 6: 636–638ISSN 0022–9032Presidential letter: From Turin (1951) toMoscow (2011). The past, present and futureof cardiovascular surgery — reflections atthe time of the Diamond Jubilee of the ESCVSLADIES AND GENTLEMEN,COLLEAGUES AND FRIENDS,The European Society for Cardiovascular Surgery (ESCVS) isthe oldest European society devoted to cardiac, vascular andendovascular surgery. The beginnings of the ESCVS go backto 1950 when Rene Leriche, a famous French surgeon, au-thor of 15 monographs and more than 1.400 publications,together with J.C. Dos Santos, E. Malan and G. Arnuf, met inParis and decided to hold a meeting in Turin, Italy on 31 May,1951 where the ESCVS was founded (Fig. 1). The first con-gress of the ESCVS was held in Strasbourg in October 1952.Much earlier, in 1917, the American Association for Tho-racic Surgery had been created in the USA, followed in 1947by the American Society for Vascular Surgery.Interestingly, in 1959, the older organisation, the AATS,reacting to the dynamic development of cardiovascular surgeryand medicine, noted the urgent need for a change and transfor-mation of the Journal of Thoracic and Cardiovascular Surgery.In Europe, thanks to the imagination of outstanding pe-ople such as Professors J.C. Schoevaerdts, M. Turina and L.K.von Segesser, besides the European Journal of CardiothoracicSurgery, a new journal was created on the occasion of the52nd Congress in Istanbul: the Interactive CardioVascular andThoracic Surgery (ICVTS). This official journal of the ESCVS isa very dynamic publication, focused on practical and instruc-tional aspects, and is appreciated by residents as a living jour-nal representing contemporary European thought on the en-tirety of cardiovascular and thoracic surgery (Fig. 2).A good example of the search for integration-orientedactions is the very young publication of the ISMICS  “Innova-tions”, which is devoted to technology and techniques in car-diothoracic and vascular surgery. We should not only prese-rve but in fact strengthen the co-operation between cardio-vascular and thoracic surgery instead of looking for new pre-texts for separation.I have no intention of entering into the artificial, com-petence disputes concerning the CARDIOVASCULAR spe-ciality — together or separately? This leads to dangerouslyexcessive formalisation instead of a joint search for solutionsto problems. I shall not hypothesise which speciality willdevelop faster, which specialities will join and which com-ponent of the ‘cardiovascular’ will in future be the moreimportant. It is my heartfelt belief that at the core of ourFigure 1. ESCVS — the genesis. R. Leriche, J.C. Dos Santos,E. Malan and G. Arnuf met in Paris and decided to hold a meetingin Turin, Italy on 31 May, 1951, where the ESCVS was foundedFigure 2. The Journal of Thoracic and Cardiovascular Surgery —its wide range of topics, and its high scientific and clinical levelhave made it a role model for interactive cardiovascular andthoracic surgery and European cardiac, vascular and endovascu-lar surgeonswww.kardiologiapolska.pl637Presidential letter: From Turin to Moscow. The past, present and future of cardiovascular surgeryinterests should always be the patient, who very often requ-ires our combined specialist care: effective, safe and free ofcomplications.Thus we are dealing with the here-and-now of our spe-ciality. From this perspective, the role of ESCVS is to createa platform for task co-operation between specialists of diffe-rent fields, in particular between cardiac surgeons and vascu-lar surgeons, for effective problem solving.Examples from everyday practice:In 1998, our centre was visited by a distinguished vascu-lar surgeon, Professor Karl Lauterjung from Munich. Duringa conference with Polish cardiac and vascular surgeons, hepredicted that classic vascular surgery would drastically redu-ce in the face of advances in endovascular techniques. Hisopinion did not find many followers, and in fact gave rise toa very heated discussion. When during instructional work-shops, Prof. K. Lauterjung successfully inserted two home-and hand-made stentgrafts, the distrust diminished only sli-ghtly, still leaving space for doubts as to his mid and long--term prediction.Today, the Report of the German Society for Thoracicand Cardiovascular Surgery, shows that the number of stent-grafts placed with the use of CPB was 26, with a 7.7% morta-lity rate and 330 patients without CPB, with a mortality rateof 5.2%. Moreover, 331 endostents were positioned in abdo-minal aorta aneurysms.In Poland, the number of stentgrafts inserted into the tho-racic aorta in 2009 was 160. It is no secret that joint sessions ofcardiac and vascular surgeons, radiologists and cardiologists havethe greatest attendance and are considered the most attractiveby the participants — doctors of various specialities.Most importantly, however, with our experience, imagi-nation and a sense of joint responsibility, we have managedto overcome barriers and limitations.With regard to the most difficult patients with aortic ste-nosis, i.e. the elderly, with past and concomitant diseases, on16 April, 2002, Alain Cribier, a French cardiologist from Ro-uen, for the first time in history performed a transcatheteraortic valve implantation. Since then, several thousand suchoperations have been carried out across the world, continu-ously improving the equipment used, and despite the factthat the method is in the process of developing, the very goodresults obtained render its use reliable even in the most diffi-cult patients.The TAVI and PAVTI programmes made it particularlyclear that co-operation between invasive cardiologists, vascularcardiologists and radiologists is essential for successful andeffective treatment. The concept of task medicine, compo-sed of a team of experts in different specialities, has not onlybeen a medical success but also an economic and organisa-tional success, as shown by the swift transformation and re-organisation of wards, not only in renowned centres such asthe Cleveland Clinic or Leipzig, but in dozens of others, inc-luding my own centre in Zabrze.According to the Register of the German Society for Tho-racic and Cardiovascular Surgery, in 2008 as many as 934 pa-tients underwent procedures using the TAVI method, witha mortality rate of 8.5% within the in-hospital period. Frommy own Polish experience, I would like to emphasise thatwith the assistance of excellent mentors, within the 16 monthsof the TAVI programme we have succeeded in taking it up to28 procedures, with a low 6% mortality within the in-hospi-tal period. But very importantly, we have done so while nur-turing partnership and active participation between cardiacsurgeons and vascular surgeons in procedures involving trans-apical and transaxillary approaches.At the same time, we have succeeded in preserving a basiclevel of reimbursement for the purchase of TAVI equipmentwithout impoverishing the funds assigned for cardiac surgeryand vascular surgery.The role of cardiac and vascular surgeons who activelyparticipate in the PAVTI programme (percutaneous treatmentof pulmonary valve disease) started in 1992 by Pavcnika andAndersen, is similar. From the Warsaw and Zabrze experien-ces, obtaining such a low level of complications in patientsafter corrections of multiple congenital diseases and who hadundergone three or four previous procedures would be verydifficult without these new possibilities.Thoracoabdominal aortic aneurysms still remain an areaof combined cardiovascular actions, and it is Prof. E. Kieffer’smotto that only in this way can the best choice of treatmentstrategy and its effects be assured.Regardless of the field of our everyday activity, I believethat the objective of the ESCVS is to stimulate actions thatwould integrate our specialities towards specific tasks and thepatients’ needs.The objectives of the ESCVS for the next two years:In the scientific regard:1. To enliven the scientific formula of the annual Congressthrough a further increase in integrated sessions and de-bates, joint focus-type sessions, not only with cardiac andvascular surgeons but also with anaesthetists, cardiologi-sts, radiologists, transplantologists and angiologists.2. To ensure the growing scientific and instructional impor-tance of the Interactive CardioVascular and Thoracic Sur-gery journal as the official publication of our society.3. To ensure a high quality programme for future congressesthat will satisfy the expectations of both residents and con-sultants through introducing the Congress Scientific Com-mittee, together with Committee Chair and Co-Chair.4. To recognise that the ageing population is an importantchallenge to contemporary cardiovascular medicine, andto support research devoted to this challenging group ofpatients.638www.kardiologiapolska.plMarian Zembala5. To promote basic and clinical research and its value incardiovascular medicine through strengthening its pre-sence at congresses.In the instructional regard:1. To participate in the European Board of Thoracic andCardiovascular Surgeons (EBTCS), together with EACTS,ESTS and other societies, in actions integrating the car-diovascular and thoracic environments in the develop-ment of resident training programmes, also with regardto catheter-based techniques of intervention, moderndiagnostic imaging and in the preparation of guidelines,registers and randomised clinical research.2. To co-operate in the development of modern cardiova-scular medicine in countries where the activity of the car-diovascular speciality remains too low, as witnessed bothby the number of procedures and the quality of treat-ment results.3. To participate in the informative-instructive CTSNet plat-form to the extent required by the organisers and theenvironment.In the organisational regard:1. To manage jointly, together with the Secretary Generaland the Treasurer, the activities of the ESCVS Board, withthe goal of opening the Society to new and original ini-tiatives, but at the same time guarding the ESCVS statuteand obtaining new funds facilitating its further develop-ment.2. To nurture actions conducive to integration, especiallywith the EACTS, with regard to jointly undertaken statu-te tasks.From this double perspective, historical and contempo-rary, and with a doubled strength, today we are re-discove-ring the value and effectiveness of the joint specialities ofour CARDIOVASCULAR TEAM. It is thanks to the team thatour actions are safer and far more effective, especially in themost challenging patients: the elderly, often aged over 80,with a long history of diseases. Today, in an era of minimal-ly invasive techniques and endovascular procedures suchas TAVI and PAVTI, there is no doubt as to how importantthe CARDIOVASCULAR TEAM is in everyday work with pa-tients and as to why we, people responsible for the ESCVSand its future, must restore unity by co-operating and oppo-sing corporate and separatist behaviour and attitudes. Fortu-nately, in pursuing these goals, we are supported by contem-porary European guidelines emphasising the safety and effec-tiveness of the treatment, not only in the medical or financialaspects, but also through evidence-based medicine, rando-mised trials and non-commercial international registers.The experience of the last 60 years of the ESCVS showsus the importance of training young residents. It is vital for thecorrect development of our specialities and the preparationof future experts in our field. It is especially important now,because in many European countries and the USA, the inte-rest of residents in our specialities has dropped dramatically.This is mostly due to the demanding nature of the specialityitself, and the excessive hierarchy still present.Let the historical experience of the creation of the ESCVSby J.C. Dos Santos, R. Leriche and cardiac surgeons: E. Derra,C. Crafoord, F. Martorell, A.M. Dogliotti and R. Fontaine, oneof the founders of EACTS, be the best lesson and message forthe future for all of us gathered in Moscow on 19–22 May2011, during the Diamond Jubilee Congress of Cardiovascu-lar and Endovascular Surgery (Fig. 3). Those names have pas-sed into the history of medicine and of our specialities be-cause they were reformers and visionaries who deserved tobecome role models in searching for brave solutions.Prof. Marian Zembala, MD, PhD, FESCPresident, ESCVS 2010–2012Moscow, 20 May 2011Figure 3. Leaders of the European Society for Cardiovascularand Endovascular Surgery and European Association for Cardio-Thoracic Surgery at the Diamond Jubilee ESCVS Congress inMoscow, 20–22 May, 2011. Standing from left: S. Schueler(Past President, ESCVS), L. Davidovic (ESCVS Vascular Councillor,Chairman of the Scientific Programme Committee), M. Zembala(President, ESCVS), D. Palombo (President Elect, ESCVS),C. Muneretto (Secretary General, ESCVS), M. Laskar (ESCVSCardiac Advisor), M. Souza Uva (ESCVS Cardiac Advisor),J.L. Pomar (EACTS Domain Chair), J.C. Schoevaerdts (Past Presidentand Honorary Member, ESCVS), F. Vermeulen (Past Presidentand Honorary Member, ESCVS), D. Taggart (President of theBritish Cardio-Thoracic Society and Chairman of the ESCWorking Group on Cardiovascular Surgery), A. Diegeler (PastPresident, ISMICS), M. Thielmann (Associate Secretary General,ESCVS), and T. Folliguet (ESCVS Cardiac Councillor, Chairman ofthe Scientific Programme Committee)

Presidential letter: From Turin (1951) to Moscow (2011). The past, present and future of cardiovascular surgery &#8212; reflections at the time of the Diamond Jubilee of the ESCVS

https://journals.viamedica.pl/kardiologia_polska/article/download/79302/61313

Presidential letter: From Turin (1951) to Moscow (2011). The past, present and future of cardiovascular surgery — reflections at the time of the Diamond Jubilee of the ESCVS

Abstract

Similar works

Full text

Available Versions

Via Medica Journals

Presidential letter: From Turin (1951) to Moscow (2011). The past, present and future of cardiovascular surgery &#8212; reflections at the time of the Diamond Jubilee of the ESCVS

Abstract

Similar works

Full text

Available Versions

Via Medica Journals

Presidential letter: From Turin (1951) to Moscow (2011). The past, present and future of cardiovascular surgery — reflections at the time of the Diamond Jubilee of the ESCVS