Translational research: from bedside to bench and to bedside again!
When research is the subject, you have certainly heard the words “translational research” or “from bench to bedside”.
What do these words mean?
Cardiac surgery and sports
The topic might seem a contradiction, how can it be possible to engage in intense sport with an operated heart? It is possible, but not for everyone and not in each case. The topic is complex and requires a differentiated approach. The major components of the equation are the following:
- Nature of the disease
- Functional condition of the heart
- Response of the heart and of the whole cardiovascular system to the operation
- Presence of any residual or other disease with particular relevance to intense sport
- Attitude of the patient and his/her family
- Sports history of the patient
Minimally invasive valve surgery: cannulation of the right axillary artery.
Taking teaching of (cardiac) surgery to another level
I very well remember my first experiences as a medical student in the operating room. I was ordered to stand in a corner with my back to the wall (just as the surgeon ordered), almost motionless because of the staff’s worry that I might touch and contaminate something sterile. I could only listen to the surgeon describing what he was doing. That was a humiliating experience and I was close to abandoning my goal of becoming a surgeon.
States of mind: #2 – Quality of care
Quality of medical and surgical care is a profoundly felt need of every patient, of every involved family. Although based on slightly different motivations, the same is requested by those who pay for the care. Therefore, the interest in defining and measuring the quality of provided care is high. This is, however, a highly complex endeavor. It requires in-depth knowledge, differentiation, multiple perspectives and expert judgment.
How can we define “quality of care”?
The Institute of Medicine (IOM) of the US National Academy of Sciences defines it as “the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
Time for a new training model in cardiac surgery
Traditionally, technical skills in surgery are taught by the “apprentice model”: trainee surgeons learn under supervision in the operating room, by performing portions of or complete real operations on real patients.
A bolt out of the blue: acute aortic dissection
This is one of the biggest emergencies in heart surgery, or, dare I say, of medicine in general. From a subjective wellbeing, a sudden sharp and excruciating pain in the chest makes the person reach out for medical help. As soon as the patient arrives to the ER, a diagnostic protocol for acute chest pain is carried out. Once acute myocardial infarction is ruled out, the patient must undergo a CT scan to either exclude or confirm acute aortic dissection.
Families
This post is a tribute to the families of our patients. To all families of all patients we care for. My thoughts especially go to the families whose relatives had a bad outcome, experienced a severe complication or who sadly did not survive surgery.
States of mind: #1 – less invasiveness (limited access cardiac surgery)
Cardiac surgery underwent a huge change since its beginnings. From an adventurous, dangerous but lifesaving endeavour carried out by real Mavericks to a surgery, which is perceived almost as routine and expected to be safe, with good and predictable results. While this latter is true (in the vast majority of cases), the change doesn’t end here: meanwhile, cardiac surgery is perceived as almost too invasive, mainly due to its standard surgical access, the median sternotomy (i.e. the longitudinal split of the long breast bone). The major invasiveness of the access to the heart is against the contemporary trend of minimal access to the internal organs, if possible through a catheter inserted in a peripheral vessel.
The new role
The foundation board of the Cardiocentro Ticino recently appointed me as the new head of the cardiac surgery department. The first day in my new position is 1st February 2015.
In this new role all individual professional qualities, such as technical skills, clinical judgment and decision-making, are considered as granted. The new challenge is leadership.