Myocardial surgical revascularization as a subspecialty: to be or not to be, that is the question

Abstract

Over the last few decades, a trend for increased specialization has been observed in all surgical domains. This has been driven by the advancement of medical knowledge and technology and by the realization of a clear association between higher volume of cases and better surgical outcomes. The field of cardiothoracic surgery has followed the same trend, but the most commonly performed operation, coronary artery bypass grafting, is still considered a generalist procedure and does not benefit from recognition as a formal subspecialty. There is robust evidence to support that a positive effect on outcomes can be achieved by both increased volume and better quality of surgical techniques and perioperative protocols. We hypothesize that a structured specialized coronary revascularization program can be initiated in every institution through a strong leadership focused on effective mentorship and training that will achieve the benchmark of less than 1% operative mortality following coronary revascularization. This review article makes a case for recognition of myocardial surgical revascularization as a subspecialty and proposes a strategy to overcome the barriers that preclude such a recognition.

Keywords

Benchmark / coronary artery bypass grafting / generalist procedure / subspecialization / volume-outcome relationship

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