Cardiac Surgery Is an Essential

Cardiac Surgery is an essential treatment for many that is often thought of as a last resort to treat heart diseases and acute cardiac medical events. Non-surgical interventions are the preferred methods of treatment in most cases and yet cardiac surgery is an essential and necessary specialized branch of medicine that has made significant scientific strides toward efficacy and care. Cardiac surgery is in fact more highly specialized and more effective than many other surgical specialties as it has been given monumental emphasis, as heart disease is the most common cause of death among most adult populations. In the United States significant research emphasis has been placed on cardiac surgery and non-surgical cardiac treatment and for this reason there are many more alternatives for those suffering from acute cardiac event and chronic heart disease than ever before. In short there is no better time in human history to have heart disease and acute cardiac events and live to tell about it. The strong emphasis on cardiac health has created a system which supports thousands of highly qualified and well trained physicians and surgeons who are highly versed in the most up-to-date specialized treatments for all the varied cardiac events and conditions.

One recognized center for cardiac surgery is Massachusetts General Hospital in Boston. The hospital has a highly recognized Thoracic Aortic Center, which collaboratively supports all aspects of cardiac treatment. The center is comprised of specialists in Cardiology, Cardiac Surgery, Vascular and Endovascular Surgery and Vascular Radiology, runs and is accessible 24 hours a day, allowing community referring physicians as well as patient access to treatment and information on a continuous basis, with a strong emphasis on long-term follow up care and outcomes. (MGH, TAC Website)

The hospital boasts a team of highly skilled cardiac surgeons who retain investment in research and development as well as a strong emphasis on better short- and long-term patient outcomes. The senior cardiac surgical department is populated by nine highly skilled surgeons led by Dr. Arvind K. Agnihotri a consummate surgeon and researcher. Dr. Agnihotri graduated from Tulane University, with a BSE in engeneering and then followed that up with an MD from the Tulane University School of Medicine. Agnihotri began his general surgery residency at University of Alabama at Birmingham Medical Center in 1997 and then went on to two significant specialty fellowships in cardiology at Massachusetts General in 1999 and Boston Children's Hospital also in cardiovascular surgery, the same year. Agnihotri is board certified in both general surgery and thoracic surgery with clinical interests in Coronary Artery Bypass, Valve Replacement and Repair, Diseases of the Thoracic Aorta, Minimally Invasive Heart Surgery and Heart Transplantation. Agnihotri also note research interests and published works on Outcomes Research, Database Development, Device Development, Advancement of Surgical Techniques and Quality Improvement. ("Arvind K. Agnihotri, M.D." MGH, TAC Website)

Agnihotri's broad clinical and research interest as well as his skill as a cardiac surgeon have clearly influenced the hospital, the Thoracic Aortic Center, specifically with the collaborative nature of the cardiac treatment departments and the major emphasis on long and short-term outcomes and likely influenced the decision to choose Agnihotri as the head of the cardiac surgery department. His research is demonstrative of his interests and is supported by a multitude of recent published works that cover the full breadth of cardiac surgery and treatment. Three examples of Agnihotri's recent published works cover the gambit of cardiac surgical intervention, with a clear and precise emphasis on patient outcomes, as Agnihotri, his research colleagues and others he works with have made the significant inference that without positive outcomes any surgical treatment has little validity and predicting such outcomes as well as possible complications may be the key to long-term success for the patient. The three collaborative articles chosen for review in this work are as follows: Changes in Mitral Regurgitation After Replacement of the Stenotic Aortic Valve, Impact of Cardiac Intraoperative Precursor Events on Adverse Outcomes, and Surgical Management of Infective Endocarditis: Early Predictors of Short-Term Morbidity and Mortality.

The first article, Changes in Mitral Regurgitation After Replacement of the Stenotic Aortic Valve (2008) stresses a relatively large patient study of those undergoing Aortic valve replacement and then possibly experiencing mitral regurgitation (MR), a common and sometimes concerning complication that as the study shows can occur without any known mitral defect. The study is significant in that it establishes the fact that MR is not as dangerous as once thought and can be resolved without further surgical intervention in many patients, where as in the past further surgical intervention was the most likely outcome. The study also indicated certain precursors or markers that allows the initial surgical screening of patients who would benefit from mitral surgery, prior to mitral failure and could therefore receive the procedure during the initial surgical intervention, rather than as a separate surgical event. It is clear that the common sense of this study is that one rather than two surgical events will elicit better patient outcomes.

The second article, Impact of Cardiac Intraoperative Precursor Events on Adverse Outcomes, demonstrates a desire to follow procedural accountability in patient outcomes. The intent of the article is to stress that not enough research has been done on process related events and the adverse outcomes to patients, though much emphasis has been given to patient related precursors to surgical outcomes. The collective assertion is that some intraoperative events are more dangerous than others and can significantly change morbidity outcomes to attempt to intervene effectively to avoid or reverse such events. This blind assessment of accountability issues regarding surgical procedure is essential to a better understanding of prevention, across the whole surgical staff as well as with regard to equipment and other aspects of care.

Finally the third research article, Surgical Management of Infective Endocarditis: Early Predictors of Short-Term Morbidity and Mortality demonstrates the need to further define and describe a high risk group of surgical patients. Patients with endocarditis require surgical intervention 20% of the time and the collaborative team of researchers want to know the predictive quality of the endocarditis variations to more quickly intervene and potentially avoid morbidity of patients. "Preoperative ECG findings of left bundle branch block and reduced left ventricular function may allow for early risk stratification of this high risk population." Again the work stresses outcomes as the essential marker to success and/or failure in cardiac surgery but also stresses predictability for adverse effects of disease. All of which indicates to this reviewer that the work done by Agnihotri, and his colleagues is essential to understandings of surgical interventions and a high level of patient efficacy, which gives this researcher rest in the idea of sending even my dearest family member to this surgeon if it were needed.