INTRODUCTION

New and effective minimally-invasive treatments for coronary artery and structural heart disease are emerging at an accelerating rate. Cardiac surgery, traditionally the gold standard treatment for most of these conditions, is no longer the immediate choice for discerning patients, attending physicians and healthcare funders. These factors when combined with pace of technological advances mean that cardiac surgery is undergoing a period of change. In this article, we consider how the transition from historical generalist–cardiologist–cardiac surgeon patients flows to more integrated patient specific care. Specifically, we will discuss how effective transition will require awareness of the drivers for change, models of best practice from other specialties and the potential benefits that this may have for patients, doctors and providers.

To illustrate contemporary practice, we present a typical day in 2015 for our cardiac surgery teams: ‘We started out the day at the 06:30 with our weekly multidisciplinary heart failure/ventricular assist/transplant meeting to review the current inpatient and outpatient consults, the postoperative left ventricular assist patients and the current cardiac transplant waiting list. Present at the meeting were heart failure cardiologists, transplant/VAD surgeons, anaesthesiologists, mid-level and allied health providers. We adjourned to the operating room where a 23 y/o woman with Shone's syndrome who had undergone two previous operations on her mitral valve as a child complicated by endocarditis was undergoing closure of a recurrent para-valvular leak by inserting a vascular plug in the left atrium under direct vision, augmented with a prosthetic patch, by an interventional and surgical team. This treatment plan was formulated in our multidisciplinary adult congenital team meeting and clinic a few weeks previously. Meanwhile, in the hybrid operating room, an 83 y/o with aortic valve stenosis was undergoing a transapical transcatheter aortic valve implantation by a team led by a cardiac surgeon and interventional cardiologist. This patient …