Two of The Baird Institute’s Cardiac Surgeons,
Prof Paul Bannon and Prof Michael Wilson, issue a warning over government policy on the ABC’s 7.30 Report.

The warning relates to government policy on a revolutionary keyhole heart surgery procedure called TAVI (Transcatheter Aortic Valve Implant) where the aortic valve is replaced without the need for open-heart surgery.  A surgeon inserts a new aortic valve into an artery with a very small wire, usually through the groin. The wire is then carefully manoeuvred up to the heart and inside the existing valve.

The government’s policy mandates that for this type of valve implant surgery, there is only the need for just one principal operator at the table, despite repeated warnings by both the Cardiology Society and the Surgical Society that this could result in dire consequences for the patients undergoing this procedure, even death!  The surgeons and cardiologists’ recommendation is for there be two operators – a cardiac surgeon and a cardiologist – working side by side and they would like the government to make this mandatory.

In the Unites States of America, the government has listened to the advice of the professional societies as well as the surgeons and cardiologists performing the procedure, that both a cardiologist and a surgeon – the “Heart Team” – be involved in operations involving the technique of Transcatheter Aortic Valve Implants.  In order to ensure that this happens, the government has made this a condition of payment.  Professor Michael Mack from the Bayler Heart Hospital in Texas who is a pioneer of the TAVI technique, said that he really believes that the government in the United States have got it right this time.

The surgeons explain that cost is not the issue as they are prepared to split the fee with the cardiologists so this will not cost the government any more than a single operator model.  Professor Bannon says that once the government rolls this out in November of 2017, they “would be morally and ethically bound not to allow the patients through to a single operator model”,

 

Experience has told us that we need to have cardiac surgeons and cardiologists at every step of the way;  at the decision making step, all the way through to the care of the patient and at the operating table.  You need both skill sets there from beginning to end.

Prof Paul Bannon

If something goes bad with the heart and the heart stops beating, you’ve got about five minutes until you have irreparable brain damage … so you don’t have a lot of time to muck around and find a solution and get somebody into the room [to assist, therefore] we both need to be here and work collaboratively.

Prof Michael Wilson

KEY POINTS

 

  • Government advisory committee recommends single principal operator for procedure
  • Surgeons say two principal operators are needed — a surgeon and a cardiologist
  • Surgeons warn they may boycott the procedure if two principal operators are not used