Letter to the Editor of Revista Portuguesa de Cirurgia Cardiotorácica e Vascular

Miguel Sousa Uva, Jean Philippe Verhoye

Notes of two cardiovascular surgeons at the ESCVS meeting, Strasbourg, France

Jean Philippe Verhoye, Vice President of the French Society of Cardiovascular and Thoracic Surgery, and myself, Immediate Past President of the European Association of Cardio-Thoracic Surgery (EACTS), just met April 13th, in Strasbourg, for the 67th International Congress of the European Association of Cardiovascular and Endovascular Surgery (ESCVS). Like Jean Philippe I was trained in France, a country where cardiac surgery was developed by vascular surgeons, whereas in Portugal, cardiac surgery was originally introduced by thoracic surgeons, whom, like Prof Manuel Machado Macedo, followed the Anglo-Saxon tradition. We thought that some of our reflections and exchange of views, during the meeting, could be interesting to the Portuguese surgical community.

The 67th anniversary of the ESCVS, created by René Leriche and João Cid dos Santos, is a great opportunity to renew the old partnership between vascular, cardiac and thoracic surgical communities.
The meeting was held in Strasbourg, the city where René Leriche established the most successful vascular surgery training program in Europe, having managed to attract trainees from all over the world, among whom Michael De Bakey, João Cid dos Santos, Charles Dubost and René Kieny We were impressed by this large gathering of vascular and cardiac surgeons, coming from a very wide number of different European, but also American and Asian countries. Sitting next to me, at the official diner, was Prof José Fernandes e Fernandes, past director of the Vascular Surgery Department of Santa Maria Hospital in Lisbon, the place where João Cid dos Santos developed the technique of arterial endarterectomy.

We had the opportunity to hear Dr Howard (Bob) Frazer, a pioneer in ventricular assist devices, remind us of his time as a resident of Dr De Bakey and Dr Cooley, in Houston. That made us think, once again, that cardiac, vascular and thoracic surgery are intimately related, and that it would be a loss for our trainees and finally for our patients if we parted away. In my everyday practice, I thank God for being trained by great surgeons, like Alain Carpentier, at Broussais Hospital and Claude Planché at Marie Lannelongue Hospital both pupils of Charles Dubost, in Paris. Jean Phillipe himself is Head of the Department of in Rennes and was a pupil of Philippe Dartevelle a pioneer in pulmonary thrombo-endarterectomy and Craig Miller an expert in the treatment of diseases of the aorta.

As History remind us we have a common surgical background. Acknowledging these roots and strengthening our bonds can only make us stronger in a flat world of increasing competition. Keeping a an open critical mind and a multidisciplinary approach mindset will help us face the challenges of information overload, technological developments and uncertainty in decision-making. Hyper specialisation is unavoidable. However, if patient centred care is the goal, it will require practice in teams of teams rather than the atomisation of sub specialties. Let me remind you that the ESCVS, like the Portuguese and the French Society, alternate their Presidents between vascular and cardiac or thoracic surgery.

No one would question that times are a changing, at great speed. However, patient-centred care, remains our ultimate goal. Cross fertilization of ideas and mutually beneficial collaboration, in multidisciplinary teams, are not a hype but a necessity. This Strasbourg meeting, and the discussion with Jean Philippe, was a fine occasion for us to think beyond frontiers, be them between specialties or between countries, and to stress the need for closer collaboration between the French and the Portuguese Societies.
From the Portuguese side, we could start by learning from the French experience in registries (EPICARD), for our own sake and for the benefit of our patients.