T. Schilling

[Disappearing borders between cardiology and cardiothoracic surgery: status quo].

Cardiology and cardiothoracic surgery are closely related so that collaboration and communication are required to offer optimal therapy for patients. During the last decades many innovations have reduced the borders between cardiology and cardiothoracic surgery. Today, cardiologists may perform coronary interventions with good results that would have previously been the domain of coronary bypass surgery. In addition new valvular interventions have been developed, such as transfemoral or transapical aortic valve implantation and endovascular mitral valve reconstruction. New developments in cardiothoracic surgery have led to less invasive procedures and many surgical procedures can now be performed with minimally invasive techniques and without a cardiopulmonary bypass. To enable optimal therapy for patients, closer collaboration between cardiologists and cardiothoracic surgeons is required setting the stage for individualized therapy in the future.

Im Spannungsfeld der Interdisziplinarität

ZusammenfassungDie aktuelle Orientierung hin zu interdisziplinären Strukturen in Klinik, Forschung und Lehre birgt neben offensichtlichen Vorteilen auch zahlreiche Risiken, die es zu berücksichtigen gilt, um mit oder trotz interdisziplinärer Arbeitsweise nachhaltig erfolgreich zu sein. Interdisziplinarität führt zu einem hohen Spezialisierungsgrad der Leistungserbringer. Dies geht mit einer höheren Erfahrung der einzelnen Spezialisten und einem Erfahrungsverlust bei denen einher, die die speziellen Leistungen nicht mehr erbringen. Nicht zuletzt durch die hohe Spezialisierung unterliegt auch das Berufsbild des Chirurgen einem Wandel weg vom Generalisten, hin zum Spezialisten. Die Lehre und Weiterbildung muss dieser Realität angepasst werden. Es bleibt offen, ob hier auch ein Grund für rückläufige Bewerberzahlen in der Chirurgie gefunden werden kann. Schließlich kann den Risiken aus dem Spannungsfeld der Interdisziplinarität mit einfachen Prinzipien partnerschaftlicher Zusammenarbeit erfolgreich begegnet werden.AbstractThe benefits of interdisciplinary approaches in patient care, research and education are quite obvious and set the trend for more interdisciplinary structures. In order to achieve sustained success, however, there are numerous risks of interdisciplinary collaboration that have to be considered. Interdisciplinarity leads to an increasing degree of specialization and consequently to a greater experience of specialists in highly specific procedures. Nevertheless, this is accompanied by a loss of experience of those who do not perform these procedures anymore. Not least, due to the high specialization, the surgeon’s profession is changing from generalist to specialist. Hence, the education of young physicians, students and researchers has to be adapted to this reality. It remains unanswered if these changes contribute to the decline in the number of applicants in surgery. In conclusion, the risks of the contradictory contexts of interdisciplinarity can be counteracted with simple principles of fair and cooperative partnership.The benefits of interdisciplinary approaches in patient care, research and education are quite obvious and set the trend for more interdisciplinary structures. In order to achieve sustained success, however, there are numerous risks of interdisciplinary collaboration that have to be considered. Interdisciplinarity leads to an increasing degree of specialization and consequently to a greater experience of specialists in highly specific procedures. Nevertheless, this is accompanied by a loss of experience of those who do not perform these procedures anymore. Not least, due to the high specialization, the surgeons profession is changing from generalist to specialist. Hence, the education of young physicians, students and researchers has to be adapted to this reality. It remains unanswered if these changes contribute to the decline in the number of applicants in surgery. In conclusion, the risks of the contradictory contexts of interdisciplinarity can be counteracted with simple principles of fair and cooperative partnership.

Organisation der klinischen Forschung

ZusammenfassungDie Translation neuer Erkenntnisse aus der Grundlagenforschung in die Versorgung erfolgt zum Teil aufgrund mangelnder Institutionalisierung der klinischen Forschung verzögert. Die Forschungsstruktur und Organisation unserer Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie werden beschrieben.Grundlagenforschung erfolgt in eigenständiger Leitung in unseren Leibniz-Forschungslaboratorien für Biotechnologie und künstliche Organe (LEBAO) und im Rahmen des Exzellenzclusters „REBIRTH – from Regenerative Biology to Reconstructive Therapy“ und bildet den Ausgang zahlreicher Studien.Klinische Forschung wird durch die oberärztlichen Leiter der klinischen Verantwortungsbereiche (aufgeteilt in Klappen- und Koronarchirurgie, Aortenchirurgie, Gefäßchirurgie, Rhythmuschirurgie, Thoraxchirurgie, Herzunterstützungssysteme, thorakale Organtransplantation, herzchirurgische Intensivmedizin sowie Kinderherzchirurgie) weitgehend selbständig durchgeführt.Ein zusätzlicher eigenständiger Bereich Klinische Forschung koordiniert, von der Konzeption über Patienteneinschluss bis zur Publikation, für die klinischen Verantwortungsbereiche deren patientenorientierte Studien und bildet einen direkten und konstanten Ansprechpartner für Sponsoren und hochschulübergreifende Forschungsstrukturen der Medizinischen Hochschule Hannover.AbstractTranslation of basic research results into routine patient care is delayed in parts by lack of institutionalization in clinical research. In this article the research structure and organization of our Department of Cardiac, Thoracic, Transplantation and Vascular Surgery are described.Basic research, separately directed, is accomplished in the Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO) and within the scope of the Excellence cluster „REBIRTH – from Regenerative Biology to Reconstructive Therapy“.Clinical research is directed by heads of the subdepartments of our institution (valve and coronary surgery, aortic surgery, surgical electrophysiology, vascular surgery, thoracic surgery, cardiac assist systems, thoracic transplantation, intensive care and pediatric heart surgery).A separate subdepartment for clinical research is responsible for study coordination and accompanies clinical studies from study design and patient screening to publication. This subdepartment also serves as a constant contact to sponsors and superordinated research organizations within the Hannover Medical School.

Schwindende Fachgrenzen zwischen Kardiologie und Kardiochirurgie: Status quo

Cardiology and cardiothoracic surgery are closely related so that collaboration and communication are required to offer optimal therapy for patients. During the last decades many innovations have reduced the borders between cardiology and cardiothoracic surgery. Today, cardiologists may perform coronary interventions with good results that would have previously been the domain of coronary bypass surgery. In addition new valvular interventions have been developed, such as transfemoral or transapical aortic valve implantation and endovascular mitral valve reconstruction. New developments in cardiothoracic surgery have led to less invasive procedures and many surgical procedures can now be performed with minimally invasive techniques and without a cardiopulmonary bypass. To enable optimal therapy for patients, closer collaboration between cardiologists and cardiothoracic surgeons is required setting the stage for individualized therapy in the future.

[Organization of clinical research: in a large scale department for cardiothoracic surgery].

ZusammenfassungDie Translation neuer Erkenntnisse aus der Grundlagenforschung in die Versorgung erfolgt zum Teil aufgrund mangelnder Institutionalisierung der klinischen Forschung verzögert. Die Forschungsstruktur und Organisation unserer Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie werden beschrieben.Grundlagenforschung erfolgt in eigenständiger Leitung in unseren Leibniz-Forschungslaboratorien für Biotechnologie und künstliche Organe (LEBAO) und im Rahmen des Exzellenzclusters „REBIRTH – from Regenerative Biology to Reconstructive Therapy“ und bildet den Ausgang zahlreicher Studien.Klinische Forschung wird durch die oberärztlichen Leiter der klinischen Verantwortungsbereiche (aufgeteilt in Klappen- und Koronarchirurgie, Aortenchirurgie, Gefäßchirurgie, Rhythmuschirurgie, Thoraxchirurgie, Herzunterstützungssysteme, thorakale Organtransplantation, herzchirurgische Intensivmedizin sowie Kinderherzchirurgie) weitgehend selbständig durchgeführt.Ein zusätzlicher eigenständiger Bereich Klinische Forschung koordiniert, von der Konzeption über Patienteneinschluss bis zur Publikation, für die klinischen Verantwortungsbereiche deren patientenorientierte Studien und bildet einen direkten und konstanten Ansprechpartner für Sponsoren und hochschulübergreifende Forschungsstrukturen der Medizinischen Hochschule Hannover.AbstractTranslation of basic research results into routine patient care is delayed in parts by lack of institutionalization in clinical research. In this article the research structure and organization of our Department of Cardiac, Thoracic, Transplantation and Vascular Surgery are described.Basic research, separately directed, is accomplished in the Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO) and within the scope of the Excellence cluster „REBIRTH – from Regenerative Biology to Reconstructive Therapy“.Clinical research is directed by heads of the subdepartments of our institution (valve and coronary surgery, aortic surgery, surgical electrophysiology, vascular surgery, thoracic surgery, cardiac assist systems, thoracic transplantation, intensive care and pediatric heart surgery).A separate subdepartment for clinical research is responsible for study coordination and accompanies clinical studies from study design and patient screening to publication. This subdepartment also serves as a constant contact to sponsors and superordinated research organizations within the Hannover Medical School.

Organisation der klinischen Forschung@@@Organization of clinical research: In der Herzchirurgie an einer großen chirurgischen Klinik@@@In a large scale department for cardiothoracic surgery

ZusammenfassungDie Translation neuer Erkenntnisse aus der Grundlagenforschung in die Versorgung erfolgt zum Teil aufgrund mangelnder Institutionalisierung der klinischen Forschung verzögert. Die Forschungsstruktur und Organisation unserer Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie werden beschrieben.Grundlagenforschung erfolgt in eigenständiger Leitung in unseren Leibniz-Forschungslaboratorien für Biotechnologie und künstliche Organe (LEBAO) und im Rahmen des Exzellenzclusters „REBIRTH – from Regenerative Biology to Reconstructive Therapy“ und bildet den Ausgang zahlreicher Studien.Klinische Forschung wird durch die oberärztlichen Leiter der klinischen Verantwortungsbereiche (aufgeteilt in Klappen- und Koronarchirurgie, Aortenchirurgie, Gefäßchirurgie, Rhythmuschirurgie, Thoraxchirurgie, Herzunterstützungssysteme, thorakale Organtransplantation, herzchirurgische Intensivmedizin sowie Kinderherzchirurgie) weitgehend selbständig durchgeführt.Ein zusätzlicher eigenständiger Bereich Klinische Forschung koordiniert, von der Konzeption über Patienteneinschluss bis zur Publikation, für die klinischen Verantwortungsbereiche deren patientenorientierte Studien und bildet einen direkten und konstanten Ansprechpartner für Sponsoren und hochschulübergreifende Forschungsstrukturen der Medizinischen Hochschule Hannover.AbstractTranslation of basic research results into routine patient care is delayed in parts by lack of institutionalization in clinical research. In this article the research structure and organization of our Department of Cardiac, Thoracic, Transplantation and Vascular Surgery are described.Basic research, separately directed, is accomplished in the Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO) and within the scope of the Excellence cluster „REBIRTH – from Regenerative Biology to Reconstructive Therapy“.Clinical research is directed by heads of the subdepartments of our institution (valve and coronary surgery, aortic surgery, surgical electrophysiology, vascular surgery, thoracic surgery, cardiac assist systems, thoracic transplantation, intensive care and pediatric heart surgery).A separate subdepartment for clinical research is responsible for study coordination and accompanies clinical studies from study design and patient screening to publication. This subdepartment also serves as a constant contact to sponsors and superordinated research organizations within the Hannover Medical School.

[Diminishing borders between cardiology and cardiothoracic surgery: quo vadis?].

UNLABELLED Increasingly complex techniques in cardiovascular medicine lead to a competitive partnership between cardiology and cardiac surgery. Common challenges will arise in the fields of coronary heart disease, heart valves, heart failure and rhythm therapy. For instance, coronary revascularization in acute myocardial infarction is no longer considered to exclusively be an interventional option. In comparison, the implantation of heart valves is increasingly carried out by cardiologists using interventional techniques. The latest designs of sutureless valves try to combine the benefits of conventional and transcatheter heart valves. Heart failure is the most common reason for hospital admission and thus an important therapeutic target for cardiology and cardiac surgery. New approaches in diagnostics, heart assist devices and cellular therapy meet this challenge. CONCLUSION In the future only a sensitive and transparent collaboration across transsectoral borders will offer optimal therapy in cardiovascular medicine.

Schwindende Fachgrenzen zwischen Kardiologie und Kardiochirurgie: Quo vadis?@@@Diminishing borders between cardiology and cardiothoracic surgery: quo vadis?

UNLABELLED Increasingly complex techniques in cardiovascular medicine lead to a competitive partnership between cardiology and cardiac surgery. Common challenges will arise in the fields of coronary heart disease, heart valves, heart failure and rhythm therapy. For instance, coronary revascularization in acute myocardial infarction is no longer considered to exclusively be an interventional option. In comparison, the implantation of heart valves is increasingly carried out by cardiologists using interventional techniques. The latest designs of sutureless valves try to combine the benefits of conventional and transcatheter heart valves. Heart failure is the most common reason for hospital admission and thus an important therapeutic target for cardiology and cardiac surgery. New approaches in diagnostics, heart assist devices and cellular therapy meet this challenge. CONCLUSION In the future only a sensitive and transparent collaboration across transsectoral borders will offer optimal therapy in cardiovascular medicine.

Schwindende Fachgrenzen zwischen Kardiologie und Kardiochirurgie: Quo vadis?

UNLABELLED Increasingly complex techniques in cardiovascular medicine lead to a competitive partnership between cardiology and cardiac surgery. Common challenges will arise in the fields of coronary heart disease, heart valves, heart failure and rhythm therapy. For instance, coronary revascularization in acute myocardial infarction is no longer considered to exclusively be an interventional option. In comparison, the implantation of heart valves is increasingly carried out by cardiologists using interventional techniques. The latest designs of sutureless valves try to combine the benefits of conventional and transcatheter heart valves. Heart failure is the most common reason for hospital admission and thus an important therapeutic target for cardiology and cardiac surgery. New approaches in diagnostics, heart assist devices and cellular therapy meet this challenge. CONCLUSION In the future only a sensitive and transparent collaboration across transsectoral borders will offer optimal therapy in cardiovascular medicine.

Schwindende Fachgrenzen zwischen Kardiologie und Kardiochirurgie: Status quo@@@Disappearing borders between cardiology and cardiothoracic surgery: status quo

Cardiology and cardiothoracic surgery are closely related so that collaboration and communication are required to offer optimal therapy for patients. During the last decades many innovations have reduced the borders between cardiology and cardiothoracic surgery. Today, cardiologists may perform coronary interventions with good results that would have previously been the domain of coronary bypass surgery. In addition new valvular interventions have been developed, such as transfemoral or transapical aortic valve implantation and endovascular mitral valve reconstruction. New developments in cardiothoracic surgery have led to less invasive procedures and many surgical procedures can now be performed with minimally invasive techniques and without a cardiopulmonary bypass. To enable optimal therapy for patients, closer collaboration between cardiologists and cardiothoracic surgeons is required setting the stage for individualized therapy in the future.