Why an increase in structural heart procedures could eventually become a problem, per CHI Health's Dr. Jeffrey Carstens

As structural heart procedures become more common and cardiologists perform fewer surgical valves, it may lead to a loss of confidence in the future, says Jeffrey Carstens, MD, executive medical director of CHI Health Heart Institute in Omaha, Neb. 

Dr. Carstens recently joined Becker's cardiology podcast to discuss what he considers the industry's biggest challenges. 

Here is an excerpt from the podcast. Click here to download the full episode.

Editor's note: This response was lightly edited for length and clarity.

Question: What are your top three biggest issues in heart surgery and care?

Dr. Jeffrey Carstens: If we look at things in heart surgery today and what are kind of the hot button issues, one is certainly the aging physician population. Our cardiac surgeons are gradually getting older every year and the pipeline is not robust. So there's more surgeons retiring than there are coming out of training and that's an unsustainable model for the future. 

I think the next thing that's sort of interesting is we have this increase in structural heart and structural heart procedures are getting more and more common, particularly around the aortic valve, but the mitral valve and tricuspid valve are coming close behind. If you look at two years ago, there were more TAVRS done than SAVRS — so more transcatheter valves than surgical valves. 

What I kind of worry about in the future is [if] there becomes this model where you do a TAVR and then you do a valve, and valve TAVR. Then at some point, if we're dealing with these low-risk populations of young people, they could easily get to a third valve. As our surgeons do fewer and fewer surgical valves, I wonder what things will look like in 15 or 20 years when we're asking them to take two implanted valves out of a patient that's at high-risk, and they're not really doing a lot of surgical valves in the first place. 

That's not a burning platform today, but it's a concern for the future; how do you keep competent as you're doing less and less surgical cases because of the advances in intervention, high-risk intervention with Impella and those kinds of assisted interventions. We're leaving the surgeons kind of the very, very worst case scenarios, and I worry that kind of drags on our surgical colleagues and how do they avoid burnout?

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