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| The Monthly Pulse |
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| Can ChatGPT transform cardiac surgery and heart transplantation?
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| The Story |
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| AI has many possible applications in healthcare, and in cardiac surgery in particular. Specifically, tools like the Generative Pre-Trained Transformer (GPT, or ChatGPT from OpenAI), can review large volumes of patient data quickly to make recovery predictions and help surgeons make informed decisions. It can simulate various surgical scenarios, identify risks, suggest specific techniques, and recommend treatment plans on a case-by-case basis. It can also support real-time decision making during surgery and offer intraoperative monitoring and analysis. |
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| What You Should Know |
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| While the potential for leveraging ChatGPT and other AI-powered tools in cardiac surgery is exciting and promising, it’s important that we also recognize their limitations. For example, surgeons draw on personal experience and firsthand knowledge to consider factors that may be overlooked by AI, such as the patient’s mental health, support systems, and physical robustness. The best use of ChatGPT and other AI is therefore likely to be one in which these tools are leveraged as support tools that complement - instead of replace - a surgeon’s experience and expertise.
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| FDA approves Boston Scientific's new drug-coated balloon for coronary in-stent restenosis
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| The Story |
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| In early March, the FDA approved Boston Scientific’s Agent Drug-Coated Balloon (DCB) for treatment of coronary in-stent restenosis (ISR). The Agent DCB delivers an anti-proliferative drug to scar tissue that forms as the previously opened coronary artery re-narrows, helping to prevent IRS from occurring in the future. This therapy is the first DCB in the U.S., though it has been used to treat more than 100,000 patients worldwide.
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| What You Should Know |
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| As many as one in 10 patients with coronary artery disease experiences ISR, despite the ways in which percutaneous coronary intervention has improved. Boston Scientific asserts that the Agent DCB will meet a critical need to treat ISR, a notoriously complex condition. The Agent DCB has been available throughout Europe and elsewhere for years, and is now expected to become available in the U.S. within the coming months.
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| Factors associated with safe and successful postoperative day 1 discharge after lung operations: a systematic review and meta-analysis |
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| The Story |
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| In a recent systematic review and meta-analysis, researchers looked for the factors that would help guide surgeons seeking a safe and successful postoperative day one (POD1) discharge following lung resection. Their findings show that younger patients without cardiovascular or respiratory comorbidities are most likely to be discharged within one day, as well as those with better preoperative pulmonary function. Additionally, shorter operations, minimally invasive approaches, and sublobar resections may help to qualify a patient for a shorter stay. |
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| What You Should Know |
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| While some surgical teams do release patients as early as POD1 following a lung resection, others prefer to keep their patients longer to monitor for complications and reduce the risk of readmission. Yet, shorter hospital stays are linked to fewer hospital-acquired conditions and decreased use of hospital resources. Overall, the research shows that discharge within one day of operation appears to be safe for patients who have received a lung resection. Readmission rates and 30-day mortality are comparable to patients who were discharged later, and POD1 appears to have significantly less postoperative morbidity.
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| Leadership Reflections |
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Preparation, Pacing, and Destination
I recently traveled to Montana with some skier friends. I am not a downhill skier, so I was looking for a different outdoor activity. One such activity involves climbing the ski slope on snowshoes and I was fortunate to have the company of several experienced uphill enthusiasts to accompany me in this pursuit. Due to my lack of experience and youthful enthusiasm, they recommended that I start in the front of the pack. (To be clear, my “youthful enthusiasm” is said in jest.) So I began the ascent covering just over 2,000 feet in a two-mile hike. As is not uncommon on Whitefish Mountain, the visibility was limited due to cloud cover. In addition, the steepness of the grade and windiness of the slope contributed to short lines of sight to the next milestone. In other words, it was difficult to have a sense of where the final destination was.
As a result of my lack of experience, the limited visibility, and the high altitude, I found myself quickly short of breath and in need of some calories and water. I had planned enough to meet those needs, and the experienced hikers provided electrolytes for my water and offered perspective around the journey ahead. They explained that we were about 5-10% into the total hike and the steepest portion of the climb was the bottom section. Setting a pace that allows a hiker to carry a conversation is a measured approach that helps ensure you can keep moving vs. a pattern of hiking, tiring, resting. With a refuel and this wise guidance, I was able to maintain a slower, more methodical pace that carried me to the lodge at the top of the mountain.
This experience was a reminder of the importance of preparation, resourcing, timing, pacing, and understanding our final destination in our strategic planning and execution processes. Without a sense of the path ahead and the location of the destination, it is challenging to measure progress or success. Knowing the destination informs resource allocation decisions around time, money, and human capital. There may be legs of the journey that require a sprinter’s mindset. For longer term success, resilience and a more measured, steady approach are important. And of course, having others there to encourage and support us along the way never hurts, either.
Have you experienced challenges as a result of insufficient information related to the goal or destination? What strategies have you utilized to overcome these obstacles?
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Sanibel Symposium |
| Wed., May 1 - Sat., May 4 |
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| 16th annual Mid-Atlantic VAD and ECMO Symposium (MAVES) |
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| AAPA 20224 |
| Sat., May 18 - Wed., May 22 |
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| 2nd Annual Hoosier Extracorporeal Science Conference |
| Sun., May 26 - Mon., May 27 |
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| 2024 AANP National Conference |
| Tues., Jun. 25 - Sun., Jun. 30 |
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