J.Jpn. Surg. Soc.. 119(1): 55-60, 2018

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Feature topic

CARDIAC AND VASCULAR LIVE SURGERY GUIDELINES FOR THE WELL-BEING OF PATIENTS

The Japanese Society for Cardiovascular Surgery, Society for Vascular Surgery, and Society for Thoracic Surgery are known for their “patient-first” philosophy and stoic attitudes. Those concepts have been put into practice by creating and enforcing various regulations and guidelines in line with respect for professional autonomy. Examples include site visits to confirm nationwide database accuracy, national monitoring of surgical outcomes with red flag functions, empowerment of a Stent Graft/Transcatheter Aortic Valve Replacement/LVAD Committee and live surgery (LS) guidelines. The LS guidelines were developed to protect patients by mandating pre- and postoperative reporting to the LS Committee, mandatory approval by the Institutional Review Board, restricting high-risk cases and the use of unapproved devices, and creating strict requirements for surgeons and hospitals. However, partially due to those high hurdles, cardiovascular LS is almost extinct in Japan. On the other hand, since the LS guidelines apply only to surgeons and not to cardiologists or interventionalists, the latter are holding LS symposiums monthly without any restrictions. This is also true for the outcome monitoring/red flag functions, and therefore unindicated or inappropriate interventions occur and go unpunished. To improve patient care, not only that provided by surgeons but also by other specialists, consistent rules should be applied and the playing field should be leveled.

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