How to retrain the cardiothoracic surgeon.

It is both an exciting and challenging time for cardiothoracic surgeons. Declining case volumes and diminishing reimbursement are causing a major disruption in the way practicing cardiothoracic surgeons approach their specialty and graduating cardiothoracic surgery residents seek employment. However, new advances in the treatment of cardiovascular diseases, such as endoluminal grafting for diseases of the thoracic aortic, are rapidly becoming available. It will take a significant commitment on behalf of busy practicing cardiothoracic surgeons to 'retrain' and develop the necessary skill-set to become proficient in catheter-based therapies and other emerging therapeutic modalities. We review the factors that contributed to the rise of cardiothoracic surgery as a specialty, the current state of the specialty and the potential that endovascular surgery offers cardiothoracic surgeons and examine the obstacles and solutions for retraining cardiothoracic surgeons.