The “heart team” concept has provided a platform to bring together cardiovascular specialists from various disciplines in the patient care process. New procedures such as transcather aortic valve replacement have required the integration of surgeons and interventionists to make decisions concerning indications and approaches. Guidelines for coronary interventions require concordant decision-making by cardiologists, surgeons and caregivers for patients with advanced disease. Establishing a dialogue, an action plan, and a QI agenda involving multiple heart programs, practices and heart team members will favorably impact standards of care. Defining a model quality agenda for the state’s cardiac surgical community is a CA STS priority.

The CA STS therefore would like to encourage all heart team members to participate in society activities – physician assistants, perfusionists, nurses, operating room staff, data managers and administrative personnel. However, the process of accomplishing this laudable goal has not be easy or obvious. Ed Fonner, before his untimely death, proposed that data managers and other heart team members be offered full membership in CASTS with privileges to become officers or directors of the corporation. This proposal was not well received by CASTS physicians and directors, who felt that it was not consistent with the goals of CASTS as a society of surgeons.

California Data Managers have proposed the formation of a new all-inclusive organization to pursue quality improvement goals. The mission of this organization is very similar to the CASTS.

“The California Cardiothoracic Surgery Collaborative (CCSC) is organized to improve decisions affecting the cardiothoracic surgical community to ensure fairness, accuracy, and completeness of publicly-reported healthcare information, to encourage adoption of evidence-based best practices, and to better manage patient outcomes data with training opportunities and peer-to-peer information exchange. Its objectives are to improve advocacy, enhance communications, pursue quality improvements, and support sound decision-making.”

Our Goals

  1. Collect, share, and analyze patient data concerning safety, quality of care, and process innovations in the cardiac surgery area to improve decision-making on quality and coast management issues.
  2. Create a collaborative infrastructure which can monitor and analyze outcomes develop best practice care processes, and through process improvement enhance the quality of care in cardiac surgery.
  3. Facilitate communications and educational activities in the cardiac surgical community to ensure the integrity of publicly-reported healthcare information and address relevant issues facing the cardiac surgical community in California.
  4. Support education initiatives aimed at improving patient health literacy, informed patient choice and medical decision-making.


The described goals are consistent with the mission of the CA STS as articulated by Dr. Fonner. While it is true that the creation of the CASTS was influenced by the need to monitor public reporting initiatives and ensure the quality of outcomes data, the interests and goals of surgeons and heart team members go well beyond these areas. In order to further collaboration and collegiality among healthcare professionals and stakeholders in cardiac and thoracic surgery, the CA STS would like to establish a dialogue to move the process of organizing heart team members in the correct direction. At present (summer 2019) a “California Cardiovascular Collaborative” program is under development by OSHPD in concert with CA STS. California members of the ACC and other members of the heart team including the data managers association.