1 00:00:00,420 --> 00:00:13,560 I think it's sort of. Many of the things that there will be in this talk. 2 00:00:13,560 --> 00:00:21,020 May never happen. Some of them will happen. Some of them already happening now. 3 00:00:21,020 --> 00:00:28,700 How that will evolve, to what extent and how all of these things will blend into one future. 4 00:00:28,700 --> 00:00:38,450 It will be interesting to explore. So. 5 00:00:38,450 --> 00:00:45,480 When I was thinking about his lecture, the first thing I thought is whether does actually defining me as a cardiac surgeon when? 6 00:00:45,480 --> 00:00:58,140 What? Do people see on me when we look around and I thought that these four things currently were the most appropriate thing that defines us, 7 00:00:58,140 --> 00:01:03,730 so Koppel, life, go-gos and the. 8 00:01:03,730 --> 00:01:11,800 Bypass machine, you know, put these things together, and probably you have a kind of a cardiac surgeon more or less. 9 00:01:11,800 --> 00:01:16,940 However, if you look at them, really a basic. 10 00:01:16,940 --> 00:01:27,050 Started from this car pool that is 6000 7000 technology and moving more advanced things, but really amazing. 11 00:01:27,050 --> 00:01:32,040 So here are some things that I was trained. 12 00:01:32,040 --> 00:01:38,970 But not practise anymore, at least that frequently, you know, I was I was trained to I want to start a cardiac surgery. 13 00:01:38,970 --> 00:01:45,860 We used to do a very big incisions almost down to the on black was cutting both legs open. 14 00:01:45,860 --> 00:01:54,610 And then asking that patient to walk or recover. Big laparotomy. 15 00:01:54,610 --> 00:02:00,820 But of course, to me. I remember patients lingering the ward for days. 16 00:02:00,820 --> 00:02:07,850 We. Now, things have changed. 17 00:02:07,850 --> 00:02:12,500 This is what I was not trained to do. 18 00:02:12,500 --> 00:02:23,310 But I practise every day. We moved into more and more minimally invasive, more accurate grafts. 19 00:02:23,310 --> 00:02:25,910 Patients have spent about. 20 00:02:25,910 --> 00:02:38,660 In days, most of our patients actually go Home Depot, the vast majority of my patients to stop taking painkillers after a couple of weeks. 21 00:02:38,660 --> 00:02:43,460 And he has some things that there were not even on the menu when I would start training. 22 00:02:43,460 --> 00:02:51,590 It didn't even exist. There were probably thought of somewhere know somebody crazy in Paris putting some vibes in or God knows what. 23 00:02:51,590 --> 00:02:58,340 But they're here to stay. And. 24 00:02:58,340 --> 00:03:02,260 We move on. What about today? 25 00:03:02,260 --> 00:03:10,120 I think today we are getting to an era of patient optimised surgical care. 26 00:03:10,120 --> 00:03:22,470 The sequence of the woods, I think it's important. We moved into what we call it, courting territory, putting two point zero. 27 00:03:22,470 --> 00:03:29,310 In that one, each member is equal. And it's important. 28 00:03:29,310 --> 00:03:42,360 And the team should be based on diversity and enable cross fertilisation, that collaborative approach. 29 00:03:42,360 --> 00:03:46,160 That we've been having up until now. 30 00:03:46,160 --> 00:04:02,450 Is primitive, we should move beyond that, because complementary is a temporary solution, or the ping based 1.0 was based on complementary services. 31 00:04:02,450 --> 00:04:10,640 But being complimentary means that if I don't need you more today, you're out. 32 00:04:10,640 --> 00:04:23,110 Shouldn't enable established partnerships. People working together not to actually decide what we're going to do, I want to get cabbage or PCI. 33 00:04:23,110 --> 00:04:29,080 But actually go beyond. Decide how we're going to do this cabbage. 34 00:04:29,080 --> 00:04:46,510 Or how we're going to do this by. Focus on similarities in synergies and emphasise core competencies and not skills. 35 00:04:46,510 --> 00:04:53,690 Because competencies involve. Skills probably stay with you. 36 00:04:53,690 --> 00:05:05,130 In a more static way. We should understand surgical techniques, yes, but what we should understand is technology. 37 00:05:05,130 --> 00:05:13,620 Techniques is a static. But surgeons are obsessed in teaching techniques. 38 00:05:13,620 --> 00:05:19,230 Technologies are dynamic. Our techniques are static. 39 00:05:19,230 --> 00:05:29,190 The technology evolves around us and around our techniques, and all of these things are changing. 40 00:05:29,190 --> 00:05:40,430 Surgical college curriculums primarily, they talk about techniques they talk about, think of information, hardly anything there about technology. 41 00:05:40,430 --> 00:05:49,290 And this is where everything is changing. What does surgery give you? 42 00:05:49,290 --> 00:05:54,320 Surgery gives you durability. OK. 43 00:05:54,320 --> 00:05:59,910 Yes, we have Tavis, and we have aortic valve replacement. 44 00:05:59,910 --> 00:06:07,000 And we may say Paris with a new trials, are suitable for low risk patients. 45 00:06:07,000 --> 00:06:17,700 But low risk patient doesn't mean low age patient. It can be a low risk 80 year old and a low risk 60 year old. 46 00:06:17,700 --> 00:06:25,280 Surgery has durability. And this is what should we base our decisions upon? 47 00:06:25,280 --> 00:06:32,980 And then we have complexity. As the easier, low risk move, more and more into very contentious approaches. 48 00:06:32,980 --> 00:06:38,760 Then how new surgeons will learn how to do the easy stuff. 49 00:06:38,760 --> 00:06:46,730 If said ended up doing more complex stuff. How the new generations of will be trained. 50 00:06:46,730 --> 00:06:52,050 We'll be trained in the conventional way as we use to train them I to an easy cabbage training, 51 00:06:52,050 --> 00:07:03,910 using air and move on, or we're going to end up having to do them a practise and we are. 52 00:07:03,910 --> 00:07:07,990 So is a challenge, you said that becoming a real statesman and probably a surgeon. 53 00:07:07,990 --> 00:07:13,310 You need to think about the next generations and not about the next elections. 54 00:07:13,310 --> 00:07:20,960 So you need to think about a couple of steps ahead of you. 55 00:07:20,960 --> 00:07:26,940 So I think what we should think about is start building walls. 56 00:07:26,940 --> 00:07:34,830 The other thing is that in the modern world, especially for young generations, people starting their careers. 57 00:07:34,830 --> 00:07:39,960 Should stop fighting in defending borders from an invasion of this. 58 00:07:39,960 --> 00:07:46,840 Stop fighting about if Poppy is better than surgery. 59 00:07:46,840 --> 00:07:54,650 You should find the way in blending into those things. 60 00:07:54,650 --> 00:08:03,960 Start building trust, because this is the most important component of teamwork and it's a great vacuum. 61 00:08:03,960 --> 00:08:10,830 We want to think that we were walking teams, are we really? 62 00:08:10,830 --> 00:08:16,940 It's extremely important to build the future and trust. 63 00:08:16,940 --> 00:08:23,150 Because when the patient comes to theatre, I trust my misfits, that's going to do its best job across the street. 64 00:08:23,150 --> 00:08:29,460 The nurse is going to do it. The perfusion is. The president was looking after the intensive care. 65 00:08:29,460 --> 00:08:35,370 And the people there. So trust is extremely important. 66 00:08:35,370 --> 00:08:37,420 Never been put. 67 00:08:37,420 --> 00:08:45,910 We expect to know you expect to be blanketing you are appointed as a consultant or a registrar, you're working for unit, you know, nobody. 68 00:08:45,910 --> 00:08:53,820 People should trust you and you should trust everyone. Educate. 69 00:08:53,820 --> 00:08:59,420 And how do we educate today? We get brilliant minds. 70 00:08:59,420 --> 00:09:07,240 It put them in the squeeze for everybody to get the same more or less active getting that. 71 00:09:07,240 --> 00:09:14,090 It is what we want to educate. Can everyone climb the tree in the same way? 72 00:09:14,090 --> 00:09:21,550 That's because we have a treat, because it means that every person is equipped for that role. 73 00:09:21,550 --> 00:09:29,910 I think we should educate full time capacity and knowledge. We should educate by engaging people. 74 00:09:29,910 --> 00:09:35,200 Understand that there is an individuality amongst humans. 75 00:09:35,200 --> 00:09:40,920 OK, we're equal, and we may have different colours. 76 00:09:40,920 --> 00:09:51,750 And we should educate to elevate. Time is of the essence, what is the point of creating cardiac surgeons had a. 77 00:09:51,750 --> 00:09:57,480 Who are training for basic cardiac? Paediatric adult. 78 00:09:57,480 --> 00:10:04,560 That's my training, eventually doing just adult cardiac. A value. 79 00:10:04,560 --> 00:10:18,620 But is it really? Let's move in the future now, and I think emerging virtual reality, augmented reality. 80 00:10:18,620 --> 00:10:24,530 We are part of our future. Imagine is not only obtaining information but has moved on. 81 00:10:24,530 --> 00:10:33,400 It has moved on into projecting 3-D at 9:40, adding tactile capacity to it. 82 00:10:33,400 --> 00:10:39,980 And simulation, is he already in training at Halley herself, surgical procedures? 83 00:10:39,980 --> 00:10:44,450 And leading into standardising procedures and training. 84 00:10:44,450 --> 00:10:50,830 We can actually probably perform the operation before we actually do it. 85 00:10:50,830 --> 00:10:53,450 And it will be better doing it. 86 00:10:53,450 --> 00:11:03,190 We don't necessarily need to train people straight into theatre, we may move into actually doing it in simulation environment. 87 00:11:03,190 --> 00:11:09,940 Because you cannot afford to do 200 cases of each type and make people competent on everything 88 00:11:09,940 --> 00:11:18,720 before they move into doing straight complex cases because the easy cases will go continuously. 89 00:11:18,720 --> 00:11:27,130 So imagine we will move on, and it's here, all of these things happening as we speak. 90 00:11:27,130 --> 00:11:33,340 It's not that much of a future will evolve because it will be the integration that will happen. 91 00:11:33,340 --> 00:11:36,650 But actually, this is present. 92 00:11:36,650 --> 00:11:47,520 And Imogene is troubling, it's becoming better in capturing increases, smiles, smaller structures and functions inside the body. 93 00:11:47,520 --> 00:11:54,830 We have functional MRI is not only MRI. Sensory, then, might need to move forward. 94 00:11:54,830 --> 00:12:00,190 Interventions at the lower level, not macroscopic anymore. 95 00:12:00,190 --> 00:12:05,320 Even down to cell level. 3D printing. 96 00:12:05,320 --> 00:12:12,110 Okay, if you're somebody would have asked me about two or three years ago which one is going to have the most impact? 97 00:12:12,110 --> 00:12:17,840 Probably, I would say 3-D printing, because that's going involve we can compress. Not so sure anymore. 98 00:12:17,840 --> 00:12:24,170 3-D printing and planning technologies are already used in surgery. 99 00:12:24,170 --> 00:12:34,570 Personalised implants in surgical instruments. So what can we plan we bring with practise and we perform? 100 00:12:34,570 --> 00:12:45,860 The first fully plastic valve. It's in stage a trial stage three and implanted about five months ago, pacing. 101 00:12:45,860 --> 00:12:52,870 He's alive and kicking and moving on. One of these things will come. 102 00:12:52,870 --> 00:12:59,510 But we are not going to be only printing valves or printing organs. 103 00:12:59,510 --> 00:13:05,750 I think we're going to move to bring in food. Printing pills. 104 00:13:05,750 --> 00:13:12,560 Specific to microbiome and the physiology of each individual patient, you don't need to go to the pharmacy. 105 00:13:12,560 --> 00:13:19,570 You're pretty depending on what ink you put can produce whatever you want. 106 00:13:19,570 --> 00:13:24,400 Nanotechnology, nanotechnology is here today. 107 00:13:24,400 --> 00:13:36,760 It is here in many forms in forms of pure metallic bits that we use for breaks and navigation on DaVinci models or anything like that. 108 00:13:36,760 --> 00:13:45,040 But also on nano drugs. Nanjing delivery systems, tissue engineering and genetic engineering. 109 00:13:45,040 --> 00:13:50,650 The. We have a problem with nanotechnology. 110 00:13:50,650 --> 00:13:58,590 We have a problem because there are not sufficient information about biological safety on nano peptides at cell level. 111 00:13:58,590 --> 00:14:07,650 And nano peptides and particles can produce allergic reactions, cause inflammation can cause direct toxicity to live in cells. 112 00:14:07,650 --> 00:14:13,720 The minute we put it in the body. And we actually stop them. 113 00:14:13,720 --> 00:14:22,520 Carry on forever. How do you get them up? Future of shattering genomics. 114 00:14:22,520 --> 00:14:29,300 Aortic surgery now in the ageing surgical team. We have somebody who does genes. 115 00:14:29,300 --> 00:14:35,180 So we're moving to understand things in a different way. We used to treat macroscopic stuff. 116 00:14:35,180 --> 00:14:39,060 We move to understanding better. 117 00:14:39,060 --> 00:14:49,450 And we understand this is profiles, and we helped develop precision medicine, but also precision care to our patients. 118 00:14:49,450 --> 00:14:56,380 And in that we have greater nomics, we have pharmacogenetics pharmacogenomics. 119 00:14:56,380 --> 00:15:03,680 STEM cell therapies and cloning. All of these things will evolve, come and catches. 120 00:15:03,680 --> 00:15:11,050 We already hear that billions spent in each one of those. 121 00:15:11,050 --> 00:15:20,770 But this can only happen in materialise. With fully integrated capacity to deal with big data. 122 00:15:20,770 --> 00:15:26,200 And I think now I'm coming to the idea that big data. 123 00:15:26,200 --> 00:15:31,200 Is what's going to make the difference? Artificial intelligence. 124 00:15:31,200 --> 00:15:35,910 Why do we place our current medical practise on statistics? 125 00:15:35,910 --> 00:15:43,670 Yes, everything is based on statistics, which are what everything is told by a population. 126 00:15:43,670 --> 00:15:55,000 By means quiet house confidence in the roads. What is machine learning and algorithms versus artificial intelligence? 127 00:15:55,000 --> 00:16:02,200 Yeah, it's ability to learn from daily data without being explicit programmed. 128 00:16:02,200 --> 00:16:07,440 That's the definition of artificial intelligence. And it's moving in. 129 00:16:07,440 --> 00:16:16,600 It's moving into the reasoning, and it will influence the way we practise. 130 00:16:16,600 --> 00:16:26,980 So artificial intelligence will be involved into the initial pre operative part and also introspectively 131 00:16:26,980 --> 00:16:34,570 and postoperatively will be influenced by collecting surgical data and from population analysis, 132 00:16:34,570 --> 00:16:48,230 which will interact in real time. Now looking to the capacity of humans in the capacity of our. 133 00:16:48,230 --> 00:16:55,360 Machine. We are just below the crossing point. 134 00:16:55,360 --> 00:17:10,060 Susan, what's going to happen is that machine capacity and machine will surpass human demands by a couple of months ago said that probably soon. 135 00:17:10,060 --> 00:17:18,460 Computer talking to humans will be a similar situation. Humans are going to treat currently. 136 00:17:18,460 --> 00:17:25,080 For humans, one millisecond is. Fast for artificial intelligence. 137 00:17:25,080 --> 00:17:35,490 It's an eternity. The fastest computer today will be exceptionally slow. 138 00:17:35,490 --> 00:17:47,220 For quantum computing, that's coming. The fastest computer today to deal with an algorithm encryption algorithm would take 10000 years. 139 00:17:47,220 --> 00:17:55,180 Quantum computing can actually go through an algorithm in 0.1 of a second. 140 00:17:55,180 --> 00:18:04,370 Next, superpower, be the one that will make one of them crazy, the one that has missiles. 141 00:18:04,370 --> 00:18:16,370 Robotics. Developments in robotics, surgical tasks will be increasingly be automated with more guidance, support and information available. 142 00:18:16,370 --> 00:18:23,390 You're going to have your Alexa to help you when you perform an operation because you can't remember everything. 143 00:18:23,390 --> 00:18:30,400 Alexa, we'll be checking you if you're doing it right up until the computer picks it up. 144 00:18:30,400 --> 00:18:43,340 Fully automated robot surgeons probably are likely to populate operating theatres in the next decade, but I'm not so sure about the decade after. 145 00:18:43,340 --> 00:18:51,560 You have the first thing in your theatre, maybe a stack, almost never the fear that you find a stack. 146 00:18:51,560 --> 00:18:58,630 In what a lot of fear did you find the net generation of da Vinci? 147 00:18:58,630 --> 00:19:06,950 And it's moving on. But probably we're moving to integrated technology. 148 00:19:06,950 --> 00:19:19,560 This is actually a model Cath lab. I went to a meeting recently where a cardiologist from India had to go away sitting in front of his computer, 149 00:19:19,560 --> 00:19:25,870 he'd do an angiogram in India from Germany. 150 00:19:25,870 --> 00:19:33,560 Using this technology. What we will need is a human, perhaps, 151 00:19:33,560 --> 00:19:41,880 though the human rights of clinicians and relationship with patients will remain central to the delivery of excellent care. 152 00:19:41,880 --> 00:19:47,400 Because we are all human. Big data. 153 00:19:47,400 --> 00:19:54,170 I think this is. What I believe the breakthrough will happen with big data. 154 00:19:54,170 --> 00:19:59,000 Data collection analysis when enabled, better prediction of disease, 155 00:19:59,000 --> 00:20:06,600 along with personalisation of treatment options, an increase in effectiveness and already. 156 00:20:06,600 --> 00:20:12,510 Bias will decrease, and holistic approach to treatment will increase the best, 157 00:20:12,510 --> 00:20:20,230 the best laboratory in the world, but probably over 60 percent efficacy be generated by humans. 158 00:20:20,230 --> 00:20:24,430 Driverless cars are not crashing because they're stupid. 159 00:20:24,430 --> 00:20:31,650 Yeah, crashing because they are based on information programmed by humans with human errors. 160 00:20:31,650 --> 00:20:35,400 So big data. Big data, what is it? 161 00:20:35,400 --> 00:20:41,770 How much is growth you give us on 13, we have 153 exabytes. 162 00:20:41,770 --> 00:20:54,040 A 2020, generally, we expect to have 2310 exabytes or more, which is 48 percent increase per year. 163 00:20:54,040 --> 00:21:02,290 Your series, listen to you constantly, EPIs, constantly collecting data constantly. 164 00:21:02,290 --> 00:21:06,490 That happens across the globe. 165 00:21:06,490 --> 00:21:13,990 Now, look, what we'll have to do, are we ready for this mortality from heart disease and developing atrial fibrillation, 166 00:21:13,990 --> 00:21:19,360 which is just being present in the American Heart Association meeting in November? 167 00:21:19,360 --> 00:21:25,960 Big data from one point seventy seven million EKGs. 400000 people. 168 00:21:25,960 --> 00:21:38,650 Medical records from 20 years ago was able to accurately predict chances of dying or developing atrial fibrillation in the next year. 169 00:21:38,650 --> 00:21:50,220 The of the artificial intelligence, the algorithm was able to accurately predict even on passages that have been cleared by clinicians. 170 00:21:50,220 --> 00:21:56,160 Even when three clinicians were looking to the same messages, they couldn't really identify the patterns in their. 171 00:21:56,160 --> 00:22:09,010 But I did. Researchers are moving on, trying to integrate those algorithms treatment options. 172 00:22:09,010 --> 00:22:17,000 Big data from aortic stenosis, what do we base our treatment of everything stent options on? 173 00:22:17,000 --> 00:22:27,770 Papers of that I take. Gouging the gas station in the guidelines, which took off about paper from 20 years ago with 28 patients. 174 00:22:27,770 --> 00:22:37,280 A correspondent on and on now, mortality from aortic stenosis and big data, over 500000 echoes analysed. 175 00:22:37,280 --> 00:22:45,380 What has shown patience with previous Article five interventions being excluded, five years and mortality? 176 00:22:45,380 --> 00:22:53,280 If you have a moderate or severe losses, it's over 50 percent. 177 00:22:53,280 --> 00:22:59,520 More importantly, it's over 50 percent if your aortic stenosis, it's got a gradient over 20. 178 00:22:59,520 --> 00:23:04,450 Which is verging into mild. Are we ready for this? 179 00:23:04,450 --> 00:23:16,090 How would you know those patients? If we replace a native ISS with a surgical induced disease with it, which is a new valve, is it better? 180 00:23:16,090 --> 00:23:24,980 We don't know. We as clinicians, we are trained to recognise established disease. 181 00:23:24,980 --> 00:23:30,500 And we are we are trying to treat established disease. 182 00:23:30,500 --> 00:23:38,900 The I can crunch data and potentially teach us things that we have been maybe misinterpreting for decades. 183 00:23:38,900 --> 00:23:49,900 So the whole environment would change. But there is one fundamental thing here is ethics. 184 00:23:49,900 --> 00:23:55,050 Yes, the future will be full of complexity, cost and certainty. 185 00:23:55,050 --> 00:24:01,930 But full of ethical implications, can we treat everyone? How far can we go? 186 00:24:01,930 --> 00:24:11,090 Ethical and social economic implications, I think, probably are the only incidents in translating these technologies into routine medical practise. 187 00:24:11,090 --> 00:24:17,400 Thank you very much.