Should Interventional Cardiologists Super-Subspecialize? Moving From Patient Selection to Operator Selection

The field of interventional cardiology has expanded rapidly. As a result, four evolving areas have evolved – peripheral vascular interventions, structural heart interventions, adult congenital heart intervention, and chronic total occlusion. The complexity of these procedures and the number of devices available has grown rapidly. In addition, the professional and public expectations of procedural success and of minimizing case–avoidance have also grown. Specific issues include volume-outcome relationships, maintaining currency and proficiency, accessibility to specialized procedures, and the need to maintain a fundamental level of expertise in acute coronary interventions.