Developing Transcatheter Skills as a Cardiac Surgery Resident: An Editorial Comment and Perspective. “Building the Hybrid Mindset without Losing the Craft”

Cardiac surgery is undergoing an identity shift, as patients are older and frailer, and the access route for many valve therapies is increasingly percutaneous. The 2025 ESC/EACTS guideline on valvular heart disease, recently published, reiterates the centrality of the Heart Team and reflects the expanding role of transcatheter techniques across aortic, mitral, and tricuspid disease.1 For training programs, the implication is clear: the “standard” cardiac surgeon can no longer be trained only for open-heart surgery. Yet transcatheter competence does not appear by osmosis. In many centres, residents’ exposure is “opportunistic”—one trainee might place femoral sheaths weekly, another might watch from the back of the room or similar. When trainees report their experience, the gaps are predictable. In a national Canadian survey, only a minority of residents and programme directors considered transcatheter aortic valve implantation (TAVI) training adequate, and access to TAVI simulation was rare.4 If percutaneous therapy is becoming standard care, variability in training becomes a patient-safety problem and a workforce problem in Europe.