HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Steven F Bolling Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bolling, S. F Articles by Romano, M. A Search for Related Content PubMed PubMed Citation Articles by Bolling, S. F Articles by Romano, M. A

The Future of Cardiac Surgery: a History Lesson

Michigan, USA

Advances in health technology have increased exponentially over the last decade. This progress has enabled all medical specialties to better treat patients and holds the promise of improving outcomes and perhaps, moving beyond palliation to cure and eventually prevention. However, while some embrace progress, others view change with fear and trepidation. Notably, in our field of cardiac surgery, there is concern of increasing competition from cardiology, as newer catheter based innovations, such as drug eluting coronary stents, rapidly increase in use. This has some predicting a limited future for cardiac surgery, as the melding of diagnostic and therapeutic catheter approaches has become the driving force in treating coronary disease, relegating cardiac surgery to the status of a safety net. Many have further suggested that innovations in interventional cardiology, combined with decreasing reimbursements are partially responsible for the decrease in interest in cardiac surgical residency training. However, this myopic view is counterproductive and a more enlightened outlook befits our heritage. Cardiac surgeons by nature and tradition are innovators, problem solvers and decision makers and we only need to take a history lesson to see the future.

Facing challenges in thoracic surgery is not new. Chest surgery was initially built around treating empyema and tuberculosis. With the advent of antibiotics, the sentiment was that the utility of thoracic surgery had come and gone. Instead with individual leadership, imagination, hard work and risk taking, significant surgical innovations in the treatment of cardiovascular diseases began. Fifty years ago direct cardiac surgery was merely a conceptual dream. This became a reality, as many cardiac surgical pioneers developed and used the heart-lung bypass machine, despite assurances from experienced and seasoned colleagues that it would never work. This momentum continued with vigor for 50 years and saw coronary artery bypass, the correction of congenital and valvular disease and transplantation become common place. While the development of catheter based treatments may eventually alter the surgeons role in certain types of heart disease, one only need look at the current trends in heart disease to realize that coronary artery bypass grafting is not our umbilical cord.

Presently, there are more than 600,000 new cases of CHF diagnosed each year in the United States. Approximately one-half of these have associated functional mitral regurgitation (MR), and more than 50% of these patients are refractory to medical therapy. This type of CHF with MR is known to have poor outcome, and only 2,000 patients are offered transplant due to a limited donor pool. This leaves well over 150,000 patients per year that require a different intervention. Mitral valve repair with an undersized annuloplasty ring, restoring the geometry of the mitral valve-left ventricular unit has been shown to improve CHF and survival.¹ Many other surgical options such as the Dor procedure, direct remodeling devices, permanent LVADs, cellular and gene therapy and many others are opening up the field of heart failure surgery.

The surgical treatment of atrial fibrillation is another frontier that is in its infancy. Based on initial work by Cox, the Maze procedure has been associated with conversion rates of up to 99%.² This is far superior to the 50% of patients that will sustain a sinus rhythm with percutaneous catheter ablation or medical therapy. Atrial fibrillation is the most common sustained dysrhythmia and it affects over 2.2 million people in the United States alone, and is growing by 160,000 new cases per year. Due to our aging population, this will only continue to increase and cardiac surgeons realistically can expect numerous referrals for the surgical treatment of atrial fibrillation.

Given these examples it would seem that the future of cardiac surgery is not only secure, but is entering a time of expanded therapy for more complex diseases. Can we use history as a lesson to predict the future? In cardiothoracic surgery, our history shows that our foundation is firm and the future is only limited by our imagination. Therefore, it is important to continue, to be motivated by a passion for progress, embrace innovation, and in that spirit, our work has only just begun.

REFERENCES

1. Bolling SF. Mitral reconstruction in cardiomyopathy. J Heart Valve Dis 2002;11 Suppl 1:S2631.

2. Cox JL, Ad N, Palazzo T, Fitzpatrick S, Suyderhoud JP, DeGroot KW, et al. Current status of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000;12(1):159.[Medline]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Steven F Bolling Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bolling, S. F Articles by Romano, M. A Search for Related Content PubMed PubMed Citation Articles by Bolling, S. F Articles by Romano, M. A