Author + information
- Wayne E. Richenbacher, MD,
- John L. Myers, MD, FACC and
- John A. Waldhausen, MD, FACC∗
- ↵∗Address for reprints: John A. Waldhausen, MD. Department of Surgery, College of Medicine, The Milton S. Hershey Medical Center. The Pennsylvania State University, P.O. Box 850, Hershey, Pennsylvania 17033.
Cardiac surgery has undergone dramatic advancements during the past 3 decades. The introduction of cardiopulmonary bypass and cardioplegic arrest ushered in the true era of open heart surgery. Bioprostheses and mechanical valves as well as techniques for valve reconstruction permit routine repair or replacement of stenotic and regurgitant native valves. Progress in the disciplines of mechanical and electrical engineering has led to the development of pocket watch-sized, physiologically responsive pacemakers as well as a variety of circulatory assist devices that include the intraaortic balloon pump, ventricular assist device and total artificial heart. The synthesis of cardiotonic and vasoactive drugs and advancements in anesthetic management, postoperative monitoring and nursing care greatly facilitate perioperative patient management.
This summary of state of the art cardiac surgery begins with a brief historical background followed by a review of recent advances in six main categories: coronary artery disease, acquired valvular heart disease, congenital cardiac disease, cardiac transplantation, myocardial preservation and mechanical circulatory assistance. In conducting the review of recent literature, particular attention was directed to large clinical series that document the results of contemporary surgical procedures, novel therapeutic approaches to current clinical problems and unresolved controversies in the field of cardiac surgery.
The abundance of surgical literature and constraints on the length of this article do not permit an exhaustive review. Apologies are extended to clinicians and laboratory investigators whose important contributions to the understanding and treatment of cardiac disease are not included herein.
☆ This article is part of a series of articles celebrating the 40th anniversary of the American College of Cardiology. The series attempts to set the stage for the future by describing current state of the art management of selected major cardiovascular problems and the basic knowledge that will provide directions for advances in diagnosis and therapy.