Dawn and Evolution of Cardiac Procedures: Research Avenues in Cardiac Surgery and Interventional Cardiology

355 Pages·2013·7.045 MB·English

by  Yves Glock (auth.), Marco Picichè (eds.)

Marco Picichè
Editor
Dawn and Evolution
of Cardiac Procedures
Research Avenues in Cardiac Surgery
and Interventional Cardiology
Foreword by
Alain Carpentier
Dawn and Evolution of Cardiac Procedures
Marco Piciche`
Editor
Dawn and Evolution
of Cardiac Procedures
Research Avenues in Cardiac Surgery
and Interventional Cardiology
Foreword by Alain Carpentier
123
Editor
MarcoPicichè
Cardiac SurgeryUnit
San Filippo NeriHospital
Rome
Italy
ISBN 978-88-470-2399-4 ISBN 978-88-470-2400-7 (eBook)
DOI 10.1007/978-88-470-2400-7
SpringerMilanHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2012943630
(cid:2)Springer-VerlagItalia2013
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To my father, a man of the utmost integrity
and a devoted parent
To my little Elsa; Mirta and Bernardo
To my mentors of surgery
Foreword
Onecenturyago,nosurgeonwouldhavedaredtouchalivinghumanheart,which
representedthelastfrontierinthedevelopmentofsurgery.End-stageheartdisease
was regarded as the normal termination of life. A few surgeons and cardiologists,
however, did not accept this fatality and began dreaming about sophisticated
procedures to take up this challenge. Development of novel cardiac surgery pro-
cedures required imagination and faith and, indeed, took decades of strenuous
work in research laboratories by unknown pioneers. Nothing is more instructive
thanthehistoryofthesedevelopmentsandthatofthemenandwomenwhoserved
themandbroughtthemtobe.AsterlingexampleisthebehaviourofJohnGibbon
facingthetragiclasthoursoflifeofawomansufferingfromamassivepulmonary
emboli. He felt guilty of not having the means to save her life. During the very
night he stood at her bedside, he conceived the heart–lung machine and drew the
energyandperseverancerequiredtodevelopit.Ittook20yearstodoitandtoday
millionsofpatients have benefited fromthisinvention. Attheoppositeendofthe
complex chain of innovation, stands the charismatic figure of the first interven-
tional cardiologist, Andreas Gruentzig who conceived and developed the trans-
cutaneous balloon dilatation technique for arterial stenosis, which also benefited
millions of patients.
Between its two extremities, the chain comprises many research scientists,
surgeons and cardiologists who should be strongly commended for having turned
cardiac surgery and interventional cardiology into the disciplines we practise
today.A50-yearoldsagaduringwhichmillionsofpatientshavebeensavedfrom
diseasesthathithertohadbeeninvariablyfatal:tuberculosis,bacterialendocarditis,
myocardial ischemia and rheumatic valvulopathies. Fifty years of tireless, daring
work and tenacity from the pioneers who made our specialty what it has become
today. From bench to bedside, these pioneers explored new procedures in a time
when theprice ofafewvictories waspaid for byanappalling number ofdefeats.
Theyoftenfacedbittercriticismandscepticismfromtheirpeersorthepublic,but
had the courage and the faith to persist, to go forward, to persevere.
The editor Marco Picichè and the authors of this fascinating story should be
congratulated for having brought these pioneers and their contributions into the
limelight. The readers, and particularly the younger ones, will find not only a
precioussourceofinformationandinspirationinthisbook,butalsotheforcesthey
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viii Foreword
needtocontributetotheopeningofnewavenuesofresearchwhichwillhopefully
lead to yet further progress in the field.
Sinceweknowthattime,windandraintendtoerasehumantracksinthesands
oflife,thisbeautifulbookwillserveinadditionasavibranthomagetopioneersin
cardiac surgery and interventional cardiology. A true masterpiece!
Alain Carpentier
Preface
Like the history of peoples, wars, geopolitical conflicts, and all great social
movements and developments, the history of cardiac surgery must be constantly
questioned and reviewed as new documents come to light or new interpretations
suggest themselves for old documents. Just as courageous and determined indi-
viduals have faced down the forces of nature over the centuries to make history
withgreatexplorationsoflandandseaoramazingdiscoveriesofflight,sotoohas
the indomitable human spirit shaped the history of cardiac surgery.
The origins of cardiac surgery are dramatic. It took root in suffering and has
developedandevolvedthroughanincalculablenumberofdeaths.Itistheproduct
of the effort and abnegation of visionaries who were often criticized and at times
dismissedasmad,aswellasthedespairofpatientswillingtosubjectthemselvesto
new and untried procedures in the hope of cheating death.
While often disregarded, the history of scientific inquiryhas much to teach us.
It can establish important links between past and present, providing a better
understanding of current practice and charting a more realistic and imaginative
path to the future. Old ideas and experiments, released from the technological
constraints of their time, can also be very useful in current research with its
modern toolsand enhanced knowledge.Ingenious theories that have fallenby the
wayside can be brought back and explored again. What is more, when we learn
and know about history, we pay tribute to those whose forward-thinking ideas
formed the embryo of our daily practice.
This book’s potential usefulnesstoresearch wasits maininspiration. From the
outset I conceived the book not as a mere history text but as a history text for
researchers. Each author of each chapter was asked to gather original writings
from libraries and the Internet and look at them anew, to offer current and future
cardiovascular researchers a detailed overview of previous investigative efforts
and an understanding of the thinking and mentality of our predecessors.
Withinterventionalcardiologyandcardiacsurgeryonacourseofconvergence
likely to culminate in hybrid management of coronary revascularization and
transcatheter aortic valve replacement, this book also includes the history of
percutaneous cardiac procedures. Increasingly, therapeutic heart procedures are
consideredasawhole,withsomeobserversmaintainingthatthesedisciplineswill
somedayjointogetherinasingleresidencyprogram.Oneofthistext’sobjectives
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x Preface
is to offer future residents a complete overview of the field and thus deepen their
personalunderstandingoftheissuesatplay.Pagesonmini-invasiveandsutureless
valve surgery have also been included, to further assist the reader in transitioning
from past to present and future.
FromtheInternetandhigh-speedtransportationtogeneticsandroboticsurgery,
wearelivinginaneraoffreneticscientificprogress.Althoughnoonecanpredict
the future frontiers of medicine, it is worthwhile remembering what Theodore
Billrothhadtosay:‘‘Asurgeonwhotriestosutureaheartwounddeservestolose
the esteem of his colleagues’’ (1883). And the words of Stephan Paget: ‘‘Surgery
of the heart has probably reached the limits set by Nature to all surgery. No
method, no new discovery, can overcome the natural difficulties that attend a
woundoftheheart’’(1897).Aftermillionsofopenheart operations since 1953—
thedateofthefirstsuccessfulcardiopulmonarybypassoperation—suchstatements
give pause.
To help speed the dawn of progress for the heart’s ‘‘two sister disciplines,’’
I have brought together an international team of cardiac surgeons, interventional
cardiologists, anesthesiologists, biomedical engineers, and perfusionists, for a
grand total of 60 authors from 22 centers and six countries: Canada, Australia,
France,Switzerland,Belgium,andItaly.Allowmetoexpressmygratitudetoeach
of them for their enthusiastic support of the project and the very high quality of
their writings.
Asitismypleasuretopersonallyknowalmostallofthem,Ihaveattemptedtofit
eachchaptertotheprofileandinterestsofeachauthor,soastoofferthereaderthe
best in quality and knowledge. I feel particularly honored as some have been
surgerymentorsofmine,makingtheircontributionsparticularlymeaningfultome.
Besides the above-mentioned objectives, I also wish to salute the many
investigators who, despite the value and innovativeness of their work, are still
unjustlyignoredbyagreatpartofthescientificcommunity.Itismyhopethatthis
bookwillfinallyearntheirnamestheirrightfulplaceintheannalsofthehistoryof
science.
Marco Picichè
Introductory Remarks
Itisfascinatingandinspiringtolookatthepastandconsidertheincredibleefforts
ofthescientificcommunitytocreateinnovativesolutionsforthebenefitofpatients
with heart diseases. The extraordinary progress in cardiology and cardiac surgery
has had a great impact on the natural history of these diseases, with constant
improvement in survival and quality of life over recent decades.
At this point in time, however, more radical changes in clinical practice are
expected owing to the pronounced variation in the epidemiology of heart disease
in different patient populations and the widespread availability of new
technologies.
There is no question that in the future, all patients with heart disease will be
treated in a multidisciplinary integrated environment by different specialists with
access to a wide variety of therapeutic options. The care will be personalized
accordingtoindividualneeds,takingintoaccountthespecificityofthedisease,the
clinical condition, the general risk profile, and the personal wishes of the patient.
Such a scenario is consistent with the concept of patient-centered care. Patient-
centered care isdefinedas ‘‘care that isrespectful of and responsive to individual
patientneeds,preferences,andvalues.’’Amultidisciplinaryintegratedenvironment
which includes specialists with different responsibilities and skills who work
togetherasa‘‘disease-focused’’teamismandatoryfortailoredpatientmanagement.
Let us consider, for example, a relatively common disease affecting the heart:
ischemic cardiomyopathy. Many diverse pathophysiological conditions are rec-
ognized as being responsible for left ventricular dysfunction, contributing to the
picture of heart failure. Patients differ considerably depending on their patho-
physiology. Ischemia, stunning, hibernation, LV remodeling with or without
dyskinetic areas, mitral regurgitation, LV dyssynchrony, various types of
arrhythmia, etc. can be identified in the individual patient and specifically
addressedbyappropriatetreatment.Inextremecases,evenhearttransplantationor
ventricularassistdevicescanbeconsidered.Itisclearthat,duetothecomplexity
of the disease and the variety of possible procedures, different cooperating and
interacting specialists are necessary for diagnosis, decision-making, and therapy.
These include imaging experts for viability studies; anesthesiologists, cardiac
surgeons, interventional cardiologists, and electrophysiologists for most possible
interventions; and clinical cardiologists for medical therapy.
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