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Thoughts on the future of cardiac surgery

When I was asked to write an editorial about the future of cardiac surgery I first thought that I should go ahead and find a definition of what the future is. The definition “the future is the time that follows the present” which I found in Wikipedia was not that helpful at first sight and I remembered that a simple definition was a differentiation between the near future and the far future. As heart surgery performed on a broader basis is only 60 years old I will try to speculate about some trends for the years to come. Surgery has accompanied mankind since the first intelligent human cultures and has survived as a discipline. Surgeons have over the course of history not always been regarded as physicians but have always played a special role in treatment of various diseases. Despite repeated attempts to classify it as a dying discipline, surgery as a specialty is well alive. And so is heart surgery. The only clear statement which can be made is that surgery as a discipline has constantly changed its appearance and will probably do so throughout the coming years. And so will heart surgery. The following trends can be seen: Cardiac surgery has developed as a subspecialty within the surgical community, and the profession of a cardiac surgeon is clearly defined except for the fact that three types of surgeons – pure cardiac, cardiothoracic, and cardiovascular – exist. The latter two are remnants of historical development and my prediction is that due to individual limits of performance capacity further subspecialization within cardiac surgery will occur. Individuals performing the entire spectrum of cardiac, thoracic and vascular procedures will become rare. Cardiac surgery units which during the first phase of development were mostly restricted to academic centres are these days found in all kinds of hospitals including private practice. Two competing trends are seen. One is the foundation of small private heart centres offering heart surgery; the other is the foundation of large mega-capacity heart centres which allow for very economical resource use. My prediction is that depending on regulations at the individual state level both trends will hold. A new trend which is coming is increased use of medical tourism by which expensive heart surgery service can be acquired in an affordable manner by patients migrating from western countries to third world countries. This trend will most probably continue. At the scientific...


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