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Ann Thorac Surg 2005;79:1470-1472
© 2005 The Society of Thoracic Surgeons
a Cleveland Clinic Foundation, Cleveland, Ohio
b Medical City Dallas Hospital, Dallas, Texas
* Address reprint requests to Dr Mack, 7777 Forest Ln, Suite A323, Dallas, TX 75230 (E-mail: mmack@csant.com).
| The first 300 words of the full text of this article appear below. |
"In times of change, the learners inherit the Earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists."Eric Hoffer
The last 50 years have been halcyon days for cardiac surgeons. The technological innovations of cardiopulmonary bypass and heart valve prostheses led to the development of the specialty in the early 1960s. The subsequent development of coronary bypass surgery, an effective anatomic treatment for the most common life-threatening disease in Western society, led to an explosion in the number of cardiac operations performed and changed cardiac surgery from a specialized service performed only at major medical centers to surgery practiced at many community hospitals. The mid 1970s to the present has constituted the "industrial era" of cardiac surgery. The income generated by relatively standard and reproducible cardiac operations has fueled a dramatic expansion of the medical infrastructure in centers large and small throughout the United States.
During this period of time, "cardiac surgery" has meant an operation performed through a median sternotomy with the use of cardiopulmonary bypass. The coronary bypass operation performed with this approach, the basis of cardiac surgical practice in mostSee page 1812 centers, is an effective operation that has produced good short-term and long-term outcomes. Any fundamental technical innovation within cardiac surgery during this period of time has been relatively modest for many reasons. There has been an understandable reluctance to tamper with success and neither the competitiveness of practice nor medical and legal considerations consistently reward technological innovation in the United States practice setting. Financial imperatives at many institutions have provided impetus for surgeons to concentrate on standard procedures that were important for the economic well-being of the institution. The changes that have occurred in bypass surgery have been mostly incremental improvements of the standard
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