The power of surgery

Our profession of cardiovascular and thoracic surgery is more and more challenged by the rapid development and increasing application of interventional techniques. At numerous meetings, we are confronted with grandiose announcements proclaimed by cardiologists: ‘Currently we treat almost all coronary patients, in the future we will also take over the cardiac valve business’. It is quite natural that, within the surgical community, these developments are accompanied by a certain degree of anxiety and restlessness. The existing system is pressurized by the implemented changes and fear arises. Man is a creature of habit and it is difficult to cope with our current fast-moving times, in which nothing will be the same as it is today. Many dynamic developments are based on technical innovations and do not only concern us but also several other branches. I will give three examples, which are representative of numerous events. The fact that banking operations are being done to an increasing extent online resulted in closing of a growing number of branch offices. Traditional media and newspaper publishers are having a hard time in the era of Internet, Google and Co. News is no longer purchased at newsstands, but is read on the iPad. In the USA, radiologists are feeling the pressure of globalization and technical innovations. At some hospitals in India and Australia, the evaluation of CT scans is delegated to doctors. Having all these radical changes in mind, I am not concerned. I am deeply convinced of the fact that the fully trained cardiovascular surgeon will always be able to meet the requirements of our constantly changing times, under one condition that we are willing to experience change and are open for new information and skills. Aristoteles said: ‘I can’t change the direction of the wind, but I can adjust my sails to always reach my destination’. The fact that surgeons have always done so is demonstrated in the history of surgery. Looking into the past makes us aware of the enormous changes and developments that lie behind us. Let us take a look at our workplace and compare an operating theatre today with one in the early days (Figs 1 and 2). Illumination, hygiene, clothing and devices are worlds apart and we have not spoken about the actual work of a surgeon yet. The heart was regarded as a taboo zone for a long time. While brain operations were being performed, the heart was still avoided. Interventions on the motor of life were considered presumptuous. At the beginning of the 19th century, the surgeon’s principal task was to amputate arms and legs. At the time, of course, these operations were performed without anaesthesia. Every effort was made to complete the procedure as soon as possible so that the patient would be exposed to the intolerable pain for a minimum period of time. An almost incredible story is handed down from those times: A surgeon, who was known for working fast, inadvertently cut-off the finger of one of his assistants while performing an amputation. The patient and the assistant subsequently died of sepsis. One of the observers was overwhelmed by the drama of the operation. He experienced a heart attack and also died. This is the only operation I know of with a mortality rate of 300%. However, the surgeons of earlier generations are known today not only for their unimaginable working conditions, unconditional swiftness and peculiar events. They are also known for their innovative drive, courage and joy of discovery. One of the most well-known persons among these medical adventurers was the German surgeon Werner Forßmann. As a 25-year-old assistant in 1929, he proved—on his own body—that one can insert a long, flexible catheter from the crook of the arm into the heart. Forßmann had to perform the procedure in secret because his seniors had forbidden the experiment. With this discovery, Forßmann laid the foundations of modern cardiac medicine. Cardiac defects and many heart diseases could only be diagnosed with the catheter. This achievement was not appreciated at all at the time. His contemporaries reacted, at best, with disinterest. Some reacted with mockery or disapproval. It was 10 years later that two American scientists transformed his pioneering achievement into a breakthrough. A further 17 years later, Werner Forßmann received the Nobel prize for medicine in 1956. The history of surgery is clearly one of persistent change. Charles Darwin stated: ‘It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change’. Surgeons of the past were pioneers with a willingness to broach new pathways. Time and again, they demonstrated their courage and willingness to take risks. If this had not been the case, we Presented at the 29th Annual Meeting of the European Association for CardioThoracic Surgery, Amsterdam, Netherlands, 3–7 October 2015.