Evaluating the Results of Cardiac Surgery

DEVELOPMENTS IN CARDIAC surgery over the last 30 years have made consideration of surgical treatment part of the evaluation of most patients with heart disease. Naturally, surgery's most active proponents and innovators have been, in general, surgeons. Nonsurgeons frequently have been passively skeptical concerning these new forms of treatment, and occasionally have been actively resistant to them. Interestingly, surgeons who have developed new operations have sometimes themselves later become skeptical about even newer procedures which threaten to make their procedure obsolete.1 The proponents and the skeptics of new operations have interacted in such a way that on occasion each has used techniques of persuasion that pass the bounds of scientific medicine. We must be cautious in criticizing these events too severely, for the world of cardiac medicine and surgery in our lifetimes has been interesting and highly productive. But from time to time we do need to review the rational process of evaluating the results of cardiac operations. Dramatic and sensational as some of the surgical advances have been, these characteristics are not useful in establishing their place in the therapeutic armamentarium. Physicians and surgeons are cognizant of the importance to the individual patient of their direct