Landmarks in Cardiac Surgery

Stephen Westaby. 683 pp. Oxford, UK: Oxford University Press; 1998. $150.00. ISBN 1-899066-54-3. During the 20th century, cardiac surgery emerged from the realm of conjecture and speculation into the clinical arena, upstaging less dramatic forms of surgery and winning widespread acclaim for its practitioners. The first cardiac operations were desperate procedures, undertaken mainly to treat battlefield injuries. By 1950, operations on the closed heart had become fairly common. Cardiac surgery did not begin to fulfill its initial promise, however, until the advent of the cardiopulmonary bypass machine in 1953. Once this device made open heart surgery possible, almost every form of heart disease quickly yielded to the scalpel. In 1967, the world was awestruck by the first human heart transplant. Later, we saw the development of left ventricular assist devices and total artificial hearts. Today, heart transplants are routine, and some cardiac operations are being performed as minimally invasive procedures. In view of these advances, it is hard to believe that cardiac surgery is still a relative newcomer. Because of this specialty’s short history, many of its original pioneers remain alive and professionally active. It is fitting that as the 20th century draws to a close, the story of heart surgery be chronicled anew while these history makers are still available to set the record straight. I can think of no one better qualified to compile such a chronicle than the author of this book, Stephen Westaby, who is a cardiac surgery pioneer in his own right. Currently at the forefront of mechanical assist device technology, Dr Westaby is a prolific author who has published 6 previous books. The present volume is an outstanding addition to his bibliography. Landmarks in Cardiac Surgery presents a wide range of information, including some material that I have never before seen in print. In addition to providing historical data, biographical sketches, and “official” portraits, it offers entertaining anecdotes and informal photos that show the human side of cardiac surgery. The first portion of the book (306 pages) consists of 8 chapters, which furnish a continuous narrative concerning the evolution of cardiac surgery. After covering the foundations of heart surgery and the advent of cardiopulmonary bypass, this section discusses congenital heart defects, valvular heart disease, thoracic aortic disease, early cardiac transplants, and mechanical circulatory support. At the end of each chapter are biographical sketches of the pioneers who contributed to the developments covered by that chapter. The narrative is exceptionally well written, informative, and entertaining. Of particular interest are the many quotes from eminent surgeons, whose words of wisdom are highlighted in special text boxes. The second and largest portion of the book consists of 2 appendices, the first of which presents 44 landmark journal articles in cardiovascular surgery, accounting for 339 pages. By collecting all of these articles under 1 cover, the author has performed a valuable service. Because each article is in its original format, this portion of the book resembles a volume of bound reprints. The second appendix (18 pages) lists the chief pioneers of cardiac surgery, along with their major accomplishments. The book contains such a wealth of information that one wishes it were somewhat better arranged. The overall layout is satisfactory, but the biographical sketches suffer from inconsistency and unevenness in presentation. Because individual pioneers are listed according to the field in which they made their greatest contribution, it is not always easy to find the entries for those who were active in more than 1 field. Moreover, within each chapter, the order of the biographies is neither alphabetical nor chronological but rather appears completely random. Therefore, in looking for a particular entry, one must often resort to the index. In addition, the number of the biographies is uneven from 1 chapter to another. For instance, the chapter on mechanical circulatory support is followed by only 1 biography; the remaining pioneers in this field are described either within the chapter itself or at the end of other chapters. These problems would have been solved if all the biographies had been presented alphabetically, in a separate section of their own, making the book much handier for researchers. Unfortunately, my review copy of the book was poorly bound. After minimal handling, the cover started to pull away from the pages. I hope that this is an exceptional case and not typical of the other copies. Despite these drawbacks, Landmarks in Cardiac Surgery is a valuable resource that belongs on the shelves of cardiac surgeons, cardiologists, historians, biographers, and others interested in the evolution of medicine and surgery. I congratulate Dr Westaby for undertaking this ambitious chronicle and producing such a fine result. Denton A. Cooley, MD Surgeon-in-Chief Texas Heart Institute Houston, Tex