Landmarks in Cardiac Surgery (review)

Stephen Westaby, with Cecil Bosher. Landmarks in Cardiac Surgery. Oxford: Isis Medical Media, 1997. ix + 683 pp. Ill. $150.00; £89.95.

Stephen Westaby, an English heart surgeon born in 1948 who trained in Cambridge, London, and Birmingham, Alabama, has produced a large and useful book that complements other recent volumes describing the invention and dramatic growth of cardiovascular surgery. He focuses on major technical developments and innovations, and his detailed summaries are perceptive and interesting. As one would expect from a practicing cardiovascular surgeon, Westaby displays a sophisticated understanding of the various operations proposed and performed to treat patients with congenital and acquired cardiovascular disease. Although readers conversant with surgical terminology, tools, and techniques will find his fast-paced narrative interesting, those unfamiliar with cardiac anatomy and physiology and surgical jargon will struggle with certain words and technical details.

This is a twentieth-century story that depends on much more than three generations of ambitious and daring surgeons--many of whom are still alive: modern cardiovascular surgery would not exist without a multitude of pharmacological discoveries such as antibiotics and anticoagulants, technological advances such as the oscilloscope and the heart-lung machine, inventions such as dacron and other synthetic materials, and diagnostic techniques such as cardiac catheterization and angiography. Thousands of surgeons, scientists, clinical investigators, and entrepreneurs (and their vitally important but forgotten support staffs) from around the world created the substrate necessary for the birth and development of cardiovascular surgery.

Without deprecating the important contributions made by specific individuals and institutions throughout the world, the critical role that the U.S. federal government played in fueling the growth of cardiovascular surgery must be acknowledged. The government's enormous and unprecedented financial support of biomedical research and specialty training following World War II provided a fertile context for invention and innovation. The advent of Medicare in 1966 poured billions of dollars into health care, a significant part of which was spent on the diagnosis and treatment of patients with cardiovascular disease. Meanwhile, we must also remember the thousands of children and adults with congenital and acquired heart disease who entrusted their lives to the surgeons who offered them the hope of a better or longer life.

This book is arranged by topic, and chronologically within each topic. Chapters are devoted to the foundations of cardiac surgery, the evolution of cardiopulmonary bypass and myocardial protection techniques, operations for congenital cardiovascular defects, surgical techniques for valvular heart disease, operative approaches for coronary artery disease, surgical techniques for disorders of the thoracic aorta, cardiac transplantation, and mechanical circulatory support devices. Many photographs of individuals and of pieces of apparatus complement the text. There are colored photographic illustrations of the various types of prosthetic heart valves, artificial hearts, and mechanical assist devices. Each chapter includes biographical sketches of the surgeons who contributed significantly to the development of new operations or devices.

More than one-half of the book (pp. 307-646) consists of forty-four "landmark" articles, reprinted in their entirety using a photo-offset duplication process. Westaby selected articles that, most would agree, represent classic contributions to the evolution of cardiovascular surgery. There are separate name and subject indexes. Yet the book has one major shortcoming: there are no references to either primary or secondary sources! This inexplicable decision on the part of the author and/or publisher severely limits the value of what is otherwise a useful book.

I was surprised that so many names were misspelled: for example, Carl Wiggers is Karl Wigger (p. 27), Albert Hyman is Highman (p. 28), James Bovell is Bovel (p. 33), Edwards Park is Edward Park (p. 94), Halsted Clinic is Halstead Clinic (p. 94), Claude Beck is Back (p. 176), Louis Gross is Louis Grosse (p. 190), John Abernathy is Abernethie (p. 227), and Borelli is Bovelli (p. 667). There are many other misspellings. There are also several errors of fact: for example, Celsus was not a physician (p. 2); figure...