Book Review

Landmarks in Cardiac Surgery

N Engl J Med 1998; 339:1949December 24, 1998

Article

Landmarks in Cardiac Surgery
By Stephen Westaby, with Cecil Bosher. 683 pp., illustrated. Oxford, England, Isis Medical Media, 1997. (Distributed by Mosby, St. Louis.) $150. ISBN: 1-899066-54-3

The development of extracorporeal circulation and the ability to perform surgery on the human heart is one of the greatest achievements of medical science in the 20th century. The extraordinary efforts related to the development of these highest forms of technology that we now enjoy are detailed in this book about the history of cardiac surgery by one of the leading cardiac surgeons in the United Kingdom. The book is interesting, and its approach differs somewhat from the usual historical treatments of medical topics. The method of presentation is personal and in many instances constitutes a behind-the-scenes approach filled with inside information and material conveyed in a somewhat spicy and controversial atmosphere, such as the description of the acrimonious details of the artificial heart saga that took place in Houston in 1968.

The book is unusual in its editorial organization. The first half consists of eight chapters that deal with separate aspects of the history of cardiac surgery. The first is an overview, beginning with the emergence of the idea of actually operating on the human heart and bringing us to the present, highly developed state of technology. The wonderment and forbidden nature of the heart throughout the ages are beautifully catalogued. Subsequent chapters describe the history of valve surgery, coronary bypass surgery, cardiac transplantation, mechanical circulatory support, surgery for thoracic aortic disease, and surgical treatment of congenital heart disease. The author pays a bit more attention to the areas he is interested in, and thus, less information is provided on valve surgery, particularly aortic-valve surgery, but a great deal of information is provided on mechanical circulatory support, an area in which the author is an acknowledged expert.

The second half of the book contains facsimiles of seminal articles on cardiac surgery, such as the report of the first valve operation by Cutler and Levine in 1923 at Peter Bent Brigham Hospital in Boston, and biographies of a select group of pioneers in cardiac surgery. Thus, half the book is text, and half consists of reproduced articles and biographies. There are also biographies in the text half of the book of other physicians who were instrumental in the development of specific areas of cardiac surgery.

The book is slanted toward the author's experience with physicians whom he has worked with and obviously admires, including John Kirklin, Denton Cooley, and Russell Brock, all of whom have had long and illustrious careers in cardiac surgery. But by and large, Westaby does incorporate most of the essential aspects of the history of cardiac surgery in the 300 pages of text.

It is a readable book, nicely organized and packaged. There are some errors in pagination in the table of contents and the subject and name indexes are incomplete. This entertaining book is a personal history of cardiac surgery. It offers a reasonably accurate, colorful account of one of the greatest advances in health care technology in the 20th century.

Lawrence H. Cohn, M.D.
Harvard Medical School, Boston, MA 02115