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J Thorac Cardiovasc Surg 2002;124:1-6
© 2002 The American Association for Thoracic Surgery

Presidential Address

Presidential address: Value, viability, and valves

From The Children's Hospital and University of Colorado Health Sciences Center, Denver, Colo.

Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, San Diego, Calif, June 20-23, 2001.

Received for publication Jan 16, 2002. Accepted for publication Feb 8, 2002. Address for reprints: David R. Clarke, MD, The Children's Hospital, Cardiothoracic Surgery, B200, 1056 E 19th Ave, Denver, CO 80218 (E-mail: clarke.david@tchden.org).

The first 300 words of the full text of this article appear below.

	Introduction

 
Members and guests of The Western Thoracic Surgical Association, I would first of all like to thank Don Doty for that outstanding introduction. It is much appreciated.

The dictionary definition of value includes (1) desirable use for an important quality, (2) having intrinsic worth, and (3) worth in money or goods. The measurement of value differs depending on one's point of view. Measured by the cardiac patient, quantity of life and quality of life are important. Measured by the cardiac surgeon, the ability to give value to patients is important, and professional and personal relationships are certainly of value. When value is measured by the health care system, cost, outcome, and availability are the yardsticks.

Viability is (1) the ability to survive, (2) the ability to take root and grow, and (3) the quality of having real meaning or pertinence. Once again, point of view affects the measurement of viability. From the patient's perspective, viability translates into active, meaningful survival and growth potential. To the surgeon, viability means professional development and personal fulfillment. To the health care system, viability is the cost-effective use of resources.

For our purposes, valves are defined as membranous folds or structures that permit blood to flow in one direction only. Many questions surround cardiac valves. What determines value in a replacement heart valve? Is valve viability significant? Is the ideal replacement valve made by man, by nature, or by some combination of both?

The historical perspective of cardiac valve surgery is important to the understanding of current practices and future possibilities. Valve stenosis was the lesion that was addressed initially. In 1914, Tuffier performed the first valve operation when he dilated a stenotic aortic valve with his finger. ¹ The patient survived the procedure but the long-term success of the operation is unknown.

As cardiac surgery . . . [Full Text of this Article]

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