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J Thorac Cardiovasc Surg 2008;136:267-270
© 2008 The American Association for Thoracic Surgery

Editorial

Cardiovascular surgery as a single specialty: The case to unify cardiac and vascular surgery

Section of Thoracic and Cardiovascular Surgery, The Heart and Vascular Center, Winchester Medical Center, Valley Health System, Winchester, Va

Received for publication February 29, 2008; accepted for publication April 17, 2008.

^_* Address for reprints: Charles Stewart Roberts, MD, 190 Campus Blvd, Suite 410, Winchester, VA 22601. (Email: croberts@valleyhealthlink.com).

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

Cardiovascular surgery came of age in the 20th century. Carrel,^1,2 in the first decade, described an end-to-end suture technique to connect blood vessels, which launched vascular surgery. Gibbon³ in 1953 first used a heart–lung machine clinically, which launched cardiac surgery. Cardiovascular deaths in the United States have led all others every year of the 20th century except 1918, the year of the influenza epidemic.

By the end of the 20th century, cardiovascular surgery was formally separated into two different disciplines, cardiac surgery and vascular surgery. Cardiac surgery is paired with general thoracic surgery as part of the specialty, thoracic surgery, which became a primary board specialty in 1971. Vascular surgery more recently emerged as a surgical specialty, first by establishing its own residency programs and later by gaining approval for a primary certificate in vascular surgery by the American Board of Surgery.⁴ Both cardiac and vascular surgery address disorders of the circulation. In my opinion, they are unnaturally separated and should be unified into one specialty. Here's why:

The organ system is the best determinant of a surgical specialty, not a region of the body such as the thorax or the abdomen. William Harvey, in his 1628 book on the movement of the heart and blood, described arteries, veins, and the heart as a system.⁵ Harvey used the term circle and it variants (circulation, circulate, circular, circuit) 27 times in the last 10 chapters (none in the first 7). It seems incongruous today to partition the circle, to have one specialty treat one part of the circulation and another specialty treat another part of the circulation, depending on its position in relation to the diaphragm or clavicle or whether the heart lung machine is necessary.

Cardiovascular is a better term to describe a surgical specialty than . . . [Full Text of this Article]

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The case to unify cardiac and vascular surgery

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J. Thorac. Cardiovasc. Surg. 2008 136: 271-272. [Extract] [Full Text] [PDF]

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