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Eur J Cardiothorac Surg 2004;26:237-238
© 2004 Elsevier Science NL

Editorial

The cardiothoracic surgeon and the basic scientist

Department of Surgery, Ulleval University Hospital, University of Oslo, 0407 Oslo, Norway

^* Tel.: +47-2211-9757; fax: +47-2211-7470
e-mail: i.j.vaage{at}ioks.uio.no

The Noble Prize in medicine for 2003 was awarded to two non-medical scientists, the chemist Paul Lauterbur and the physicist Peter Mansfield for their work to create and develop magnetic resonance imaging. The really basic discoveries in medicine leading to the achievement of the Noble Prize, is now more as a rule than otherwise made by non-medical basic scientist.

In cardiothoracic surgery the traditional image is that of the brave surgeon standing in the operating room all night long performing new, brave and maybe revolutionary operations and developments in direct contact with the patient. And this has been, and is still partly true. The heart lung machine was constructed by Gibbons and Gibbons, and in the first decade following the start of heart surgery, our surgical forefathers frequently performed ‘the first’ of a variety of operations. Amplifying the image of the clinically inventive surgeon is the fact that during the 50 years of open-heart surgery, the clinical developments have evolved so rapidly that procedures may even have become outdated before supplementary data could be produced in the research laboratory. Unfortunately, in some cases this development has been too rapid fast and with too little scientific foundation.

However, the image of the lone and clinically inventive surgeon is not the only truth. The European masters behind two heart valves with world wide successes, Viking Bjørk and Karl Hall, both worked closely with engineers in the development of the design. The valves would never have been made such a success without the engineering expertise.

In this number of the journal there is an article by Szabo et al. [1] on a new computer model of mitral valve hemodynamics. This is an excellent example of today's collaboration between cardiac surgeons on one side and computational and engineering expertise on the other side. The collaboration enables an accurate simulation of transmitral flow curves from pressure signals, or inversely, the estimation of pressure values from transmitral flow signals. Theoretically this can be very useful for non-invasive diagnostics. Some readers may be skeptical towards the policy of publishing a work which is easily readable for only a small minority of the readers of the journal. However, if we only publish works in the mainstream of interest to the practicing surgeon, we do not fulfill our purpose and duty to promote novel and potentially important developments. But only the future will tell whether a specific work represents a real breakthrough.

To promote the development of our speciality it is important to encourage such works as the investigation by Szabo et al. [1]. We have to realise that other professions can add to and elevate many of our studies to a level we never could reach ourselves. Even if we may be next to God in the operating room, there is no guarantee that we are anything, but at best eager amateurs in engineering, in cell biology, and in basic science in general.

Why should cardiothoracic surgeons get involved in basic science? Why cannot we just leave the basic science, the molecular biology, and the engineering and computational science to those who are true professionals in these fields? Indeed, the excellence of our speciality is in the operating room, but in the future, more and more parts of the road to excellence will be created outside the operating room. Unless we actively take part in these developments, the chances are they will not appear in our field and leave us in a clinical backwater. Further, our strength as clinicians is that we can identify the areas which need improvement, direct where to go with the knowledge, and thus promoting the evolution of our speciality into a modern, integrated field of knowledge.

Examples of joint efforts are the developments of computer enhanced technology for operations and the transplantation of cells to the damaged myocardium. These techniques are still at a starting level. The first so-called ‘mobile phone’ appearing in the 1960s was like a big suitcase placed in the trunk of the car. Compare this to the cell phones of today. The computer-enhanced surgery and the applied molecular biology in cardiac surgery is at present probably at the stage of the ‘mobile phone’ of the 1960s. We as surgeons cannot be in front performing the necessary basic work in engineering and molecular biology, but we can be in the forefront of initiating collaborations with different professions. We can pinpoint to other professions the specific surgical problems to be solved, and be willing to ourselves grasp the basics of their knowledge to identify possibilities and limitations in order to ensure fruitful collaborations. The percentage of articles with basic science collaboration is increasing in the EJCTS. The study of Szabo et al. [1] is an excellent example, and helps promote the development of cardothoracic surgery as a modern speciality with a dynamic and scientific profile.

Footnotes

Presented at the joint 17th Annual Meeting of the European Association for Cardio-thoracic Surgery and the 11th Annual Meeting of the European Society of Thoricic Surgeons, Vienna, Austria, October 12–15.

References

1. Szabo G., Soans D., Graf A., Beller C., Waite L., Hagl S. A new computer model of mitral valve hemodynamics during ventricular filling. Eur J Cardio-thorac Surg 2004.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jarle Vaage Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vaage, J. Search for Related Content PubMed PubMed Citation Articles by Vaage, J. Related Collections Cardiac - physiology Valve disease