We live in an age when surgery is effective, almost pain-free and far less risky than ever before. This is a relatively recent development, which we are apt to take for granted.
Consider yourself suffering from rheumatic heart disease a mere 60 years ago. The surgeon would have recommended a widening of the valve performed by inserting his finger blindly into the narrowed mitral valve opening in your heart, a procedure with limited benefits when the valve was heavily diseased.
On September 21, 1960, Albert Starr implanted the first successful artificial valve and ushered in modern open-heart surgery.
Similarly, if you suffered from anginal chest pain, you would have been prescribed medication to alleviate symptoms but the relentless disease progression would have curtailed your life expectancy.
Several operations of dubious value had been tried with the goal of stimulating growth of new blood vessels to supply the starved heart muscle. Other operations purposely damaged nerves in order to alleviate painful symptoms.
On November 30, 1967, Rene Favoloro performed the first successful direct coronary artery bypass and, 30 years later, this became the commonest operation in the West.
The aim remains the reduction and ultimate eradication of cardiovascular and pulmonary disease by means other than surgery
We now live longer, partly as a result of these successes. Age-related degenerative aortic valve disease is the new epidemic.
The plethora of artificial valves available today to treat this condition are the fruits of many years of cooperation between surgeons, cardiologists and engineers.
Aortic valve replacement is routinely performed in the elderly with very gratifying results.
On December 3, 1967, days after Favoloro’s landmark bypass, Christiaan Barnard performed the ultimate operation, a heart transplant. After many years of refinement in aftercare, this operation now transforms beyond recognition the lives of thousands of recipients.
Yet another successful operation, surgical ventricular reconstruction, reshapes the pumping chamber of the heart that has been severely damaged by a massive heart attack. It too can change a person’s life dramatically.
Aortic dissection, an acute ‘catastrophe’ that kills almost all sufferers within 24 hours, is now within the realm of the cardiovascular surgeon. In experienced hands, it can be repaired with a high success rate, bringing new hope to these patients.
All these, and many more operations, are performed in Malta.
Our unit, established in 1995, has treated tens of thousands of patients with diseases of the heart and lungs. Treatment has evolved with less invasive procedures and novel devices.
The aim, however, remains the reduction and ultimate eradication of cardiovascular and pulmonary disease by means other than surgery.
On World Heart Day, I look back at my career spanning over 35 years in this speciality and reminisce over many fascinating experiences and many a brave patient.
My practice has evolved such that it bears no semblance to that in 1983, when I first ventured into a cardiac theatre. I look to the future and hope that patients will adopt a healthier lifestyle and that future scientists will unlock the secrets of a long and happy life.
Alex Manché is the chairman of the Department of Cardiothoracic Surgery at Mater Dei Hospital.