Cardiac Surgery in the Adult

Here we have the opportunity to partake of the genesis of a surgical classic. Cardiac Surgery in the Adult follows the original edition, edited by L. Henry Edmunds, Jr, published in 1997, and the second edition, edited by Lawrence H. Cohn, published in 2003. For this third edition, Dr Cohn has taken on the editorial assignment again. In the ten years since publication of the first edition, this compendium has become the standard reference in the field. This latest edition solidifies this pivotal role.

The book is an encyclopedia of cardiac surgery in adults, with chapters ranging from the history of the field to stem cell–based therapies. Included are scholarly but accessible summaries of current knowledge about the physiology of the heart and the pathophysiology of cardiovascular disease, the nature and roles of various diagnostic procedures, summaries of the principles of preoperative evaluation and postoperative care, key tenets of cardiac anesthesia, detailed descriptions of the surgical treatment of coronary artery and valvular heart disease, the potentially catastrophic disorders that affect the aorta, and up-to-date expositions of cardiac replacement, mechanical support, and other current and future therapies for the failing heart. The included DVD with surgical clips is a novel addition.

One of the more remarkable realities documented in this tome is the incredible depth and breadth of knowledge about the surgical treatment of cardiovascular disease, nearly all of which has been developed in the last 60 years. The progress merely in the last generation or so is astounding. The standard text in the field 30 years ago barely touched on or did not mention blood cardioplegia, reperfusion injury, cyclosporine, stem cells, dobutamine, bileaflet mechanical valve prostheses, transesophageal echocardiography, coronary and aortic stents, off-pump bypass surgery, transmyocardial laser revascularization, angiogenic growth factors, tissue engineering, or ventricular assist devices. As much as this edition is a testament to the knowledge and persistence of the editor, it stands as a living memorial of the tenacity and inventiveness of all who have contributed to the development of modern cardiac surgery in adults.

Inevitably, and especially in a multiauthored volume, there is repetition. However, this repetition fails to qualify as redundancy. While the authors’ perspectives on beating-heart surgery are offered both in the chapters on minimally invasive and off-pump surgery, it is helpful to have access to the thoughts on such topics of more than one author or group. The same might be said of left ventricular aneurysm, the treatment of which is discussed both in the chapter dedicated to this disorder and in the chapter on complications of myocardial infarction. On the other hand, it is not clear that the discussion of aortic valve replacement requires separate chapters describing the various biological and mechanical alternatives (mechanical, stented bioprosthestic, unstented xenograft, homograft, and autograft valves), although this is the approach taken. In contrast, coverage of mitral valve replacement is appropriately more compact. There are no chapters on ventricular remodeling or cardiac trauma.

These are minor limitations, the identification of which is inherent to the role of book reviewer. The more important observation is that the third edition of Cardiac Surgery in the Adult has earned its place alongside its predecessors as a classic in the field. Established surgeons, and those aspiring to be, will want this volume in their libraries, where its consultation will enhance patient care, teaching, and research.