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Advances in Cardiology and Cardiac Surgery

Remarks of Dr. Craig Smith - Past President, American Association for Thoracic Surgery

At the 92nd Annual Meeting of the American Association for Thoracic Surgery held in May 2012 in San Francisco, Craig R. Smith, MD, Chairman of Surgery, NewYork-Presbyterian/Columbia, addressed the attendees as outgoing President (2011-2012). Reflecting on a wide range of subjects, Dr. Smith also commented on advances and innovations in surgery and medicine today and, as one example, transcatheter aortic valve replacement.

Innovation is driven by people who generate ideas. By people who are constitutionally incapable of focusing on tiny inflections along the asymptotic part of the technology curve, where quality becomes the primary, innovation-stifling objective. These are people, by the way, who often chafe under the yoke of what many call education. Specific forecasting matters little when you know where to look for these people. Find them, and you know where the next big idea will come from, even if you do not know what it is.

On these points, transcatheter aortic valve replacement is instructive. In the idea stage, and in early experimental development, it seemed a reckless fantasy for which the most common forecast was a 100 percent stroke rate. In a surprisingly short time, it has become available for commercial use for certain situations, and the forecast everyone wants to hear is how soon it will completely replace surgical aortic valve replacement. We missed the chance to learn from history, and again sat on the sidelines, driving surgical aortic valve replacement along its quality asymptote, mistaking mini-this and mini-that for innovation, while cardiologists had all the fun.

We awoke from our slumber in time to form exciting new collaborative relationships with our cardiology colleagues, who began teaching interventional skills to a small cadre of cardiac surgeons. We have now proved that fully trained cardiac surgeons can learn, and practice cardiac surgery and interventional cardiology, in all their flavors. As we mint more and more of these chimera, their creativity will take us in new and surprising directions, on both sides of the former cardiology/surgery divide. Where did these pioneering chimera come from, and where will their successors come from? They will come from this audience in front of me.

The men and women who will carry our specialty and this Association forward after we have gone will be very similar to those who preceded them. Not because they will be performing the same procedures we perform, in the same way, but because they will have the same traits and share similar values. They will not need to be engineers or biochemists or geneticists. They will be men and women for whom the multifaceted excitement of uncertainty is irresistible. They will be men and women who infinitely prefer haggling in a sweaty marketplace of unanswered questions to lounging in a temple of unquestioned answers. Combine that with restless curiosity, imagination, creativity, persistence, and risk-embracing boldness, and the development of revolutionizing treatments of disease in the thorax and blood vessels will come from us.

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