2006 William W. L. Glenn Lecture–Rebuilding the Heart: New Horizons for Cardiac Surgeons
Cardiac surgery is changing today, as it was during the time of Dr William Glenn. In those days, cardiac surgeons were trained to do thoracic and vascular surgery.Today, cardiac surgeons are retraining to do intravascular and minimally invasive cardiac and vascular procedures. However, today’s cardiac surgeons should also retrain to employ gene-enhanced cell therapy to modify both the heart and the vasculature to improve the outcomes of their interventions. Cell transplantation has come of age and is undergoing extensive clinical trials. The implantation of precursor cells induces angiogenesis, improves regional and global function, and enhances the recruitment of reparative cells to the heart. In addition to correcting anatomic cardiac lesions, surgeons may be able to restore function to the heart by a combination of cardiac regeneration and rejuvenation of the response to injury. Tissue engineering may restore heart function without synthetic materials, provided the surgeon employs the right combination of cells and biodegradable scaffolds. These grafts may be ideal for the surgical repair of congenital cardiac defects, and clinical trials are underway. The implanted grafts grow and remodel as the child becomes an adult. Cardiac surgeons are retraining to acquire new skills to correct cardiovascular defects. In addition, surgeons should acquire the knowledge required to regenerate and rebuild the heart and vasculature.