Introduction

Abstract

It is important to remember before discussing in depth this particular aspect of heart disease that we are still faced with many major deficiencies in the surgical treatment of cardiac disease. Approximately half of the deaths in the United Kingdom and the United States of America were cardiovascular and of these approximately 17% were under the age of sixty-five (Figure 1.1). Many of these people could have been treated by surgical means and yet examination of the number of operations done in that year shows that only approximately 1% of these people received surgical care. The figures for heart replacement are even more unsatisfactory; in the whole world only a handful of patients had their hearts replaced. Many young people who were otherwise fit have died simply because they did not have enough myocardium to support their circulation. What is perhaps worse than this failure to apply heart transplantation has been its unfavourable reception. It is a reasonable and satisfactory procedure with good results for this early stage in its development, despite the horrendous mortality rate which daunted the first replacements of the aortic valve and the early disastrous attempts to repair complex congenital difficulties of tetralogy of Fallot. It would be better if the new was compared with the established and not with the theoretical, and if more consideration was given to the fate of the patient with terminal heart failure.