View from North America's cardiac surgeons.

Over the last 50 years, cardiac surgery has evolved into a dominant specialty for the treatment of heart disease, especially coronary heart disease which remains the world's leading cause of death. The advent of effective stenting for coronary heart disease has coincided with a plateau and then reduction in the volume of coronary surgery in most developed health care economies over the last few years. Similarly an ageing population coupled with changes in the epidemiology of valve disease from predominantly rheumatic to predominantly degenerative disease is reflected in an increasing demand for surgery for mitral regurgitation and aortic stenosis in the elderly frequently coupled with coronary surgery. Many surgical practices depend on high volume coronary surgery so this growth in valve surgery will have only limited impact on the threat from a reduction in coronary surgery. It is imperative that the specialty explores new innovations since the long-term future of the specialty is inextricably dependent on pioneering activities similar to those of the founding fathers of the specialty.