Felix Unger - Böcker

These are some of the urgent questions posed by this stimulating and wide-ranging new colloquy. Bringing together a wealth of wisdom and experience in medical science and in Buddhist thought and ethics, the discussants together address issues of vital current concern. They ask, for example, to what degree science and religion, as well as other fields of learning, may find common ground. They examine the pitfalls, as well as the opportunities, posed by genetic engineering. They examine the need for science to develop a proper ethical dimension, particularly in relation to weapons of war, if it is to realize its true potential. Exhibiting everywhere a sensitive humanity, as well as a deep respect for their different backgrounds, the participants exemplify in these civilized exchanges a mutual passion for developing dialogue as a profound and practical way of cultivating both toleration and peace.

The uniqueness of human dignity must remain at the centre of all efforts to achieve this goal. They have to be maximised to serve members of society throughout their lives, both for cure and prevention. However, preventive medicine can only be practised in partnership with individuals acting responsibly. A healthcare system on a European scale is an enormous endeavour. Currently, there are severe differences evident in the national provisions. The dichotomy has to be addressed where individual national structures are oriented toward European standards, while the care to the individual is delivered locally. The Strategic Vision aims to address the need for an overall strategy that can be adapted and implemented on the local bases. It puts a specific emphasis upon cost containment. New mechanisms have to be implemented to control the cost of healthcare. Clear rules for delivery are needed to prevent the advent of multi-class healthcare. This requires the development of a new underlying philosophic paradigm.

Das neue Paradigma der Medizin für das 21. Jahrhundert stützt sich auf drei wesentliche Säulen: Zuwendung zum Patienten und Motivation zur Gesunderhaltung, zu welcher mit entsprechend gesunder Ernährung und Fitness der Einzelne selbst einen entscheidenden Beitrag leisten kann - Ultramedizin, die unabdingbar ist - Immer speziellere minimal invasive Methoden können bei Diagnostik und Therapie individuell gezielt dem Patienten helfen - Prävention und Prädiktion, die eine grössere Aufmerksamkeit in Bezug auf die effektiven Möglichkeiten verdienen.Das aktuelle Paradigma ist Grundlage der entsprechenden modernen Ausbildung der jungen Ärzte für die Gesellschaft und basiert auf Zuwendung, Ultramedizin und Gesunderhaltung. Es ist damit die entscheidende Basis der medizinischen Versorgung unserer Bevölkerung, die möglichst patientenorientiert sein sollte.

Attempts to reconstruct various parts of the heart started even before the beginning of open cardiac surgery. By the late 1950s and early 1960 s several closed and open procedures had already been described. In that era, several surgeons in Europe and the Americas were particularly prompted to develop various techniques of valve re­ construction because of the lack of acceptable valve prostheses and conduits which have become available subsequently. At that time, several congenital lesions still defied definitive correction, and clinical attempts at left ventricular wall replacement had not yet got under way. A renaissance in different cardiac reconstructive procedures started at the beginning of the 1980s. As the problems relating to valve prostheses became more generally appreciated and the importance of chamber volumes and geometry (atrial or ventricular) was accorded due importance in the long-term follow-up, there was a resurgence of surgical attempts at reconstruction in congenital and acquired cardiac lesions so as to approximate the natural state. At the same time several characteristics of this reconstructive "discipline" became apparent. First, cardiac reconstructive surgery has remained a surgical "art" with a gradually increasing number of interested cardiac surgeons.

The uniqueness of human dignity must remain at the centre of all efforts to achieve this goal. They have to be maximised to serve members of society throughout their lives, both for cure and prevention. However, preventive medicine can only be practised in partnership with individuals acting responsibly. A healthcare system on a European scale is an enormous endeavour. Currently, there are severe differences evident in the national provisions. The dichotomy has to be addressed where individual national structures are oriented toward European standards, while the care to the individual is delivered locally. The Strategic Vision aims to address the need for an overall strategy that can be adapted and implemented on the local bases. It puts a specific emphasis upon cost containment. New mechanisms have to be implemented to control the cost of healthcare. Clear rules for delivery are needed to prevent the advent of multi-class healthcare. This requires the development of a new underlying philosophic paradigm.

In this book, the latest results in coronary artery surgery are discussed and the factors decisive for long-term prognosis are elucidated. The indications for re-operation are considered and redefined, and the surgical technique with regard to multiple bypass is described. The aim of the book is to depict clearly long-term prognoses and to determinate the future needs of coronary artery surgery in the next decade. This far-sighted approach also makes the book a valuable reference for the planning and extension of cardiology centers in Europe. 1

J. Navratil The performance of operations on the heart and its replacement by a trans­ planted or artificial heart has been an age old dream of man. Rehn for example in an early attempt, in 1868 performed a closure of a heart wound after a thoracic puncture. At that time noone thought that this attempt was the beginning of cardiac surgery. The dream was partially realized when the replacement of the heart function by the heart-lungmachine became possible. Immediately following the first operations, cardiac surgeons and cardiologists saw with great enthusiasm that this machine could be an important tool for correcting congenital and non­ congenital heart diseases. However, the heart-lungmachine was soon seen to not be an optimal instrument for controlling cardiac failure after cardiopulmonary bypass or myocardial infarction. then arose for the development of mechanical assistance to the heart. Concepts The rollerpump was first designed for assisted circulation and could be applied clinically in 1962. A new concept of mechanical assistance to the heart was pro­ vided by the intra aortic balloon pump and later by the bypass ventricles. Use of the intra aortic balloon pump can reduce cardiac work by counterpulsation in accord with the natural ECG. The bypass ventricle can functionally replace the heart in series or parallel to the natural heart. The intra aortic balloon pump, now an established method, has reduced the number of patients who used to die from cardiac failure.

It is a great pleasure to have the opportunity to edit a new volume of "Assisted Circulation". In the past 5 years there have been many changes in the philosophy of assisted circulation. There have been a large number of clinical application- of left ventricular assist devices, biventricular assist devices, and total artificial hearts; one artificial heart was implanted electively in December, 1982, in a patient with an end-stage cardiomyopathy. A great deal of help is necessary in editing a book. I want especially to thank the Austrian Research Council and the University of Innsbruck for their support of my work. I am most grateful to my co-workers R. Schistek, I. Koller, J. Hager, and R. Nessler, and especially to my secretary, W. Kirchner, who had the most secretarial load ofthe editorial work. I would also like to thank Dr. J. Wieczorek, Mrs. M. Schafer, Mrs. M. Griindler, and the Springer staff who gave this second volume an attractive format and made it accurate as usual. It was with great sorrow that we learned of the sad death of Dr. Emery Nyilas in June 1984, who played a great part in the development of artificial hearts. I hope that this second volume will also raise new items for discussion, resulting in new concepts, so that the third volume can introduce new devices and report on more clinical applications.

Assisted Circulation 3 is an authoritative review of the progress which has been achieved in the last 5 years since the appearance of Assisted Circulation 2 in 1984. The present book highlights the work of well-known experts on - new indications for assisted circulation, - cardiac assist devices as bridges toward transplantation, - temporary mechanical heart support, - results of long term studies into problems of tissue overgrowth, infection, and physiological regulation of cardiac devices, and - new results on cardiac transplantation and the new immunsuppresive regima. Assisted Circulation 3 is the latest product of an ongoing effort by the editors to keep readers abreast of recent advances in the field on a regular basis.

Assisted Circulation 4 is an authoritative review of the progress which has been achieved in the last 5 years since the publication of Assisted Circulation 3 in 1989. The present book highlights the work of well-known experts on indications for assisted circulation, cardiac support devices such as bridges, devices for transplantation, devices for chronic mechanical support, biological energy sources, cardiomyoplasty, extracorporeal membraneoxygenation and an overview of cardiac devices support with a specific emphasis on xenotransplantation. Assisted Circulation 4 is the latest product of an ongoing effort by the editors to keep readers regularly informed of recent developments in the field. Assisted Circulation is a standard technology in cardiac surgery and especially in cardiac transplantation.