Letter from the Editor

M*A*S*H – More About Surgery of the Heart?

Robert Altman gave us M*A*S*H. He turned Richard Hunter's novel into a hugely successful movie to be followed by a long-running TV series. In this he immortalized the image of the archetypal grumpy thoracic surgeon in the character of Captain “Trapper” John McIntyre: always a bit difficult, at the same time very down to the point, acting swiftly, and having a great sense of sarcastic humor.

Somebody gave Robert Altman her heart. At the age of 71 he underwent a heart transplantation. He made this public only ten years later in 2006 at the occasion of his Academy Honorary Award (aka the “Oscar”), having been afraid of not getting any more projects if it would have been known that his health was at risk. In his laconic style, worthy of “Trapper” himself, he remarked in an interview with Variety magazine that “I have a female heart, I think. It feels like it. It's about 40 years old now …” – when he was 81. Richard Altman died later that year, in 2006, from leucemia, supposedly a sequela of chronic immunosuppression – or merely age.

This Hollywood biography mirrors the story of heart transplantation. It has become an established if ultimate treatment option for selected patients. It is still afflicted by a stigma. It is not without danger in the long term. And many of its mysteries will probably remain unsolved forever. For the very first successful heart transplantation on December 3rd 1967 Christian Barnard also used the organ of a female donor, who had become the victim of a traffic accident in front of the Groote Schuur Hospital, for a male recipient with end-stage coronary heart disease many years her senior. Meanwhile, molecular techniques have proven that an organ recipient becomes a chimera. The psychological implications of this fact remain manifold and continue to fascinate the imagination of fiction writers. Does an elderly man, having received the heart of a young Mexican woman, start watching soap operas? Is he irritable towards the end of a month? Does he develop a craving for enchiladas? Does he wonder where his heart came from? Clint Eastwood, in his adaptation of Michael Connelly's novel Blood Work, personifies the thoughts, worries, fears of such a patient in a commanding way.

In this issue of The Thoracic and Cardiovascular Surgeon we have concentrated on thoracic organ transplantation. The articles cover a wide spectrum from basic research to technical discussions to the highly political and relevant issue of organ allocation. Editorial Board member Hermann Reichenspurner has written an outspoken Invited Commentary on what the situation in Germany is really like. Very unusual, but an editor's delight, is a painstaking bibliometric analysis of lung transplantation research articles. It reflects both the enormous scientific development achieved over a relatively brief period of time as well as the staggering increase in scientific publications as such.

Extracorporeal Life Support can, in a way, be regarded as a short-term heart transplantation substitute. The German Society for Thoracic and Cardiovascular Surgery is publishing its recommendations for the appropriate use of these highly invasive techniques which have become the subject of much controversy. Potential pitfalls are illustrated by a complementary study on cannulation issues. Yet another “official” paper explains the new changes implemented in GERAADA, the society's highly successful and constantly growing database on aortic dissection. Concomitantly with the publication of this issue the new, improved version will be launched on the website.

Please enjoy your reading – I won't keep you any longer. Final cut to “Trapper” John: “We are the pros from Dover and we figure to crack this kid's chest and get out to the golf course before it gets dark.”