Friedrich Mohr from the Cardiologist's View: A Visionary Leader in Cardiac Medicine

Cardiac surgery and cardiology have been the two most rapidly advancing subdisciplines in medicine which, as a result, have had a major impact on life expectancy in the industrial countries. In the decades of the 1960s and 1970s, they were complementary, that is, conservative management of the cardiac patient by the cardiologist, invasive treatment by the surgeon. At this time heart operations were associated with high mortality rates, and cardiologists were only performing diagnostic procedures in an elaborate manner. This parallel existence started to change after the introduction of coronary angioplasty by Grüntzig et al in 1978,[1] and in particular after the routine use of coronary stents 20 years later. Many surgeons of the first generation could not accept this competition from the other discipline although it was highly appreciated by the patients. It is fully understandable that the pioneers of coronary artery bypass grafting (CABG) were very critical of percutaneous procedures because they had just succeeded in reducing the complication rates of CABG to a very low range. Moreover, only a few surgeons of the next generation were still willing to accept percutaneous procedures as an alternative to open heart surgery, as it is established today and anchored in common guidelines. Friedrich Mohr was among the first to acknowledge the achievements of interventional cardiology and to be visionary enough to seek for cooperation, which in the end funneled in today's “heart teams.”

Upon my first contact with Friedrich Mohr in 1995, when he had just begun to work in Leipzig, I was treated with great respect as an interventional cardiologist, which I had had not previously experienced from cardiac surgeons. Unfortunately, we had no opportunity to work together directly in patient care, but our ways repeatedly crossed from that time on. He was always a strong believer in his profession but could accept less-invasive advances if they were for the benefit of the patient. Obviously, only a surgeon who is excellent and who believes in his skills can digest the fact that part of his working field is taken over by another discipline. Thus, he not only accepted the stenting of coronary arteries in certain indications but also became a leading promoter of catheter-based valve implantation, when some cardiologists were still doubtful. His striving for scientific truth is best illustrated by his leading role in the SYNTAX study, which has become a landmark trial for coronary revascularisation.[2] This characterizes him as a strong supporter of evidence-based medicine.

The German Cardiac Society appointed Prof. Friedrich Mohr as the Congress President for its annual meeting in 2010, an honor that had only once before been given to a cardiac surgeon ([Fig. 1]). He used this honorable position to improve the relations between surgery and cardiology and gave a memorable opening speech.

Fig. 1 Professor Friedrich Mohr addressing the German Cardiac Society at its annual meeting in 2010.

A personal highlight, but also a courageous step for the German Society for Thoracic and Cardiovascular Surgery, was to be nominated for Congress President of the annual meeting in 2012 ([Fig. 2]). The appointment of a cardiologist must have irritated many cardiac surgeons in Germany and acceptance was also not unanimous among cardiologists. It was meant to break down walls between the two professions and foster a team spirit. It seems we still have ways to go before cardiac surgery and cardiology completely grow together as a field of heart medicine. However, Friedrich Mohr has placed several of his team members in leading positions across Germany to carry on his visions.

Fig. 2 Friedrich Mohr and the author during the annual meeting of the German Society for Thoracic and Cardiovascular Surgery in Freiburg 2012.

• References

• 1 Grüntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301 (2) 61-68
• 2 Mohr FW, Morice MC, Kappetein AP , et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381 (9867): 629-638