The Responsibility of the General Thoracic Surgeon in Cardiac Surgery

Cardiac and intrathoracic vascular surgery has arrived at the point where certain established operations may be safely carried out by the general thoracic surgeon in a non-university hospital. The medical responsibility for the proper handling of such operations is shared equally by internist, surgeon, and anesthesiologist. Accurate preoperative diagnosis is essential to the proper management of the individual case in order for the operating surgeon to be sure that he will be able to carry out a technique previously proved to be generally effective. Diagnostic problems of any sort must be referred to cardiac catheterization laboratories whose function it is to clarify difficult and complicated situations. Exploratory cardiotomy as well as new operations whose techniques are still under investigation should not be performed in other than fully equipped centers. A present trend is the development in certain metropolitan areas of completely equipped cardiac diagnostic and surgical facilities which are not directly connected with university hospitals. Presumably the number of such centers will remain small because of the limitations of expense and the necessity for highly trained personnel. Their establishment seems logical, however, provided that each center remains an integrated community project. The functioning of such a laboratory, the East Bay Cardio-Respiratory Center, has been briefly described.