change in attitude among surgeons results in a rapid, and expensive,
ballooning in costs and device usage.
Attempting to decipher the number of valve operations per year based
upon recent publications limits this author to patients at least a decade
ago. The most recent clinical volumes among US cardiac surgeons
represent the year 2007. In a 2011 publication, using the Society of
Thoracic Surgeons (STS) database, a total of 292,543 valve operations
were performed over the five-year period of 2003–07. Simple arithmetic
yields an average of 58,509 operations per year. That squares with data
from above-mentioned subtotals. There were about 45,000 isolated valve
operations per year in the early 2000s, with at least ten thousand more
combined valve operations. Unbelievably, in just one decade, that number
has tripled to 143,500 valve operations in 2014,^39 and with the Baby
Boomers just reaching the average age of valve surgery patients (sixty-
seven years),^40 valve surgery promises to rapidly grow.
CABG is the most commonly performed open-heart operation, with
201,600 operations in the year 2014.^41 There has been a trend over the last
fifteen years of decreasing CABG numbers, in large part due to the ability
of cardiologists of addressing coronary vessel disease “percutaneously,” or
via a catheter in the femoral artery in the groin. It is likely that
cardiologists will continue to address more heart conditions with
minimally invasive technology, sometimes in a fashion that seems daring,
impossible, and perhaps risky, as will be seen. CABG surgery is performed
by “jumping” a stenotic (clogged) artery with a patient’s own vessel graft
(vein from a leg or small artery from the chest wall). It is sewn in place
with a polymer suture that is permanent. Although the suture is not the
device around which the operation revolves, CABG cannot be reliably
performed without modern polymer implants like polypropylene suture.
Pacemakers were first used sixty years ago, and have become the
eleventh most expensive inpatient operation. In 2014, there were $2.8
billion in aggregate costs for inpatient stays, but a significant portion of
pacemakers are placed on an outpatient basis.^42 Recent analysis has shown
the rate of pacemaker placement in 2009 had risen to 61.6 implantations
per 100,000 capita, equating to 188,700 patients. Assuming no further
growth in pacemaker placement (unlikely), pacemaker placement in 2014
would equal 194,346 patients. Steven Kurtz and his coworkers have shown
that implantable cardioverter defibrillators (a device that senses an