SURGERY WITHOUT INTERVENTIONS

Cardiac surgeons took to the heart and claimed an exclusive privilege to intervene. The task of cardiologists was to identify ''candidates'' and feed the Great Surgical Machine. Recently catheter surgery has de veloped and fell into the hands of cardiologists, who became intervent ionists. Cardiac surgeons are concerned about losing interventions and their identity. The analysis of the current situation implies a revis itation of old concepts: surgery, intervention, therapy, patients, inv asiveness etc... etc... and a review of our therapeutic philosophy. Th erapeutic plans comprise three interrelated components: the target, th e bullet (therapeutic agent), and the gun (the way of delivering the b ullet on target). This description characterizes surgery as a way of d elivering. If side effects are effects that do not affect the target, surgical procedures are mostly side effects, with significant morbidit y. Future surgical rationales should reconcile target-specific therapy and minimal collateral damages: Minimal Surgery! or to use a new buzz , less invasiveness. Cardiac surgery has focused too much on surgical practice and neglected the rest of cardiology, missing opportunities f or new researches, new rationales, and new techniques. Surgeons must b ecome again Renaissance Men, involved in the entire field of cardiolog y, with a special skill in surgical techniques. Cardiac surgeons shoul d no longer confine their practice to the delivering end. This end doe s not, any more, justify the means.