Any writing about this evolving field rapidly becomes a compromise with impossibilities. No one agrees, for example, on when to operate for aortic regurgitation. The author quotes Lord Brock, saying that most of our answers about when to operate are still too empiric. Nevertheless, in giving some provisional replies, this book represents one surgeon's assimilation of disparate opinion, how he thinks, and how he acts in detail.
Senior readers may disagree about initial conservative treatment of postinfarction ventricular septal defects or grafting only the anterior descending branch for left main coronary disease. (Most US surgeons graft the circumflex also.) The author underestimates some mortality, eg, 2% for mitral valve replacement. Similarly, few believe that 95% of patients who have undergone coronary bypass will stay symptom free.
Despite his enthusiasm, Holden's invigorating style and English perspective offer a worthwhile reading experience. After learning that transthoracic reoperations are now being performed to