Sir Magdi Yacoub is currently professor of cardiothoracic surgery at the National Heart & Lung Institute at Imperial College London and founder and director of research at the Harefield Heart Science Centre (Magdi Yacoub Institute). At ACC.12, Dr. Yacoub delivered the 43rd annual Bishop Lecture, "The Search for Excellence," as part of the Legends of Cardiovascular Medicine Series.

Early Years

Dr. Yacoub was born in Egypt and then borne across the country during his formative years by his father, a general surgeon. While not something he enjoyed at all, he said, it was "a massive education in how to adapt and make friends. I have learned from my gypsy days that it really is important to move around, adapt, and be in service to mankind and benefit from all these different facets of culture."

With a "passion for heart surgery," Dr. Yacoub developed original operations for several complex heart conditions, including:

• Transposition of the great arteries
• Double outlet right ventricle (Taussig Bing) anomaly
• Single ventricle
• Valve conserving operation for aneurysms of the ascending aorta (including Marfan's syndrome)
• Mitral valve replacement using homograft or autograft aortic valve (the Top Hat operation)
• Mobilization of the right and left fibrous trigones for subaortic stenosis
• Transaortic repair of the syndrome of prolapsing aortic cusp and ventricular septal defects

His work in congenital heart disease led to his describing the coronary anatomy of these patients—work that remains important today for those performing congenital heart disease surgeries.

Dr. Yacoub developed valve-conserving surgeries which, in the case of the mitral valves, proved to be superior to valve replacement in 90 percent of patients. He was similarly involved in developing valve-conserving operations for aortic and tricuspid valves. His work and that of others established the evidence for and the unique advantages of a living aortic valve, demonstrating the sophisticated functions of the aortic valve at cellular and molecular levels.

His critical work in heart transplantation, heart-lung transplantation, and single lung transplantation was responsible for the establishment of the largest heart and lung transplantation program in the world, where more than 3,000 transplant operations have been performed. As well as service to the community, the center has been a source of inspiration for basic science advances as well as the development of left ventricular assist devices (LVADs), promoting them for the "bridge to recovery," including development of a novel combination therapy utilizing LVADs and nonpharmacologic therapy to reverse end-stage heart failure (HF). His developments included total heart transplantation with bicaval anastomosis and En-block double lung transplantation with revascularization of the bronchial arteries.

Today

Professor Yacoub currently oversees more than 60 scientists and students in the areas of tissue engineering, myocardial regeneration, stem cell biology, end-stage HF and transplant immunology. His own work continues in tissue engineering heart valves, novel LVADs, and wireless sensors.

Dr. Yacoub describes global health as a "burning issue." The World Health Organization estimates that 17 million people died of cardiovascular disease in 2008, and 80 percent of these were in low- and middle-income countries. It will require an integrated approach, including better health care delivery (with 50-60 percent of the effort, he said, targeting pediatrics), infrastructure, research, sustainability, and networks of excellence.

"It is becoming more and more obvious," he said, "that this massive problem has to be dealt with because it is unacceptable, but also because we can learn a lot, which will benefit us, and finally if we neglect it, it will hit us."

His own efforts have been substantial. Sir Yacoub is founder and chairman of the QAL Advanced Cardiovascular Network, a not-for-profit organization established in 2008 with the principal focus of reducing the burden of CV disease worldwide through a program of basic science and translational research. Additionally, he is founder and president of the Chain of Hope charity, treating children with correctable cardiac conditions from war-torn and developing countries, as well as establishing training and research programs in local cardiac units.

The Chain of Hope and Magdi Yacoub Institute have established a research institute in Mozambique dedicated to understanding, preventing, and treating unique local heart diseases that affect children in Africa, such as endomyocardial fibrosis and rheumatic fever. His programs in Jamaica have been functioning for more than 25 years now. The Ethiopian Heart Center, a project of the Children’s Heart Fund and his own Chain of Hope charity, is the only heart hospital in Ethiopia, serving a population of 82 million. The center performs adult heart surgery, too, but at the present time 60 percent of the cardiac surgeries are in children. Other work is being done in Kenya, Uganda, Burundi, and Malawi, which has one of the lowest life expectancies in the world and no facilities for either cardiology care or cardiac surgeries. "We are collaborating with several groups to build facilities for them."

Said Dr. Yacoub: "I get very upset when I hear that cardiac surgery is being threatened—threatened by what? People talk about the golden days of cardiac surgery; I think they are yet to come and, as I have just shown, there is still plenty to do everywhere in the world. We should not be looking inside, we should be looking outside."

To listen to an interview with Magdi H. Yacoub, MB, BCh, about the future of cardiac surgery, visit youtube.cswnews.org. The interview was conducted by Patrick T. O’Gara, MD.

Keywords: Heart-Lung Transplantation, Rheumatic Fever, Charities, Heart-Assist Devices, Stem Cells, Life Expectancy, Double Outlet Right Ventricle, Endomyocardial Fibrosis, Regeneration, Heart Failure, Bronchial Arteries, Cardiac Surgical Procedures

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