Medicine: Old Hearts, New Plumbing

It was only 7 a.m., but the operating room in Cleveland Clinic's cardiovascular unit was going full tilt. Nurses, technicians and visiting doctors watched as members of a surgical team took their places around the operating table. With confidence born of experience, the surgeons made a vertical incision from the patient's collarbone to his diaphragm, sawed through his breastbone and then, using a framelike mechanism, spread the rib cage and exposed the pericardium, or heart sac.

As if on cue, Dr. Donald Effler, tall, athletic and at 55 one of the country's leading...

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