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academic centres ACADEMIC HEART SURGERY academic hospitals annual number anticoagulation blood thin aorta aortic artery bypass graft Artificial heart valves artificial mechanical heart atherosclerosis attitude towards surgery biological or tissue biological valves blood supply bypass graft surgery Cape Town cardiac operations cardiac surgery cardioplegic solution cardiothoracic surgery causing brain damage Christiaan Barnard clinical closed mitral valvotomy CLOSED-HEART clotting coronary artery bypass developed a multitude donor hearts donor organs durable Groote Schuur Hospital growth in cardiac health care costs heart muscle heart operations heart valve replacement heart-lung machine immunosuppressive drugs Japan majority mechanical heart valve mechanical valves million population modern medicine Myocardial ischaemia number of cardiac number of patients operations per million penetrating wounds population were performed private sector rheumatic fever risk South Africa South African population steel and pyrolitic successful closed mitral surgeon surgical procedures systemic hypothermia tissue valves transplant programmes University of Cape valve replacement surgery