The initial concept for the GHI envisaged a centre only providing heart surgery for adult patients with acquired heart disease; in particular coronary surgery, which was flourishing at the time. It was the high demand for this type of surgery which revealed the shortage of heart surgery capacity that led to long waiting times for patients and the much-discussed "death while on the waiting list". However, it had already become evident during the planning stage that interventional cardiology with balloon dilatation of coronary stenoses was developing into a viable alternative to bypass surgery. As a result, a cardiological department for handling mainly catheter-assisted diagnostics and intervention was included in the plans. To this end, an operating theatre was converted into a catheterization laboratory and a limited number of beds were reserved for such activities. Despite the limitations placed on this department, a measure intended to improve acceptance of the Heart Institute by the numerous cardiology clinics existing in Berlin at the time, the cardiology department headed by Prof. Eckart Fleck achieved tremendous success, not only because of the large number of patients treated, but also with scientific contributions to developments in interventional techniques and imaging methods, both angiography and magnetic resonance imaging.

Progress in catheter-based interventional procedures has had a significant effect on changes in the spectrum of coronary surgery. Most of the "simple" coronary cases with a well-defined coronary stenosis for which, twenty years ago, surgical intervention would have been the therapy of choice, are now being treated more and more often by balloon dilatation and stent implantation.

Nowadays, surgery is normally reserved for patients with severe, diffuse coronary sclerosis, emergencies following acute cardiac infarction, patients who have undergone multiple or unsuccessful interventions and patients with severely impaired ventricle function and who are in line for a heart transplantation. It is exactly these difficult cases which the GHI’s surgery department has devoted itself to since its very beginnings, in keeping with the institute’s policy of never turning a patient away. The positive aspect is that the intense activities in this particular sector of advanced cases have meant that the heart institute has gained an enormous wealth of experience, making it, in turn, a sort of "last chance" for many patients from all over Germany and the rest of the world.

In the case of heart valve disease, this applies especially to patients with severe endocarditis, patients who have undergone multiple surgery, and older patients requiring combination surgery. Along with mention of the institute’s own development work on valve reconstruction methods, special reference should be made here to the cardiac homograft valve bank, set up in 1987 as one of the first of its kind, where human heart valves are prepared as replacements and kept in deep-freeze storage. This valve bank, which has now been expanded to include a tissue bank, is gaining new relevance in connection with topics such as human cell cultures, regenerative medicine, stem cell transplantation and "tissue engineering".

Aortic diseases, aneurysms and dissections, both in the thoracic and abdominal regions, have been among the GHI’s special areas of interest from the very beginning. With around 4,500 interventions, the institute has the widest experience in this field in the whole of Germany, and the frequency of such interventions is increasing. Aortic operations are among the most serious surgical interventions of all. Nowadays, an increasing number of such interventions can be substituted by a much more gentle method combining surgery and catheterization, i. e. implantation of a stent. At the Heart Institute, these interventions are performed in the operating theatre either by surgeons who are also adept in catheterization techniques or in co-operation with our cardiologists. This allows an emergency operation to be carried out immediately, if necessary. These practices have set internationally recognized standards for "hybrid surgery", which in my estimation in the future will become very significant in other areas of cardiac medicine, too. Our clinic has also taken initial steps in this direction for treating congenital heart defects, and similar efforts are being made in the field of heart valve disease.

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