Stem-cell research and genetic bioengineering offer some of the most promising results in terms of gene therapy. Patients may ultimately be able to regrow their own heart tissue. To a limited degree, the body naturally regrows heart tissue after a heart attack. Heart cells also die off intermittently and are replaced. Researchers are attempting to use genetic engineering to develop strategies for regrowing lost cardiac tissue on a large scale, eventually enabling patients to repair their own hearts in the same way that skin regrows or the intestine can develop new cell linings. Also, human genome studies now point the way to a better understanding of familial risk and eventually will lead to “vaccinations” against such risk. The future could bring in to focus a well-defined genetic predisposition to disease and then a  treatment strategy to “change the blueprint” in the patient’s DNA to a healthy one

Robots are already entering into the practice of medicine. Cardiac surgeons can now perform heart surgery with robots. Instead of opening the whole chest to allow the hands of a person to reach inside and work on the heart, robotic surgery requires only small openings the size of a pen to introduce robotic instruments. Surgeons use remote controls to direct the long, thin fingers of the robotic device, guiding them to conduct the operation. The surgeon can even perform robotic surgery while standing in a separate room. Ultimately, the best surgeon in the world could be called upon to operate online on a patient who resides in another city. (A surgical backup team would be available to operate directly in case of a malfunction of the robot.) Academic centers are now gearing up to train the cardiologist and cardiac surgeon of the future, who can use catheter-based repairs such as stents and stent valves, and perform robot-assisted surgery as well.

	Robotic surgery will ultimately allow the best surgeons to operate on patients located in another city or even another nation.

We need to think about different ways to display the human body—a type of virtual reality that enables us to see both the surface and the inner workings of the heart and the body. Medical students, surgeons, cardiologists, and other physicians will be able to train using computer interactions, in much the same way that pilots learn how to fly using simulators. Once the trainees have demonstrated their ability to perform certain procedures in a virtual environment, they would graduate to applying that knowledge and skill set to actual patients. This approach would clearly cut down on medical errors and unnecessary deaths. It would improve the quality of training while reducing the cost. It would revolutionize patient education as well by providing interactive Web-based materials, such as this e-seminar, that give more complete and accessible information to preoperative patients and those seeking preventive strategies.

Finally, in the future we may be able to digitize and merge all patient data together. Ideally, we would create an electronic environment that allows physicians to manage their patients at any time from any place. Instead of searching through charts, notes, and files, we would refer to a single screen that provides a cohesive information assessment—including every diagnostic test, surgical and interventional procedure, laboratory result, and office visit. Perhaps this data could even be made available on a wireless screen that physicians can carry in their pockets or on a notebook computer. Computerization would increase efficiency in medical practice as it has in the financial services sector. The government has expressed an interest in this happening as quickly and affordably as possible. Eliminating paper charts would also reduce medical errors as long as there is a universal standard for digital medical records. Simply screening for drug interactions and transmitting medical records in real time would reduce morbidity and improve communication between treating physicians.