A Short History Of Heart Surgery

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“Dr. Wangensteen was really an imaginative man. On one wall of his office he kept a list of all the staff surgeons and what their special interests were. For example, next to his name was written ‘stomach cancer and duodenal ulcer.’ Whatever his special interest was, that surgeon was supposed to keep up to date on all the literature and sort of specialize in those operations.

“I finished my residency in 1951 and went on the staff. I was in his office one day and he asked me what I wanted to list as my special interest. I said, “Open-heart surgery,” and without batting an eye that’s what he wrote down next to my name, even though at that time no one had ever done an open-heart operation. That’s the kind of man he was.”

In 1954 Dr. Lillehei and his coworkers tried a new approach to open-heart surgery, a technique they had worked out on dogs. Their patients were almost invariably children with congenital heart defects, usually holes between the walls that were supposed to separate one chamber of the heart from another. They would attach the patient’s circulatory system to that of one of the parents—using plastic tubes inserted into blood vessels in the groin—and the parent would, in effect, act as the heart-lung machine for the patient. “When we proposed doing this, there was a lot of opposition, of course, as there always is to anything new. At a surgical meeting where we explained what we planned to do, one surgeon said, ‘You’ve got a chance to get in the record books; you may perform the first operation with 200 percent mortality.’

“It didn’t work out that way. In fact, of the forty-five cases we did between 1954 and 1955, not one donor died. We lost sixteen patients, but we saved twenty-nine; and you have to remember that, without surgical repair, all fortyfive would almost certainly have died.

“In retrospect, it was actually an excellent way to repair heart defects in very sick children, because during the cross-circulation the healthy parent’s body corrected any metabolic problems that the child might have. Remember, in 1954 we didn’t know the importance of potassium and blood acidity and all the other things we know now.”

Late in 1955 Lillehei and his team gave up the cross-circulation technique because Lillehei and Richard DeWall, a former general practitioner who had decided he wanted to get into research, developed a heart-lung machine that was not only simple but reliable. “We had always known we could get oxygen into the blood,” Lillehei said. “All we had to do was bubble oxygen into it. The problem was getting the bubbles out. Once we solved that, using a helixshaped series of coils to return blood to the patient, we were home free. Sure, there were surgeons who said we’d wind up pumping air into the patients and they’d get air emboli and have strokes and other problems, but that never happened. The bubble oxygenator worked beautifully.”

As a matter of fact, the heart-lung machines that are now used routinely all over the world are almost exclusively of the bubble oxygenator type developed by Lillehei, DeWall, and their coworkers in 1955. It is for this invention, as well as for his pioneering work in hypothermie total-inflow occlusion and cross-circulation surgery, that C. Walton Lillehei is often referred to as the father of open-heart surgery.

F ROM 1955 ON , progress in heart surgery was rapid. In 1941 cardiac catheterization had been developed, enabling physicians to take blood samples from and measure pressures in all the chambers of the heart. In 1962 Dr. Mason Sones, at the Cleveland Clinic, developed a technique for taking X rays of the blood vessels of the heart. With catheterization and accurate X-ray methods, diagnosis of heart disorders became specific and reliable; and with reliable heart-lung machines available so that the heart could be safely stopped, at least temporarily, all sorts of heart repairs became practicable.

On January 23, 1964, Dr. James Hardy did the first heart transplant in a human; unfortunately he had to use a chimpanzee heart as a replacement, there being no human donor available, and it was too small to sustain the patient. In 1967 Dr. Christiaan Barnard, who had been trained by Lillehei, did the first successful human-to-human heart transplant. (It was followed by a worldwide and premature explosion of heart transplants, few of which were successful.) By 1982, however, due primarily to the work of Dr. Norman Shumway at Stanford, and to the development of new antirejection drugs, the one-year survival rate after heart transplantation was near 75 percent, and the projected five-year survival rate was at least 50 percent.