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50 Years of Cardiothoracic Surgery

As early as the 4th and 5th century BCE, the heart, lungs, veins, and arteries were known to be critically important organs in the human body—although it would be a few more centuries before dissection allowed scientists of the time to better understand how these parts worked to pump blood and give life. When modern medicine emerged in the 19th century, a new understanding of microbiology and bacteriology greatly reduced infection rates and the use of anesthetics such as ether and chloroform also became more common. These two advancements set the stage for the astounding medical innovations of the next century. And yet, surgery of the heart and lungs presented special problems because the heart performed the important task of carrying blood to the brain. A beating heart would lead to excessive blood loss, and a heart that wasn’t beating resulted in a brain-dead patient after only four minutes.

The devastation of World War II led to more progress in the field of surgical medicine. Doctors on the battlefield, desperate to help save the lives of injured soldiers, pioneered new advancements in antibiotics, anesthesia, and blood transfusions. Army surgeon Dr. Dwight Harken successfully removed shrapnel from the hearts of wounded soldiers during the war, proving that the heart could in fact be operated upon. Soon after the end of the war, Harken and Dr. Charles Bailey of Philadelphia used the same technique to repair defective heart valves, a condition known as mitral stenosis. However, this type of closed-heart surgery had its limitations, and patients with more serious heart conditions had few options.

Solving this problem became a defining issue in the mid 20th century. Doctors from all over the world worked furiously to resolve the conundrum. One solution came when Dr. Wilfred Bigelow discovered that cooling the body’s core temperature slows the heart rate and allows a longer time in which to operate—ten minutes as opposed to four. Drs. John Lewis and Walton Lillehei of the University of Minnesota used the hypothermia method to close an atrial septal defect in 1952, and Dr. Henry Swan perfected the procedure, eventually performing hundreds of open-heart surgeries with relatively low mortality. This rather cumbersome method was ultimately short-lived, however, when it became clear that more complex heart conditions would require more time than the cooling of the body allowed. It was evident that a better approach was needed.

Heart surgeons of the time understood that a successful heart-lung machine—that is, a machine that would bypass the heart and lungs and take over circulation of the blood during the surgery—had to not only pump blood, but also resupply oxygen to the red blood cells and pump blood at sufficient pressure to supply all the organs in the body, all without damaging blood platelets in the process. Anticoagulation was also necessary to prevent bleeding out during surgery. The latter problem had been earlier solved by the discovery of heparin in the early 1900s. The heart-lung machine had several prototypes, but it wasn’t until the 1950s that surgeons were able to use such a device to repair the hearts of patients.

From 1950 – 2000, the following timeline describes some of the important milestones in cardiothoracic surgery that followed the development of cardiopulmonary bypass, a revolutionary advancement that has since saved thousands of lives.

1951—Dr. Clarence Dennis of the University of Minnesota performed the first open-heart surgery using a heart-lung machine. The patient is a six-year-old girl suffering from an atrial septal defect. She does not survive.

1952—Dr. Forest Dodrill and colleagues use a mechanical pump (developed with General Motors) to perform the first successful total left-sided heart bypass on a 41-year-old man in Detroit. The patient’s own lungs were used for oxygenation.

1952—Dr. Paul Zoll applies electrical charges to the outside of a patient’s chest to successfully restart his heart.

1953—Dr. John Gibbon performs the first successful intercardiac surgery of its kind using a heart-lung machine he developed with IBM. The patient is an 18-year-old girl with congestive heart failure due to an atrial septal defect. Unfortunately, the next two patients to receive surgery with the machine do not survive.  Gibbon declares a one year moratorium on further surgeries using his machine.

1955-1956—A team led by Dr. John Kirklin of the Mayo Clinic uses a heart-lung machine based on Gibbon’s model to perform intercardiac surgery on eight patients, four of whom survive.

1958—Swedish surgeon Dr. Ake Senning places the first implantable pacemaker in a patient with Stokes-Adams syndrome.

1960—The first aortic valve replacements are placed by Dr. Dwight Harken and Dr. Lowell Edwards, both of whom use a caged ball valve. In the next seven years, 2000 of these valves are implanted.

1960—Dr. Robert Goetz performs what appears to be the first coronary artery bypass operation on a human. He receives criticism for attempting the experimental surgery, and never performs another.

1963—An artificial left ventricle assist device is successfully used to help wean a patient from cardiopulmonary bypass after heart valve surgery.

1964—Dr. Charles Dotter performs the world’s first percutaneous transluminal angioplasty in Oregon.

1967—A South African surgeon, Dr. Christiaan Barnard, transplants the heart of a 23-year-old woman into a middle-aged man. He survives for 18-days before dying of pneumonia brought on by powerful anti-rejection drugs.

1968—Dr. Norman Shumway of Stanford University performs the first heart transplant in the United States. The patient survives for 14 days. Following the sensation of this first operation, several more transplant surgeries take place, but with high mortality.

1974—Dr. Andreas Gruentzig performs the first peripheral human balloon angioplasty

1981—Shumway performs the first successful heart-lung transplant with colleague Dr. Bruce Reitz.

1982—American surgeon Dr. William DeVries implants a permanent artificial heart into a patient at the University of Utah

1998—Dr. Friedrich Wilhelm Mohr and Dr. Alain Carpentier perform the first robot-assisted mitral valve repair and coronary bypass surgery in France.