Surgery, though extreme, is one of the most effective treatments of any cardiovascular
disease. The following is a surgeon to surgeon outline of the history of discoveries
and advancements which have contributed to better and more effective surgery
techniques.
Alexis
Carrel
French-born American surgeon. He pioneered the replacing of parts of dangerously thinned or ruptured blood vessels (called aneurysms) with vascular tissue from other areas, thus initiating vascular surgery.
Robert
E. Gross
American surgeon, who in 1938 performed the first successful major surgery on the great vessels near the heart, with the ligation of ductus arteriosis. He also made many other important contributions that have altered the practice and understanding of surgery, pediatrics, and cardiology throughout the world.
Dwight
Harken
U.S. Army surgeon who saved lives of many World War II solders. After many preparatory experiments on animals he was able to successfully remove shell fragments and bullets from the hearts of his otherwise doomed patients. After accomplishing his new technique, he was ready to try a yet even more daring procedure - reparation of the valves inside the heart. In 1948, within days of each other, he and another American surgeon, Charles Bailey, performed mitral valve operations on a beating heart. In this operation the surgeon made a small hole and carefully widened the narrowed mitral valve using their fingers. The procedure, called closed or blind heart surgery, was initially very risky but eventually its success increased and it become accepted in other hospitals. However, to perform more complicated procedures blood needed to be drained from the heart in order to open the organ up. Since only after 4 minutes after cessation of blood supply the brain becomes damaged, such operations were thought to be impossible (until John Gibbon invented the heart-lung machine).
Helen
Brooke Taussig
American physician, saver of thousands of "blue babies". She studied heart disorders in children and, with Alfred Blalock, developed a surgical technique which involved creation an extra vessel which lessened the suffering of "blue-babies". In such conditions children appear bluish because their blood do not contain a normal amount of oxygen. This is caused by a common congenital cardiac malformation, Tetralogy of Fallot, that prevents normal passage of the blood to the lungs. At Taussig's times it was not possible to correct defects inside the heart and the Blalock-Taussig operation saved the lives of thousands children: many of her patients lived long enough to have their pathology completely corrected by open-heart surgery when this type of surgery became available.
Bill
Bigelow
Canadian surgeon who developed new, hypothermic approach in which the body was cooled to 80 F. In such conditions, blood flow could be stopped for 10 minutes without brain damage and therefore surgeons had more time to complete an operation.
Walton
Lillehei and John Lewi
Two University of Minnesota surgeons who performed the first open heart surgery in 1952. They repaired a hole in the heart of 5-years old patient. To slow the heart and decrease tissues demand for oxygen they cooled patient body to 80 degrees. Then they clamped veins to empty heart from blood and were able to sew up the opening. The operation was a success and was then used by others to repair small heart defects. However the short time window (10 min) was not sufficient to perform more serious operations.
John
Gibbon
American surgeon from Great Britain was working on the heart-lung machine for quite some time. Such a device had to be connected to the great vessels and would for several hours replace the function of the heart by mechanistically pumping the blood through the body and the function of the lung by aerating passing blood. Gibbon's first devices were bulky and dangerous, however, in 1953 the first truly successful machine was tested and the possibility of prolonged heart surgery finally became a reality.
Dennis
Melrose
English surgeon who developed a solution to stop the beating of the heart during the surgery. This greatly increased success of performed surgical procedures because it is obviously much easier to operate on a still object. An entire new set of operations become possible, including patching holes in the ventricular septum, the insertion of artificial valves and replacement of blocked coronary vessels.
Christian
Barnard
South African surgeon who performed first heart transplantation in 1967; the patient only lived for 18 days. Dr. Barnard and other surgeons also did other transplants, but these surgical miracles were short lived, with a majority of patients dying within 1 year after the operation. The failure of the transplants was due to infections which were developed after the patient received too many immunosupressant drugs, or due to the rejection of the donor heart as a result of not enough immunosuppressant drugs.
Norman
Shumway
Transformed the heart transplant procedure from medical disappointment to success story. He succeeded due to two major improvements. First, he and his team of doctors and researchers developed a procedure which allowed them to monitor the process of heart rejection and give the patient immunosuppressant drugs only when needed. Secondly, they used a newly available drug, cyclosporin, which prevented organ rejection but did not significantly compromise the patient's immune system. The success of the improved transplantation procedures revived the hope of millions of patients who suffered from terminal heart failure. Currently the major problem with heart transplantation surgery is not the procedure itself but a shortage of donor hearts. With over 2 million Americans suffering, only about 2 thousand donor hearts are available each year. Three alternative strategies are being proposed to alleviate the shortage of donor hearts: artificial hearts, heart assisting devices and ventricular remodeling (see below).
Randas
Batista
Brazilian physician, performed a novel surgical procedure in 1994 to treat pathologically enlarged hearts. When a diseased heart dilates (meaning its diameter increases) it becomes much less efficient (see LaPlace's Law). Batista's procedure, sometimes called ventricular remodeling, involves cutting a swath of ventricular muscle and sewing the rest of the chamber back together. The smaller heart can then pump blood more efficiently. The procedure is not universally accepted and only time will tell whether ventricular remodeling is a real milestone in the heart surgery.
