On 6–10 October 2004, the Texas Heart Institute will hold a scientific symposium, in part to celebrate 50 years of open heart surgery. In 1954, Dr. C. Walton Lillehei, at the University of Minnesota, first demonstrated the feasibility of intracardiac repair of congenital anomalies. He did so by using cross-circulation, which he had experimented with in his laboratory. The news spread rapidly that the era of “open heart surgery” had arrived.
The dawn of elective heart surgery had actually occurred 10 years earlier, in November 1944, when Dr. Alfred Blalock at Johns Hopkins performed a successful palliation of cyanotic heart disease by creating a systemic-to-pulmonary arterial shunt. I was present and on his team. Blalock's historic operation inspired surgeons to develop techniques that could arrest circulation of the heart and lungs long enough for them to perform precise, intracardiac repair.
Temporary cardiopulmonary substitution required a circuit with a pump and an oxygenator. Pumps were already available in designs that would not injure the blood. Among the most available were roller pumps and synchronized finger pumps, which massaged the blood along a flexible tube. The greater challenge was the oxygenator.
Lillehei and his team had determined that the human lung was ideal for efficiency, and they were intrepid in their use of a living donor oxygenator—the mother of the patient, or sometimes the father. For practical reasons, however, cross-circulation was not embraced by other surgeons. At the time, a number of artificial (mechanical) oxygenators had been designed for organ perfusion and preservation, but they were complex and are too varied to describe in this brief commentary. Some of those oxygenators were tried for human surgery, but they met with limited success. In 1955, however, Dr. Richard DeWall, a junior colleague of Lillehei's, first successfully used a simple bubble oxygenator that he had developed. Removal of the frothy bubbles was accomplished with a defoaming silicone agent that restored the blood to liquid form. The open heart surgery technique had finally become reproducible and practical.
We eagerly followed this lead because of its simplicity, as compared with the other complex systems. This was all we needed to start an open heart surgery program in our hospital. Soon the volume of cases that my colleagues and I had performed exceeded all others in the new era of open heart surgery. Cardioplegic agents were introduced to arrest the heart, preserve the ischemic myocardium during aortic cross-clamping, and control the incidence of air embolism. We further simplified cardiopulmonary bypass (CPB) by demonstrating that the circuit could be primed with crystalloid saline and glucose solutions, which eliminated the need for blood transfusion. Of course, during the years that followed, pumps and oxygenators have been refined and improved further, making CPB safer and more dependable.
In retrospect, I believe that the credit belongs to Lillehei and his colleagues for opening the door—for providing the key to an exciting era. At a medical meeting shortly after Lillehei's historic intracardiac operation, I said that he had provided “the can opener to the biggest picnic cardiac surgeons had ever known.” Even now, I couldn't agree more.