Part I – A Remarkably Young Story – Standing On Tall Shoulders – The History of Cardiac Surgery by Thomas N. Muziani PA-C, CP
“The more extensive a man’s knowledge, of what has been done, the greater will be his power of knowing what to do.” Benjamin Disraeli 1804-1881, Prime Minister of the United Kingdom and Great Britain
“Those who cannot remember the past are condemned to repeat it.” George Santayana 1863–1952, Life of Reason
The story of cardiac surgery is remarkably young. I began the profession of Perfusionist (we were called “Pump Techs” back then) in 1968. Hired on as a surgical orderly in Los Angeles, CA, I was assigned to the heart rooms and it was love at first sight. All that neat equipment! Our monitors amounted to GE televisions with round tubes that we connected to Statham transducers the size of your fist.
It must be mentioned at this point that so many devices that we utilize everyday during cardiac surgery had their origin with the United States space program. From transducers for physiologic monitoring, pulse oximetry, lasers, non-invasive blood pressure cuffs to digital readouts and ECG synchronization. Cardiac surgery, in large part due to its popularity, became a large benefactor from the space program. As the Apollo program would look to the end game, some of the brightest engineers were let go. They formed their own businesses and medicine reaped the benefits. Most of these companies located in the Southern California region for a myriad of reasons. Since that is where I worked, I became friends with many of these outstanding individuals. In 1978, I was asked to assist with developing some monitoring equipment for the seats of what would become the Space Shuttle at Ames Dryden Flight Research, Edwards AFB at NASA…but, that’s another story.
Our oxygenators were stainless steel disc type that required 20 units of blood to prime. Our heat exchanger was the Sarns “bullet type” that required extreme care when putting together for fear of scratching the inner surface. Cardioplegia was delivered via the Sarns coronary bubble trap that again, required extreme care when assembling lest you risk having massive leakage of blood all over the heart lung machine.
As the orderly, I would arrive at 3 AM to start setting up for a 0730 case. The duties included cleaning and alcohol everything down…from lights to operating table wheels. Then, I would take an old fashioned sphygmomanometer connected to my transducer and, with tape on the TV screen, create pressure numbers for the arterial pressure. CVP pressure was a water manometer.
The “Perfusionist” at that time was a Pediatric Cardiologist from UCLA. He could actually make more money during the 60’s “pumping” cases. Once he realized how happy I was setting everything up, he naturally gave me more responsibility. Along the way, I was provided a small library of books…and that is exactly how I became a Perfusionist… Pierre Galletti and get your hands dirty. Then, the US Army decided they wanted my body and I was drafted 07/07/ 1970.
But I digress. The history of cardiac surgery. Writing history is always subjective. You do not want to leave anyone omitted. However, you must make decisions on what is considered very important and who should be included. The true intent of this story is to provide an overview of pertinent events in cardiac surgery with a focus on how many major breakthroughs in medicine were strictly by accident. As Louis Pastor once said: “Chance favors the prepared mind”.
1896-1928: The Embryonic Stage and Dogma
On 9 September 1896, Ludwig Rehn from Frankfurt, Germany, dared go where everyone else feared to tread; He sutured a stab wound in the right ventricle. Many consider this the origin of cardiac surgery. Although war, from the Civil War to present day may be considered the major platform for advancement of cardiac surgery, this simple trauma in 1896, more often than not, would just elicit a priest rather than a doctor.
From the dawn of history, the heart and lungs were considered sacrosanct. Thou shall not touch. The ancient tribes of South and North America, the Incans, Aztecs and Mayans considered the heart and lungs gifts from the Gods. The heart, with its warmth, the smoke (steam) that would float from it on a cold day, assured them this was a sacred object. Therefore, if your opponent lost in battle or you needed to repay a debt for lack of rain etc., you extracted the beating heart and presented it to your God.
The origin for the word “cardiac” is the Latin word; Cardiacus. It means the center of emotion, the center of the total personality, spirit, courage, enthusiasm. The origin for the word “lungs” is the Greek word; Pneuma. It means the vital spirit, soul, the Spirit of God, the Holy Ghost.
To some degree, many historians believe this cultural dogma lay the foundation for the idea of never touching beneath a person’s ribcage. It was very difficult and fraught with peril. Then, in the early 1880’s, Block of Danzig and Simplicio Del Vecchio of Italy reported the repair of experimental wounds of the heart. However, one of the most prominent surgeons at the time, Theodor Billroth, pronounced that: “A surgeon who would attempt such an operation (cardiac suturing) should lose the respect of his colleagues”.
In 1896, Great Britain’s Sir Stephen Paget predicted that: “Surgery of the heart has probably reached the limit set by nature to all surgery; no new method and no new discovery can overcome the natural difficulties that attend a wound to the heart”. That same year Rehn accomplished the “impossible”.
On 2 September 1902, John H. Gibbon of Philadelphia operated on a moribund patient for a wound of the heart, but the patient died before the wound could be closed. Half a century later (1953) his son, John H. Gibbon Jr. would be the first to conduct open heart surgery with the aid of a mechanical heart lung machine. On 14 September 1902, Luther L. Hill of Montgomery, Alabama, first successfully sutured a cardiac wound in the United States.