| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1996;62:636-637
© 1996 The Society of Thoracic Surgeons
Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
On September 9, 1996, cardiac surgery will be 100 years old. This date commemorates the centennial of the first successful cardiac operation: the suture of a heart wound by Ludwig Rehn. Although similar procedures had been attempted without success, Rehn's case represents a starting point in our specialty of cardiac surgery. This daring operation, its successful outcome, and the symbolism of the organ created a milestone in medical history by proving the Fallopian aphorism "Vulnerato corde homo vivere non potest" ("Man can not live with a wounded heart") wrong. Contrary to scientific opinion at that time, Rehn demonstrated that operating on the heart was feasible. His patient, a young gardener named Wilhelm Justus, had been stabbed in the chest on September 7, while walking in a park near the Main river in Frankfurt. He was attended to by Dr Siegel, one of Rehn's assistants. Doctor Rehn was out of town, and when he returned to the hospital on September 9, he was informed of the stabbing case. Seeing that the young man was dying, Rehn decided to operate in an attempt to save Justus' life. At 7:30 PM the operation started. Even though Rehn was an able surgeon, he failed to properly expose the heart. The chest was entered through the left fourth intercostal space. After the pericardium was opened, the incision proved to be inadequate, for the right ventricle kept disappearing under the sternum during systole. The 1.5-cm wound in the right ventricle was closed with three silk stitches carefully placed during diastole [1]. Fortunately, for both Justus and Rehn, the operation was a success. During convalescence, the heart worked "better than before the injury," a jocular remark based on the fact that the patient has been just dismissed from the military service because of an irregular heartbeat.
After this dramatic birth, cardiac surgery had a stunted infancy and adolescence. Other than pericardiectomy, pioneered by Sauerbruch and Rehn, few successful cases involving cardiac surgery were reported until the 1940s. Tuffier's transparietal dilation of an stenotic aortic valve (by invaginating the aortic wall through the valve orifice) in 1912, Cutler's first mitral valvulotomy in 1923, and Henry Souttar's first finger mitral commissurotomy in 1925 were sporadic feats with no continuity. Years later, in a letter to Dwight Harken, Souttar complained: "I did not repeat the operation because I could not get another case ...It is no use to be ahead of one's time" [2]. It took 25 years for Bailey and Harken to "rediscover" mitral commissurotomy. The practice of cardiac surgery in those days was difficult. Doctor Robert E. Gross had to schedule his first ligation of a patent ductus arteriosus while his chief, Dr W. Ladd, was away on a trip to Europe. Doctor Gross was sure that Dr Ladd would not have granted him permission to perform the procedure, so he did it when his chief was absent. When Dr Ladd returned and learned of the unapproved operation he fired Gross.
Fifty years after Rehn's historic operation, cardiac surgery finally began to blossom. The closed mitral commissurotomy, championed by Bailey and Harken in 1948, became an accepted procedure. John Gibbon, who initially conceived and built the heart-lung machine for treatment of massive pulmonary embolism, performed the first successful heart operation with cardiopulmonary bypass in 1953. Shortly thereafter, Lillehei and Kirklin routinely performed successful open heart procedures in two separate centers 140 km away, the University of Minnesota and the Mayo Clinic. This seminal work provided "the can opener for the largest picnic thoracic surgeons will ever know" [3]. Starting with the correction of congenital anomalies in the 1950s, our specialty progressed to treat valvular diseases in the 1960s and ischemic heart disease in the 1970s. The 1980s witnessed the upsurge of cardiac transplantation, the use of mechanical hearts, and a renascence for techniques of myocardial protection. The cardiac surgeon has evolved from the brave man who travelled the short, but unknown distance between the skin and the heart 100 years ago to the intellectual surgeon who combines dexterity with the understanding of physiology, biochemistry, and statistics.
Industry has paralleled the growth and development of cardiac surgery [4]. More efficient oxygenators, improved heart valves, and smaller and more durable pacemakers are all products of technology applied to improve the safety of cardiac surgery. The antegrade/retrograde/cold/warm/intermittent/continuous/blood cardioplegia debate is a healthy exercise in the search for the optimal myocardial protection. On its 100th anniversary, the specialty is alive and well. Less invasive surgical procedures are being tested, heralding a potential new trend in cardiac surgery. Unfortunately, some of these practices are stimulated more by cost containment than by our patients' well being [5]. Despite financial constraints and the continuous attacks of invasive, nonsurgical, balloon-toting specialists [6], the future looks bright [7]. Cardiac surgical research is at the molecular level. Leukocyte-endothelial interaction, inflammatory mediators, angiogenic growth factor, myocyte preconditioning, and gene therapy are becoming common subjects in the specialty journals. Xenotransplantation is around the corner. Technology continues to support progress. Surgical risk is assessed by computer-based studies, the laser is in the operating room, intraoperative transesophageal echocardiography allows instantaneous evaluation of surgical procedures, and the patent ductus is being interrupted through a thoracoscope (poor Dr Gross ...!).
All cardiac surgeons should be proud and pleased to be a part of this fascinating 100-year adventure.
Footnotes
Address reprint requests to Dr Aris, Cardiac Surgery Service, Hospital de la Santa Creu i Sant Pau, San Antonio M. Claret 167, 08025 Barcelona, Spain.
References
This article has been cited by other articles:
|
|
 |
|
  A. Aris Francisco Romero, the First Heart Surgeon Ann. Thorac. Surg., September 1, 1997; 64(3): 870 - 871. [Abstract] [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
