After World War II, many milestones were achieved in the field of medicine. Microsurgery, keyhole surgeries, and organ transplants are commonplace today. However, numerous techniques, machines, and surgeries were only developed post-1945. Significant breakthroughs in cardiac surgery were accomplished during this time, with the most crucial being the discovery of the heart-lung machine, clinically referred to as a cardiopulmonary bypass (CPB), which profoundly transformed the practice of cardiac surgery.
Today, we celebrate the 70th anniversary of the first successful cardiac surgery, which was made possible by Dr. John Heysham Gibbon, a cardiac surgeon and inventor of the heart-lung machine.
The journey began during his fellowship at Harvard in 1931 when he encountered a patient who had a massive pulmonary embolism after a cholecystectomy. Under Dr. Churchill, he performed the Trendelenburg operation, but the patient did not survive. This experience left a profound impact on him(1), and he became convinced that the patient would have survived in a bloodless field(2). He believed that if her venous blood were taken, oxygenated, and returned to the arterial circulation, it could have saved her life. He started researching and developing his plan into a working machine. No attempts had been made before to take over the function of the heart and lungs, but he foresaw this technique and started its development.
Initially, Gibbon and his wife used this method on cats, and by 1935, he could successfully replace the function of the heart and lungs in cats for 20 minutes. However, most of the cats did not survive longer than 23 days(2). Despite this, he continued to use this technique on dogs, with low survival rates at first. In 1945, he achieved better survival rates with modifications to the circuits of the machine, including the application of filters for clots and suction to prevent air entry."
The first operation with this machine was performed in February 1952 on a 15-month-old patient with an alleged atrial septal defect. During this time, cardiac catheterization was associated with a high mortality rate in pediatrics and was therefore avoided in this patient. Unfortunately, the patient did not survive as the patent ductus arteriosus was misdiagnosed as an atrial septal defect.(2)(3)
The second procedure and the first successful cardiac surgery were performed on May 6th, 1953, on an 18-year-old patient experiencing symptoms of right-sided heart failure due to an atrial septal defect. The circuit was first heparinized, and the arterial inflow cannula was placed in the left subclavian artery, while tubes were connected to the superior and inferior vena cava for venous drainage. The heart was accessed using a clamshell incision. After achieving a bloodless field, the septal defect was repaired with a cotton suture. The heart-lung machine was operated by Gibbon’s wife, Mary, who became the first-ever cardiac perfusionist. The total bypass time was approximately 26 minutes. Cecelia Bavolek, the patient, made an uneventful recovery and was announced as the first successful cardiac surgery.
Dr. Gibbon went on to operate on two more patients, but both did not survive these procedures. He decided to terminate his career in open-heart surgery, leaving colleagues, students, and countless clinicians to utilize this discovery to the fullest.(3)
Subsequently, he researched the improvement of heart-lung machines, leading to better survival rates and substantially increased cardiac surgeries in the 1950s.
Dr Gibbon. started practicing general thoracic surgery leaving back cardiac surgery to others. Even after 70 years, the heart-lung machine still stays relevant.
According to the National Institute for Health and Clinical Excellence (NICE), the survival rates 1 year after either form of open-heart surgery are similar at about 96-97 percent, making it as safe as any other surgery (4). Typically, a patient achieves normalcy within a week of cardiac surgery, which demonstrates the tremendous progress that the field of cardiovascular surgery has made over the decades. The cardiovascular medicine community owes an immense debt of gratitude to Dr. John Gibbon and his revolutionary invention.
References:
(1) Romaine-Davis A. John Gibbon and His Heart-Lung Machine. Philadelphia, Pa: University of Pennsylvania Press; 1991
(2) https://www.understandinganimalresearch.org.uk
(3) Lawrence H. Cohn. Fifty Years of Open-Heart Surgery. Circulation. 2003;107:2168–2170
(4) https://www.medicalnewstoday.com/articles/312888
(HN)
