HISTORY OF CARDIOVASC: SURGERY - PASCaTS

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HISTORY OF CARDIOVASC: SURGERY

Global Heart Valve Disease Day Webinar

HISTORY OF CARDIOVASCULAR SURGERY

Milestones of Cardiac Surgery in Africa

1953: Jean Demirleau in Algeria performed a closed mitral valvotomy in Africa.

1958 The first open heart surgery (closure of ASD) was performed in Africa by Christiaan Barnard in Cape Town

1967 The first world-wide human heart transplantation was performed in Africa by Christiaan Barnard in Cape Town,

South Africa.

1960 First close (closed mitral valvotomy in Accra, Ghana by Charles Easmon

1960 The first closed mitral valvotomy in Ibadan, Nigeria.by John Weaver

1964 First open heart surgery (ASD closure by surface cooling, Accra, Ghana), West Africa by Charles Easmon.

1974 First open heart surgery in West Africa using the heart lung machine in Enugu, Nigeria by Magdi Yacoub

1978 First open heart surgery in Abidjan,Cote d‘Ivoire.by Dominique Metras

1980 The first close mitral valvotomy in Monrovia, Liberia by Charles Yankah

1989 Resuscitation of cardiac program in Ghana by Kwabena Frimpong-Boateng.

1992 The first open heart surgery in Dakar, Senegal by Mouhamadou N‘Diaye

1970 The first open heart surgery in Kampala, Uganda East Africa by Lindsay Grigg the first open heart surgeries

(closure of ASD in deep hypothermia and circulatory arrest)

1973 The first open heart surgery in Nairobi, Kenya, East Africa was performed Eddy Knight.

2002 The first open heart surgery, paediatric program in Asmara, Eritrea by Bolous Asfour and Andreas Urban

HISTORY OF CARDIAC SURGERY II

DEVELOPMENT OF HLM

Milestones

☺1937 First PDA ligation was performed by Thomas Streider – the patient died on the 4th postop. day

☺1938 Gross ligated a PDA successfully in a 1 year old girl. An era of surgery of cong heart dis.

☺ 1944 Crafoord and Nylin repaired coarctation of the aorta by resection and end to end anastomosis in Sweden

☺ 1944 Blalock (and Taussig) created a Subclavia-PA shunt to palliate a patient with TOF. This provided a hope for children and adults with cyanotic cong. heart disease

Ligation of Patent Ductus Arteriousus (PDA)

August 26, 1938, when Robert E. Gross of Boston, Massachusetts, successfully ligated a PDA.

It is largely unknown that in the same year and before Gross, Emil Karl Frey, a surgeon at the Medizinische Akademie in Dsseldorf, Germany, had already ligated a PDA successfully.

Milestones

☺ Attempts Using Closed Surgery

ADVANCES IN THE MANAGEMENT OF CONGENITAL HEART DISEASES

•Congenital heart surgery is very special. It is a profession that combines art, science and skill.

•Congenital heart surgery is a young specialty. It has been characterized by a history of innovation.

The 1950’s might be referred to as the “maverick era”. Since then huge advances have been made

Milestones
Closure of Atrial Septum Defect

1952, Charles Baily successfully repaired a large septal defect in a thirty-eight-year-old woman by a method which he called “Atrio-septopexy”

In January 1952, Charles Baily successfully repaired a large septal defect in a thirty-eight-year-old woman by a method which he called “Atrio-septopexy” (left figure). He made an incision in the right atrial wall, inserted his finger through the hole to investigate the right atrium and the defect, and then sutured the right atrial wall to the rim of the defect. He used this technique in twenty patients total, fourteen of which had the secundum defect; the mortality rate was 14.3% -- an improvement on the alternative methods which had been used during the past 4 years.

Total Cardiac Inflow Occlusion and Hypothermia

It was becoming evident that progression in Cardiac Surgery could only be obtained through the development of methods which allowed direct vision and a dry field. Two promising techniques at the time were total cardiac inflow occlusion and hypothermia

Total cardiac inflow occlusion

1940 Richard Varco, University of Minnesota: Total cardiac inflow occlusion.

Time restriction remained an obstacle for this method.

Milestones
Development of Hypothermia

During the early fifties, different methods of induced hypothermia were developed – including bathing the patient in ice water (above figure), using drugs, and cooling the chest cavity with cold saline – but the major drawbacks, arrest of blood flow to the brain and other organs such as the kidneys, was still a problem.

Experimental Deep Hypothermia

1951: W.G. Bigelow, a surgeon at the University of Toronto, hypothermia to obtain direct vision in intracardiac surgeries. His successful results, on 13 monkeys in 1951, were a promising starting point.

Milestones

1952-1954 –

A concept of deep hypothermia was introduced

A patient with ASD was slowly cooled down with refrigeration blankets to 28 degree centigrade. They then opened the chest, occluded the vena cava, opened the right atrium, and closed the ASD.

Milestones
First intracardiac operation in deep hypothermia and circulatory arrest without heart lung machine

September 1952: Richard Varco and John Lewis, University of Minnesota.

The first intracardiac operation performed in a dry operating field under direct vision without heart lung machine.

Lewis and colleagues operated on 60 patients with atrial septal defect using deep hypothermia and 54 survived (1952 – 1954).

Milestones
The first successful open heart surgery with a heart lung machine

☺ 1953 John Gibbon

In May 6, 1953, a major breakthrough in heart surgery was achieved when John H. Gibbon, at the Jefferson Medical College in Pennsylvania, performed the first successful open heart surgery on an eighteen-year-old girl with an atrial septal defect. For this operation he used the Gibbon-IBM heart lung machine, developed over the past decade and a half, with the help of engineers from IBM in New York.

The first successful open heart surgery with a heart lung machine

May 6, 1953 at Jefferson Medical College Hospital, Dr. John Heysham Gibbon, Jr. used the Heart-lung machine, Model II, 1951 to close ASD in a 18 year old Cecelia Bavolek. Art/Photo Collection, AG-054

Mayo-Gibbon heart-lung machine, 1958

1955: Dr. Earl Wood and Dr. John Kirklin, working with engineers from the Custom Engineering and Development Company of St Louis, Missouri, produced this more commercially viable version in 1955.
It was also used at London's Middlesex Hospital

Modification of the heart-lung machine

developed by the surgeon John Gibbon

Milestones

Early 1954 –

Pessimism was universal

Open heart surgery –

“Great concept but sick human heart could not tolerate it !!!”

Milestones
Use of Cross Circulation

1954 – Walton Lillehi and associates operated on a child with VSD using controlled cross-circulation,

University of Minnesota, USA.

A total of 47 pts were operated using this technique.

63% of these pts were alive 30 years later.

Milestones
Development of the Bubble Oxygenator

1955 Richard De Wall of University of Minnesota, together with Walton Lillehei

The device was an instant success and was used throughout the world because it was inexpensive, easy to assemble, and heat sterilizable. Throughout the years to come, oxygenator designs became more advanced, eventually leading to the development of membrane oxygenator and hollow fiber oxygenators

Milestones

Milestones

John Kirklin and colleagues used the modification of the Gibbon oxygenator and began to operate on intracardiac malformations successfully

Extracorporal Circulation with a Heart Lung Machine for Open Heart Surgery

History of Cardiac Surgery

1896

Ludwig Rehn successfully stitched a wound in the heart..

1912

Ludwig Rehn und Ferdinand Sauerbruch performed the first successful pericardectomy for a constricting pericarditis..

1924

Martin Kirschner performed the first successful pulmonary embolectomy using the technique developed in 1907 by Friedrich Trendelenburg.

1923/25

Elliott Culter und Samuel Levine (cardiologist) performed in 1923 transventricular and Souttar in 1925 Soutar transatrial (auricle) mitral valve valvotomy .

1929

First heart catheterization a self experiment by Werner Forssmann.

1931

Ferdinand Sauerbruch successfully operated on a right ventricular aneurysm..

1938

Emil Frey performed the first surgical ligation of a patent Ductus arteriosus Botalli.

1944

Clarence Crafoord performed the first successful repair of aortic coarctation by resection and end to end anastomosis.

1944

Alfred Blalock and Helen Taussig (cardiologist) performed the first left Art. subclavia to Art. pulmonalis shunt to improve the oxygen saturation in a child with tetralogy of Fallot.

1948

Thomas Sellors and Russell Brock independently performed transventricular pulmonary valvotomy for congenital pulmonary stenosis.

1948

Robert Gross und Tyge Sondergaard performed atrial septal defect (closed technique).

1950

Wilfred Bigelow developed a technique for cerebral protection during circulatory arrest.

1952/53

John Lewis performed the first open congenital heart surgery in hypothermia.

1953

John Gibbon developed a heart lung machine for open heart closure of atrial septal defect.

1954

Äke Senning und Clarence Crafoord.resected atrial myxoma in extracorporal circulation .

1954

Walton Lillehei, father of open heart surgery, used the Cross-Circulation technique to correct tetralogy of Fallot-Tetralogy in a child.The circulation of the parent was connected to that of the child to maintain the circulation when the child’s heart was arrested during the open heart operation.

1958

Äke Senning implanted the first heart pace maker.

1960

Dwight Harken performed the first aortic valve replacement with a cage ball prosthesis.

1961

Albert Starr performed the first mitral valve replacement with a cage ball prosthesis (Starr-Edwards Valve).

1962

Frank Mason Sones performed the first selective coronary angiography during a heart catheterization..

1963

Hans Borst performed aortic arch operation in hypothermia and circulatory arrest.

1967

Rene Favalaro performed coronary artery revascularisation with a coronary artery vein graft (CABG) and Vasilii Kolessov with Art. mammaria.

graft.

1967

Adrian Kantrowitz performed the first intra aortic balloon pump (IABP) counterpulsation for treating patients in cardiogenic shock.

1967

Christiaan Barnard performed the first human orthotopic heart transplantation.

1977

Andreas Gruentzig performed the first coronary balloon angioplasty.

1981

Bruce Reitz performed the first heart lung transplantation.

History of Heart Halve Surgery

Surgery of Endocarditis

Historical Developments

History of Transcatheter Heart Valve

Repair and Implantation