History of cardiac surgery DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG ,DNB CTS SR)

1. History of Cardiac Surgery
Dr NIKUNJ
(RESIDENT CT SURGERY STAR HOSPITAL)

2. • medicine
• The danger of touching the heart
• Anesthesia
• Control of the airway
• Vascular surgery
• Cardiac catheterization
• Heart-lung bypass

4. 19 th century
• The development of major surgery was retarded for centuries by a lack of knowledge and
technology
The earliest operations on the pericardium performed by
• Francisco Romero (1801)
• Dominique Jean Larrey (1810)
• Henry Dalton (1891)
Daniel Hale Williams (1893)
The first surgery on the heart itself was performed by Axel Cappelen on 4 September 1895
at Rikshospitaltin Kristiania, Cappelen ligated a bleeding coronary artery in a 24-year-old
man who had been stabbed in the left axilla and was in deep shock upon arrival.
The first successful surgery on the heart, without any complications, was performed by
Dr. Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on
7 September 1896.

6. Lillehei performed surgeries using cross-circulation, in which a donor was hooked up nearby to
take up the pumping and oxygenation functions of the patient as he was being operated on.
.

7. • In 1958, Lillehei was responsible for the world's first use of a small,
external, portable, battery-powered pacemaker was invented by Earl
Bakken

8. Viven thomas
Alfred blalock Helen.b taussig

9. • Cohn reported his attempts with atrial wall invagination for experimental
ASD closure in dogs in 1947.
• In 1952, Lewis and Taufic reported ASD repair in a 5- year-old girl using
hypothermia and inflow occlusion. This was the first successful open
heart repair under direct vision and marked the onset of the open heart
surgical era
• Dr. John Gibbon opened the modern era of open-heart surgery on May 6,
1953, using the heart-lung machine, or cardiopulmonary bypass (CPB),
when he successfully repaired an ASD in an 18-year-old woman

10. Coronary artery bypass surgery
• The first coronary artery bypass surgery was performed in the United States on
May 2, 1960, at the Albert Einstein College of Medicine-Bronx Municipal Hospital
Center by a team led by Robert H. Goetz and the thoracic surgeon
• Soviet cardiac surgeon, Vasilii Kolesov, performed the first successful internal
mammary artery–coronary artery anastomosis in 1964.[
• However, Goetz has been cited by others, including Kolesov, as the first successful
human coronary artery bypass.Goetz's case has frequently been overlooked.
• The anastomosis was intima-to-intima, with the vessels held together with
circumferential ligatures over a specially designed metal ring.

11. • René Favaloro an Argentine surgeon, achieved a physiologic approach in
the surgical management of coronary artery disease—the bypass grafting
procedure—at the Cleveland Clinic in May 1967.His new technique used
a saphenous vein autograft to replace a stenotic segment of the right
coronary artery . Later, he successfully used the saphenous vein as a
bypassing channel, which has become the typical bypass graft technique
we know today
• In 1968, doctors Charles Bailey, Teruo Hirose and George Green used the
internal mammary artery instead of the saphenous vein for the grafting

12. CPB
• An Austrian-German physiologist Maximilian von Freyconstructed an
early prototype of a heart-lung machine in 1885 at Carl Ludwig’s
Physiological Institute of the University of Leipzig
• However, such machines were not feasible before the discovery
of heparin in 1916 which prevents blood coagulation.
• A Soviet scientist Sergei Brukhonenko developed a heart-lung machine
for total body perfusion in 1926 which was used in experiments with
canines.

13. CPB

14. cardioplegia
• The earliest attempts to perform open heart surgery before the advent of the heart-lung
machine used systemic hypothermia produced by surface cooling not only to protect the
heart but to protect the brain and other organs during circulatory arrest.
• However, uniform cardiac hypothermia is difficult to achieve solely by the introduction
of cold intracoronary perfusates, and systemic hypothermia is necessary
• In an attempt to overcome this problem, Shumway and associates introduced the
concept of profound local (topical) hypothermia by filling the pericardial sac with ice-
cold saline
• After the initiation of open heart surgery with use of extracorporeal
circulation by Gibbon, it soon became obvious that aortic cross-clamping was necessary to
provide a bloodless field to facilitate the precise repair of intracardiac defects,
• Melrose and colleagues2 introduced the concept of “elective cardiac arrest” by rapidly
injecting into the aortic root, after aortic cross-clamping, a 2.5% potassium citrate
solution in warm blood to arrest the heart.
• Soon thereafter, experimental and clinical evidence demonstrated the development of
severe myocardial necrosis associated with the Melrose technique.

15. Heart transplant
• In 1945, the Soviet pathologist Nikolai Sinitsyn successfully transplanted a heart from one frog to
another frog and from one dog to another dog.
• world's first adult heart transplant was performed by a South African cardiac surgeon,
• Christiaan Barnard, using techniques developed by Shumway and Richard Lower.
• Barnard performed the first transplant on Louis Washkansky on 3 December 1967 at Groote Schuur
Hospital in Cape Town.
• Adrian Kantrowitz performed the first pediatric heart transplant on 6 December 1967 at
Maimonides Hospital
• Shumway performed the first adult heart transplant in the United States on 6 January 1968
at Stanford University Hospital

16. Heart transplant
Christiaan Barnard

17. The development of heart valve
surgery
• The invention of the heart-lung machine - allowed the development of
open-heart surgery.
• An important aspect of this was the treatment of defective valves
• Charles A. Hufnagelwas an American surgeon who in the early 1950
invented the first artificial heart valve
• first variation of the ball-in-cage valves
• This event accelerated the development of other artificial heart valves.

18. • The caged-ball valve created by Albert Starr and Lowell Edwards was
implanted for the first time in September 1960 in the mitral position
• the Starr–Edwards prosthetic valve a benchmark in the field of
valvular surgery

19. THANK YOU