1) Cardiac surgery has evolved significantly from the late 19th century. Early operations on the pericardium took place in the early 19th century but were rarely successful. 2) A major breakthrough was the first successful open-heart surgery performed by John Gibbon in 1953 using the first heart-lung machine. This allowed for direct visualization and repair of cardiac structures. 3) The development of cardiopulmonary bypass by Lillehei in 1954 and the use of mechanical pumps by Kirklin further advanced cardiac surgery by allowing for longer, more complex procedures. 4) Milestones since then include the first coronary artery bypass by Favaloro in 1967, innovations in heart valve surgery and replacement,

1. A Brief History of Cardiac
Surgery
Preetam Sahani
MBBS, DNB (Gen. Surgery), MDHM (Osmania Univ.), MCh (CTVS, DU)
Department of Cardiovascular and Thoracic Surgery,
AIIMS, Raipur

2. Theodor Billroth….
“A surgeon who would attempt
such an operation [cardiac suture]
should lose the respect of his
colleagues”
“Father of modern abdominal surgery”

3. • Surgeon: Dr W Devries
• Patient: Dr Barney Clarke
• Dec 2 1982
• University of Utah Hospital
• Implantation of the first permanent
artificial heart – The JARVIK 7
• "We should remember that without the
consent of many courageous patients, the
great advances [in cardiac surgery] could not
occur" Dr S Westaby

4. 19th century
The earliest operations were on the
pericardium took place in the early part of
19th century
-Francisco Romero (1801)
-Dominique Jean Larrey (1810)
-Henry Dalton (1891)
-Daniel Hale Williams (1893)
However it was Harris Schumaker in 1969 who
categorically pronounced the pericardium as being a
part of the heart
Dominique Jean Larrey
Henry Dalton- 1891 Daniel H Williams-1893

5. • Dr Axel Cappelen:
- 1895, Oslo, Norway
- ligated a bleeding coronary
artery in a 24-year-old man who
had been stabbed in the left
Axilla
- Left thoracotomy
- Post op fatality due to
mediastinitis

6. The Prelude…
• Stephen Paget - famous British surgeon,
remarked in his textbook on surgery of the
chest as late as in 1896, (famous for his "seed
and soil" theory of metastasis)
“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 of the heart”

7. 9th September 1896……
By 1907, Rehn reported 124 such attempts with 40% survival rate. This was accomplished in the era
before endotracheal intubation, antibiotics, and blood transfusion!

8. • Blood types were first identified by Landsteiner and others in 1900–
1902, and
• blood typing before transfusion was introduced by Ottenberg in 1907.
• satisfactory anticoagulation of the blood with citrate (A. Hustin and L.
Agote) and addition of glucose (Rous and Turner), so that it could be
bottled and stored to make administration practical, was not
introduced until 1915–1916

9. Evolution of valve surgery…
• Theodore Tuffier
• 13th July 1912
• First surgeon to operate on the aortic
valve
• Closed aortic valvulotomy by
invaginating a finger into the aortic
valve through the aortic root.
• Patient followed for 12 years

10. Surgery of the Mitral valve…
• Elliot Cutler..Harvard Medical school
• 1923, first Mitral valvulotomy
• 12 yr old girl with Severe Rheumatic MS
• Used a tenotomy knife to cut the mitral leaflet
• Created a mitral incompetence in all cases
• Abandoned the procedure due to a 90% mortality

11. Closed mitral valvulotomy…
• Sir Henry Souttar
• 1925
• Performed the first transatrial digital closed mitral
valvulotomy for severe MS
• Patient was doing well at 5years of follow up died of a stroke
• However he was not allowed to operate any further
• CMV was never attempted upon for the next 23 years.
• Successful conquest of mitral stenosis would
have to wait 23 more years.

12. Helen Taussig, Alfred Blalock, Vivian Thomas…

13. • 1944
• The Blalock-Thomas-Tausig shunt
• Anastomosing the subclavian artery to the
Right pulmonary artery
• Eileen saxon (15 months)
• The Blue baby syndrome (TOF)
• Performed the surgery on thousands of
cyanosed children at a mortality of less than 5
percent.
• Something the Lord Made …

14. Re-emergence of the mitral valvulotomy…
• Horace G Smithy and Charles Bailey
• 1948
• Smithy performed valvulotomy by the old
cutler method
• Bailey incised the commisures leading to
the emergence of mitral commissurotomy

15. First Open heart Surgery…
-April 15 1952, Robert
E. Gross at the Boston
Children's Hospital
successfully used his
"atrial well" technique to
close an atrial septal defect
-able to digitally explore
the atrial structures and
perform a surgical repair
working beneath the layer
of blood
-Gross was also the first to
Surgically ligate the PDA
way back in 1938

16. • On September 2, 1952,
• John F. Lewis and colleagues at the University of Minnesota
successfully closed an ASD under direct vision during 5.5
minutes of circulatory arrest (caval inflow occlusion)
permitted by moderate surface-induced hypothermia (26°C)
• This method, although it continued to be used for several
years for surgical repair of these defects, had the obvious time
limitation of about 8 to 10 minutes
• There remained the need for a heart-lung machine to
support the patient and permit the surgeon time to
accomplish complex intracardiac repairs under direct vision

17. Father of cardiac surgery…. Dr John Heysham Gibbon Jr
• On May 6, 1953
• closed an atrial septal defect in an 18 yr old girl Cecelia
Bavolek.
• The first successful intracardiac surgery of its kind
performed on a human patient
• Ms. Bavolek was connected to the device for three-
quarters of an hour and for 26 crucial minutes, the
patient totally depended upon the machine’s artificial
cardiac and respiratory functions.
• Dr. Gibbon first used this heart-lung machine clinically in a
15-month-old child in February 1952, but she died during
surgery because she had an undiagnosed PDA instead of the
anticipated ASD.
The Jefferson’s Heart Lung Machine

18. Concept of Cardiopulmonary bypass..
• C Walton Lillehei
• Univ. of Minnesota
• March 26, 1954

19. C Walton Lillehei.. Controlled crosscirculation
• intracardiac surgery with total CPB
using the patient's parent as the
"heart-lung machine" (so-called
controlled cross-circulation, in which
the parent's femoral artery and vein
were connected to the patient's
arterial and venous system
respectively
• March 1954 and July 1955, 45 patients 27
with VSD, 10 with tetralogy of Fallot, and 5 with AV
canal—with 28 survivors
• Lillehei had clearly demonstrated the potential for
CPB to permit major open heart surgery once a
satisfactory artificial heart-lung machine was
available to skillful cardiac surgical teams

20. • John W. Kirklin
• the first successful series of patients to undergo intracardiac
surgery with the aid of a mechanical pump oxygenator
• March – May 1955
• the heart-lung machine was a Mayo modification of the Gibbon-
IBM model,
• March 1955, the first child survived a repair of a VSD
• 8 patients, 4 survived (50% survival)
American cardiothoracic surgeon, general surgeon, prolific author and
medical educator who is best remembered for refining John
Gibbon's heart–lung bypass machine via a pump-oxygenator to make
feasible under direct vision, routine open-heart surgery and repairs of
some congenital heart defects

21. Prosthetic heart valves…
• Dwight Harken in 1960 successfully replaced
the aortic valve in two patients with a caged
ball prosthesis
- removing shrapnel from the hearts of 130
soldiers during the war without a single
fatality
- opened the first intensive care unit in 1951
• Albert Starr of the University of Oregon,
successfully replaced the mitral valve in six
patients with a caged ball prosthetic valve
between August 1960 and February 1961

22. Prosthetic heart valves…

23. Bhagwant Kalke…1964

24. Coronary artery bypass grafting…
• 1957- Bailey and Longmire, Coronary endarterectomy
• May 1967- Rene Favaloro
- at the Cleveland Clinic first interposed a segment of
saphenous vein (end-to-end) to relieve a stenotic right
coronary artery
- performed his first aortocoronary bypass graft to the right
coronary artery
• 1968- W Dudley Johnson
- had the greatest impact on the widespread use of CABG
using the saphenous vein. He suggested and demonstrated
that CABG was applicable to most patients with coronary
artery disease by placing multiple grafts distal to all disease
and targeting the left anterior descending artery, branches
of the circumflex, and the posterior descending coronary
arteries in addition to the right coronary artery.

25. Resurgence of valve repair…
• Dr Alain Carpentier –
• 1970’s
• The French Correction
• Resurgence of the concept of mitral
valve repair as an alternative to
replacement with prosthetic valves
• Mitral annuloplasty rings

26. Legends …
• Dr Denton A Cooley-
• 1969 and 1970
• First to implant a total artificial heart in a man who subsequently
lived for 65 hours.
• Developed one of the first prototype of the Intra Aortic Balloon
counterpulsation pump.

27. Dr Michael E Debakey…
• Lebanese American surgeon
• Known for a number of surgical innovations in the field of cardiac
surgery.
• Pioneered the engineering of ventricular assist devices
• Worked extensively on developing mechanical hearts and
developed a Total Artificial Heart used by Denton cooley in
one of his patients who could not be weaned off cardiopulmonary
bypass
• Extensive work on the surgery of Aortic aneurysms
• First to use dacron grafts.

28. Generations of Total artificial heart…

29. Pioneering Heart Transplantation… The Stanford group
• Richard Lower
- performed over 250 canine heart transplants and over 800
in humans,
- pioneered the use of cyclosporin to prevent transplant
rejection
- developed a biopsy technique to monitor
rejection
• Norman Edward Shumway
- world's first heart-lung transplant was
performed in 1981, by both Shumway
- The orthotopic technique which became
the standard technique for heart
transplant

30. Cardiac Transplantation…
• Christian Neethling Barnard
• 3rd December 1967
• Groote Schuur Hospital in Cape Town, South
Africa,
• Mortality, POD 18; klebsiella sepsis
• Louis Washkansky received the heart of Denise
Darvall

31. • Barnard (who used Shumway and Lower's research) conducted the
first successful (i.e. not resulting in immediate death) human
transplantation in South Africa on December 3, 1967.
• Adrian Kantrowitz subsequently also conducted a transplant in New
York City on December 6, 1967.
• Shumway performed his first human heart transplantation on January
6, 1968.
• Lower performed his first successful human transplantation in May of
that same year.

32. • Adrian Kantrowitz (October 4, 1918 –
November 14, 2008) was an American
cardiac surgeon
• world's second heart transplant attempt
at Maimonedes medical centre, in
Brooklyn, New york on December 6,
1967.
• The infant lived for only six hours. At a
press conference afterwards, Kantrowitz
emphasized that he considered the
operation to have been a failure.[4]
• Also invented the intra-aortic balloon
pump (IABP), a left ventricular assist
device (L-VAD), and an early version of
the implantable pacemaker.

33. Heart Transplant in india…
• Prafulla Kumar Sen MD (7 December 1915 – 22 July
1982)
- led the first human heart transplant procedure in India
in 16th feb 1968
* KEM, Mumbai
* patient died of a heart failure after 3
hours
- became the fourth surgeon in the world to
carry out this operation.
- It was also the sixth attempt at this procedure in the
world.
- second heart transplant at KEM, patient survived for16
hours

34. First Successful Heart Transplant in india…
• Dr P. Venugopal along with 20 surgeons
successfully performed India's first heart
transplant at the AIIMS on 3 August 1994
• After the Transplantation of Human Organs Bill
finally received the President’s assent on 7 July
1994

35. We wouldn’t be surgeons if not for our patients who have had the
courage to trust their lives in our hands
First heart transplant in AIIMS, Raipur, probably by 2025
Thank you