Open-heart surgery

For many years, major heart surgery--opening the chest to operate directly onan exposed heart--was considered outside the realm of possibility. The heartwould cease beating during such operations. How could patients survive? A few pioneers did perform emergency surgery directly on the open heart, one of the first being African-American surgeon Daniel Hale Williams, who opened thechest of a stabbing victim and sewed up the pericardium (the sac surroundingthe heart) in 1893. Both Ludwig Rehn (1849-1930) and Forina sutured heart wounds 1896. More lengthy and complicated heart operations, however, required away to keep the blood oxygenated and circulating while a patient's heart wasundergoing the operation. American surgeon, John H. Gibbon, Jr., devoted himself to solving this problem in the 1930s. Assisted by his wife Mary, Gibbon persisted until he had developed a workable pump-oxygenator, or heart-lung machine, that shunted blood from the veins through a catheter to a machine thatsupplied the blood with oxygen and then pumped the blood back into the arteries. On May 6, 1953, Gibbon connected Cecilia Bavolek, a patient suffering from heart failure, to the heart-lung machine and operated directly on her heart, closing an opening between her atria. This operation ushered in theera of open-heart surgery.

The methods and technical details of open cardiac surgery were refined throughout the 1950s by a number of surgeons and engineers, notably Owen Wangenstein at the University of Minnesota and John W. Kirklin at Minnesota's Mayo Clinic. By 1960 open-heart surgery was standard practice and began to be used notjust for repair of cardiac malfunctions but also for replacement of defective heart parts--even the whole heart itself. Surgeons Albert Starr and M. L. Edwards of Portland, Oregon, designed a ball-and-cage artificial heart valve and successfully implanted it in a 52-year-old patient in 1961. Rene G. Favalaro introduced coronary artery bypass surgery in 1967. The heart gets its blood supply from coronary arteries that branch off from the aorta. These arteries can narrow from accumulations of plaque, which also promote clot formation,and can thereby become blocked, causing severe chest pain (angina) and, in some cases, heart attack. Favalaro and his surgical team at the Cleveland Clinic devised a technique of grafting a vein from the patient's leg around a blocked portion of a coronary artery, creating an alternate blood pathway. Favalaro's bypass surgery was made possible by the use of microsurgical techniquesarteriography (direct images of the heart prior to open-heart surgery) and the heart-lung machine. Within three years of Favalaro's pioneering 1967 operation, coronary bypass surgery gained wide acceptance. Its use in cases of mildly clogged arteries dropped off in the late 1970s with the advent of balloonangioplasty.

The most dramatic development in open-heart surgery was the heart transplant,first successfully performed in Cape Town, South Africa, by Dr. Christiaan Barnard in 1967. Another dramatic step in open-heart surgery was revealled in1996 when Randas Batista, an obscure cardiac surgeon from a country clinic insouthern Brazil, hit the headlines in the United States. Batista cuts a triangular chunk from the left ventricular muscle of an enlarged heart in an effort to save the life of patient with chronic heart failure. Researchers do notyet understand why a weak heart thickens and grows--sometimes ballooning totwice it's normal size--but they do know it no longer pumps efficiently and eventually fails completely. Contrary to popular opinion, Batista believes itis the size of the heart, not the weakened muscle, that kills people. He hasused his controversial technique on more than 400 people since 1994. In 1996,prominent U.S. surgeons travelled with the ABC news team from 20/20 to Brazil to see Batista's technique first-hand. Since May, 1996, Patrick McCarthy of the Cleveland Clinic has performed the surgery on more than 24 patients. All but one were still living four months later.

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