Il Dott. Andrea Camera e l’équipe di Ortopedia e Traumatologia della Clinica Città di Alessandria - Policlinico di Monza, hanno partecipato alla 24esima edizione del Congresso...
The history of cardiac surgery
Modern cardiac surgery basically dates back to the introduction of open-heart surgery.
It was the May 16th 1953, when John Gibbon, a surgeon from Philadelphia, after 25 years of study and experiments, successfully performed the first open-heart cardiac surgery in extracorporeal circulation on an 18-year-old girl, thus curing her congenital heart disease.
In the mid-50s extracorporeal circulation became easier, more reliable and less risky. This caused cardiac surgery to develop significantly and by the end of the 60s most surgical procedures that are still performed, started to be carried out.
The first surgeries where extra corporeal circulation was used, treated congenital heart diseases and relied on the progress made in anatomy and physiopatology in the previous years and the latest progress in cardiac diagnostics, particularly as for the use of catheters and cardiac angiography.
Later, this technique was used to repair several heart valves diseases. However, surgeons soon realised that these disease would be easily treated by replacing the natural valve with an artificial one.
After several researchers' unsuccessful attempt to create an artificial valve, Albert Starr, a young surgeon from Portland (Oregon) and Lowell Edwards a retired engineer, built an efficient artificial valve, which was first successfully implanted on September 21st 1960.
From that moment on, many heart valve prosthesis were built, improved and implanted in million of patients.
After the cardiologist Mason Sones, first performed selective coronarography, an ultrasound procedure that allows to have a detailed view of the damage to the coronary arteries, the Argentinian surgeon René Favaloro performed the first coronary artery bypass to revascularize myocaridal ischemia. In the following years, coronary artery bypass started to spread all over the world.
A few months after, on 3rd December 1967, at 3 in the morning, at Groote Schuure hospital in Cape Town, South Africa, a great event changed the history of surgery and left the public opinion in shock and awe: an unknown surgeon named Christiaan Barnard performed the first adult heart transplant.
In the following months heart transplants were performed worldwide.
Shortly after, however, the initial enthusiasm was doused. Several patients were dying of transplant rejection. Transplant programmes were suspended.
Thanks to the painstaking work of Norman Shumway, a surgeon from Stanford University ,California, a new efficient therapy to manage transplant rejection started to be used.
Only two years after the first transplant had been performed by Cristiaan Barnard, on april 4th 1969 in Houston, Texas, Denton Cooley implanted an artificial heart to keep the patient alive until a real heart would be available. The artificial heart kept the patient alive for 64 hours and then the real heart was implanted.
Yet, the patient's conditions got worse and he died 32 hours after the surgery.
This clinical testing is one of the milestones of medicine and was followed by a series of controversial ethical, political, medical, legal events that led two masters of surgery such as Michael DeBakey and Denton Cooley to come into conflict and not talk to each other for almost forty years. Only in October 2007, the two surgeons reconciled at a public ceremony.
In the years that followed the surgical procedures were improved. Nowadays, surgery keeps making progress and strives to treat older and older patients with serious and complex diseases.
Recently, mitral valve conservative surgery has taken significant steps ahead, and so has conservative aortic valve surgery.
This evolution is due to three main factors: the change in the prevalence of certain types anatomopathological alterations of the valves, which basically took the place of rheumatic diseases; the progress in echocardiography, thanks to which higher diagnostic precision was possible and finally the introduction of new techniques and materials during surgery.
In more recent days, a new, more frequent approach to non-invasive or minimally invasive surgery has gradually developed. These techniques still use extracorporeal circulation membrane oxygenation, but do not involve the opening of the sternum. The surgeon performs small cuts in the patients skin and inserts catheters into them. This makes the surgery less traumatic, requires low-dose of anesthetic and causes smaller unsightly scars.
Even smaller cuts are now being made and computer-assisted systems allow the surgeons to visualize the area they are operating on a monitor.
The newest system, that is still being tested though, is robotic surgery. Instead of directly moving the instruments, the surgeon uses methods to control the instruments; either a direct telemanipulator or through computer control.
New techniques without extracorporeal circulation, aimed at reducing surgery trauma, have been developed:
Beating-heart bypass and transcatheter aortic valve implantation.
It is worth mentioning that whilst the first breakthroughs were due to the intelligence, commitment and courage of pioneers, the more recent progress has been made thanks to the cooperation between scientific and technical disciplines like clinical medicine, engineering, mechanical immunology, from materials science to new sensor and transductors, from pathological anatomy to electronics and energetic systems.
It was the May 16th 1953, when John Gibbon, a surgeon from Philadelphia, after 25 years of study and experiments, successfully performed the first open-heart cardiac surgery in extracorporeal circulation on an 18-year-old girl, thus curing her congenital heart disease.
In the mid-50s extracorporeal circulation became easier, more reliable and less risky. This caused cardiac surgery to develop significantly and by the end of the 60s most surgical procedures that are still performed, started to be carried out.
The first surgeries where extra corporeal circulation was used, treated congenital heart diseases and relied on the progress made in anatomy and physiopatology in the previous years and the latest progress in cardiac diagnostics, particularly as for the use of catheters and cardiac angiography.
Later, this technique was used to repair several heart valves diseases. However, surgeons soon realised that these disease would be easily treated by replacing the natural valve with an artificial one.
After several researchers' unsuccessful attempt to create an artificial valve, Albert Starr, a young surgeon from Portland (Oregon) and Lowell Edwards a retired engineer, built an efficient artificial valve, which was first successfully implanted on September 21st 1960.
From that moment on, many heart valve prosthesis were built, improved and implanted in million of patients.
After the cardiologist Mason Sones, first performed selective coronarography, an ultrasound procedure that allows to have a detailed view of the damage to the coronary arteries, the Argentinian surgeon René Favaloro performed the first coronary artery bypass to revascularize myocaridal ischemia. In the following years, coronary artery bypass started to spread all over the world.
A few months after, on 3rd December 1967, at 3 in the morning, at Groote Schuure hospital in Cape Town, South Africa, a great event changed the history of surgery and left the public opinion in shock and awe: an unknown surgeon named Christiaan Barnard performed the first adult heart transplant.
In the following months heart transplants were performed worldwide.
Shortly after, however, the initial enthusiasm was doused. Several patients were dying of transplant rejection. Transplant programmes were suspended.
Thanks to the painstaking work of Norman Shumway, a surgeon from Stanford University ,California, a new efficient therapy to manage transplant rejection started to be used.
Only two years after the first transplant had been performed by Cristiaan Barnard, on april 4th 1969 in Houston, Texas, Denton Cooley implanted an artificial heart to keep the patient alive until a real heart would be available. The artificial heart kept the patient alive for 64 hours and then the real heart was implanted.
Yet, the patient's conditions got worse and he died 32 hours after the surgery.
This clinical testing is one of the milestones of medicine and was followed by a series of controversial ethical, political, medical, legal events that led two masters of surgery such as Michael DeBakey and Denton Cooley to come into conflict and not talk to each other for almost forty years. Only in October 2007, the two surgeons reconciled at a public ceremony.
In the years that followed the surgical procedures were improved. Nowadays, surgery keeps making progress and strives to treat older and older patients with serious and complex diseases.
Recently, mitral valve conservative surgery has taken significant steps ahead, and so has conservative aortic valve surgery.
This evolution is due to three main factors: the change in the prevalence of certain types anatomopathological alterations of the valves, which basically took the place of rheumatic diseases; the progress in echocardiography, thanks to which higher diagnostic precision was possible and finally the introduction of new techniques and materials during surgery.
In more recent days, a new, more frequent approach to non-invasive or minimally invasive surgery has gradually developed. These techniques still use extracorporeal circulation membrane oxygenation, but do not involve the opening of the sternum. The surgeon performs small cuts in the patients skin and inserts catheters into them. This makes the surgery less traumatic, requires low-dose of anesthetic and causes smaller unsightly scars.
Even smaller cuts are now being made and computer-assisted systems allow the surgeons to visualize the area they are operating on a monitor.
The newest system, that is still being tested though, is robotic surgery. Instead of directly moving the instruments, the surgeon uses methods to control the instruments; either a direct telemanipulator or through computer control.
New techniques without extracorporeal circulation, aimed at reducing surgery trauma, have been developed:
Beating-heart bypass and transcatheter aortic valve implantation.
It is worth mentioning that whilst the first breakthroughs were due to the intelligence, commitment and courage of pioneers, the more recent progress has been made thanks to the cooperation between scientific and technical disciplines like clinical medicine, engineering, mechanical immunology, from materials science to new sensor and transductors, from pathological anatomy to electronics and energetic systems.
