Director's Forum--A Half Century of Open Heart Surgery: Personal Reflections
Dr. Robert Litwak is a pioneer in the field of open-heart surgery. His career began with residencies in Philadelphia and Boston under Drs. Charles Bailey and Dwight Harken, the founders of modern open-heart surgery. In 1956, Dr. Litwak performed the first open-heart surgery in the southeastern United States while at the University of Miami School of Medicine.
Advances in the medical field in the past century have made the seemingly impossible possible. During World War I, there was a 24 percent mortality rate from thoracic (heart & lung) wounds, but the mortality rate dropped to 8 percent during World War II. Dr. Litwak attributes the drop to the skilled surgical teams and nurses, advances in anesthesiology, availability of antibiotics, and a better understanding of the physiological problems caused by such wounds. Additionally, the Intensive Care Unit (ICU) was developed and first utilized during this time, as were the first blood banks.
Back in the 1920s, doctors had given great thought to heart repair but did not have the necessary technology. In 1923, Drs. Elliot Cutler and Samuel Levine attempted to open the mitral valve while operating on the heart but only one in six patients survived. Some 25 years later, surgeons were successfully operating on patients with obstructed mitral valves.
In 1944, as World War II was nearing its end, Dr. Harken (whom Litwak later would study under) operated on 134 soldiers who had shrapnel, bullets, or other foreign bodies in, on, or near the heart or lungs without a single mortality. And, he accomplished this without the availability of the yet-to-be-developed heart-lung machine. That same year, at Johns Hopkins University, a team of doctors first attempted and succeeded at operating on a baby suffering from tetralogy of Fallot, a potentially fatal illness in which a heart defect prevents the flow of blood to the lungs. Some years later, Dr. Litwak recounted, he had operated on a baby just two days old suffering from severe tetralogy. Today, that baby is a thriving male in his 30s.
In the early 1950s, a hypothermia technique allowed doctors to perform simple heart operations. In 1953, Dr. John H. Gibbon invented the first practical artificial heart and lung machine, which allowed him to perform the first open-heart surgery. Gibbon's heart-lung machine permitted surgeons to perform more complex operations by supporting cardio and respiratory function so that doctors could repair heart and lung defects.
By the late 1960s, surgeons began performing coronary artery surgery (rerouting blood around clogged arteries by grafting veins and arteries from other parts of the body to restore blood flow to the heart). Over the years, the risk of complications from bypass surgery has greatly diminished. Today, a variety of options exist to repair obstructions, including angioplasty (using a catheter), enlarging obstructed valves and arteries, repairing defects and arrhythmias, inserting implants, and performing transplants. Dr. Litwak spoke optimistically about the future of the profession, predicting an increase in the number of keyhole operations and a wider use of robotic methods.