50 Years of Cardiovascular Surgery at Mayo Clinic in Rochester

The cardiac surgical team in 1955.

In 1955, a young surgeon in Rochester, Minnesota, embarked on a planned series of cases using a heart-lung machine, which allowed direct visualization of the inside of the opened human heart to repair otherwise-fatal intracardiac defects. Four of the initial 8 patients survived, and with this success, John W. Kirklin, M.D., and his team at Mayo Clinic in Rochester had effectively made open heart surgery a therapy that would become widely available.

The idea that complex cardiac surgery might someday be possible developed as surgeons gained skill and confidence working around the heart during World War II; Dwight Harken, M.D., reported removing 100 intracardiac foreign bodies during the war. This experience led to closed mitral commissurotomy and closure of some atrial septal defects using the atrial "well" technique. John Lewis, M.D., at the University of Minnesota, even used deep hypothermic circulatory arrest to close an atrial septal defect. Extracardiac procedures such as closure of patent ductus arteriosus and repair of coarctation of the aorta were pioneered at Mayo Clinic by Oscar T. Clagett, M.D. It was apparent, however, that complex cardiac repairs would require some means of pumping oxygenated blood for the patient while the surgeon worked inside the heart.

A number of teams around the world were working on developing a machine for cardiopulmonary bypass. John H. Gibbon, M.D., of Philadelphia, had been working on such a device since 1937. His work was partially supported by Thomas J. Watson, the chairman of IBM. In 1952, Gibbon attempted to close an atrial septal defect using his machine, but the patient died and was found at autopsy to have had a patent ductus arteriosus. In May 1953, Dr. Gibbon successfully closed an atrial septal defect using the machine, but 2 subsequent patients died, and he abandoned further attempts.

John W. Kirklin, M.D.

In 1952, Dr. Kirklin brought together a group of clinicians at Mayo Clinic to proceed with the development and clinical application of a cardiac surgical program using a mechanical pump oxygenator. The group included Jesse E. Edwards, M.D., in pathology; Earl H. Wood, M.D., and H. Jeremy Swan, M.D., in physiology; Howard B. Burchell, M.D., in cardiology; James W. DuShane, M.D., in pediatric cardiology; Robert T. Patrick, M.D., in anesthesiology; David E. Donald M.D. MRCVS, in research; and E. Richard Jones in mechanical engineering. After evaluating a number of potential devices, Dr. Kirklin obtained the blueprints of the Gibbon-IBM pump oxygenator. Based on this design, a pump oxygenator was developed by the biomedical engineers at Mayo Clinic. A laboratory program of research and development ensued. After 2 years, the investigators were ready to proceed with clinical application.

Earl H. Wood, M.D.

Many of the initial failures in open heart surgery were attributable to misdiagnosis or to incorrect understanding of the anatomy of the congenital defect. Professor Denis Melrose from London would later report, "Consider a group of people practicing in animals the management of an open heart operation. Remember the clumsy perfusion equipment, primitive anesthesia, little or no measuring equipment, a host of mysteries gradually overcome. Then the first attempt at clinical application. Suddenly, the rules established are completely without validity, drowned in a torrent of blood streaming into the heart from an [unexpected] patent ductus, a large bronchial [collateral] or an incompetent aortic valve."

During the research and development phase, Dr. Kirklin worked with Dr. Edwards to develop a detailed understanding of congenital heart disease to plan surgical repairs. In addition, great strides were being made in the ability to make a correct preoperative diagnosis. Cardiac catheterization was being developed, and many major contributions came from Mayo Clinic. Dr. Wood developed the strain-gauge method of measuring arterial blood pressure, an extension of his work developing a gravity suit, or G suit, for the military during World War II. His laboratory, in conjunction with the Eastman Kodak Company, also made use of the knowledge of dye chemistry obtained at the end of the war to develop the dye-dilution technique used to determine cardiac outputs and identify intracardiac shunts.

First Mayo-Gibbon pump oxygenator

The mechanical pump oxygenator built at Mayo Clinic was a relatively sophisticated machine. Safety features included a device to sense the level of blood in the venous reservoir that automatically activated an occluder mechanism. The occluder mechanism controlled the source of blood pumped to the oxygenator (venous reservoir or recirculated blood) to maintain both the oxygenator blood flow and the venous reservoir volume constant. The oxygenator consisted of up to 14 wire-mesh screens, each 12 by 18 inches. The speed of the arterial pump was automatically controlled by a level-sensing device in the oxygenator reservoir. Carbon dioxide flow to the oxygenator was automatically controlled by a pH meter to maintain pH of 7.43 to 7.45; oxygen flow was constant. The pump oxygenator needed to be primed preoperatively with 6 units of blood, a separate operating room in which to prepare it, and about 6 hours to clean after each case.

The team planned to proceed with a series of 5 (later expanded to 8) patients, regardless of the outcomes. No cardiac surgical procedures had been performed using a mechanical pump oxygenator since Gibbon's experience. Families were told of the risks, imponderables, and possible benefits of this new and unproven surgical treatment. The first procedure was performed by Dr. Kirklin on March 22, 1955, in the Colonial Building of Methodist Hospital; Dr. Patrick was the anesthesiologist. A 5-year-old child underwent repair of a large ventricular septal defect. The arterial cannula became dislodged shortly after bypass began, which required rapid correction and de-airing of the circuit. Fortunately, the well-prepared team was up to the task, and the operation was successful. The patient's postoperative course was uneventful.

Mayo Clinic Proceedings, May 18, 1955. The first series of 8 patients were reported.

The first report of this experience was published in the Proceedings of the Staff Meetings of the Mayo Clinic in May 1955 and described 8 patients, 4 of whom died postoperatively, and represented the first clinical series of patients having open heart surgery with a mechanical pump oxygenator. This series pioneered the new era of open heart surgery. Cardiac surgery had become a reality, and surgical treatment of heart disease became widely available with dissemination of the heart-lung machine. Dwight C. McGoon, M.D., joined the cardiac surgery staff in 1957, and the surgical suites were moved to Saint Marys Hospital to accommodate the rapidly increasing volume of cardiac surgery at Mayo Clinic.

Meanwhile, C. Walton Lillehei, M.D., at the University of Minnesota, had begun a series of open heart procedures using controlled cross-circulation. In these procedures, the cardiopulmonary bypass "machine" was the patient's mother or father. The parent's femoral vessels were cannulated, and his or her oxygenated blood was pumped to the patient undergoing the cardiac repair. A total of 45 such operations were done in subsequent months with 18 deaths.

Dwight C. McGoon, M.D.

Following the success at Mayo Clinic, however, Dr. Lillehei abandoned the cross-circulation technique and began using a mechanical pump with a bubble oxygenator. Reflecting on this era, cardiac surgeon Norman E. Shumway, M.D., of Stanford University, later remarked, "There, for a shining moment, the only institutions in the world where one could go for open heart surgery were 90 miles apart, at the Mayo Clinic and the University of Minnesota."

The success of this initial series of open heart operations at Mayo Clinic required the multidisciplinary effort of a group of talented and dedicated individuals. Expertise in physiology, engineering, cardiology, pathology, and anesthesiology led to the refinement and building of the pump-oxygenator machine, the proper preoperative diagnosis, the development of precise surgical techniques based on a detailed understanding of the defect to be repaired, and careful intraoperative and postoperative monitoring and care.

Cardiopulmonary bypass has been used to perform more than 63,000 cardiac operations at Mayo Clinic, and more than 2,300 such procedures are currently performed annually. The Division of Cardiovascular Surgery, comprising a staff of 9 cardiovascular surgeons, is chaired by Hartzell V. Schaff, M.D.; Martin D. Abel, M.D., is director of the Division of Cardiovascular/Thoracic Anesthesia. More than 120 cardiothoracic and cardiovascular surgeons have been trained at Mayo Clinic in the intervening 50 years; subspecialty training in cardiac anesthesia is also offered. Thousands of journal articles describing surgical technique, optimal timing of operation, pre- and postoperative physiology, pathology, anesthesia technique, and imaging modalities have been published by Mayo Clinic clinicians. This knowledge, coupled with technologic innovation, has permitted increasingly complex procedures to be performed. All categories of congenital heart disease are now potentially treatable. Surgical risk has been reduced and now depends primarily on the patient's noncardiac conditions and the condition of the heart muscle itself. Today, oxygenators are disposable membranes primed with crystalloid solution.

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Mayo Clinic in Rochester recognized the 50th anniversary of this pioneering event with "Celebrating 50 Years: The Development of Cardiopulmonary Bypass and Cardiac Surgery at Mayo Clinic" on May 12, 2005. The event included the opening of Heritage Hall Exhibit, a display featuring photos and artifacts from 50 years of innovation in cardiac surgery at Mayo Clinic. Read more about our celebration of this milestone.

Cardiovascular Surgery Leadership

John W. Kirklin, M.D. 1964-1966
Dwight C. McGoon, M.D. 1967-1978
James R. Pluth, M.D. 1979-1986
Gordon K. Danielson, M.D. 1986-1992
Hartzell V. Schaff, M.D. 2001-present

Current Cardiovascular Surgery Staff

Hartzell V. Schaff, M.D., Chair
Richard C. Daly, M.D.
Joseph A. Dearani, M.D.
Thoralf M. Sundt III, M.D.

Current Cardiovascular/Thoracic Anesthesia Staff

Martin D. Abel, M.D., Director
John P. Abenstein, M.D.
Roxann D. Barnes, M.D.
Daniel R. Brown, M.D.
David J. Cook, M.D.
Niki M. Dietz, M.D.
Mark H. Ereth, M.D.
Philippe R. Housmans, M.D., Ph.D.
Michael E. Johnson, M.D., Ph.D.
James J. Lynch, M.D.
Gregory A. Nuttall, M.D.
William C. Oliver, Jr, M.D.
Kent H. Rehfeldt, M.D.
Gregory J. Schears, M.D.
Thomas N. Spackman, M.D.
Paul E. Stensrud, M.D.
Norman E. Torres, M.D.
Roger D. White, M.D.