It was 1899 when the first surgical treatment of angina pectoris was first proposed – the idea is generally credited to Francois Franck. It might be difficult to imagine such a complex and significant procedure dating back to such an early time, but the history of heart surgery is a history of development. It would take decades for Franck’s idea to come to fruition and still decades more of advancements have taken place as the medical field continues to improve.
Photos courtesy of Pexel
While heart procedures are still major events for those who undergo them, continuous development has greatly enhanced the possibilities for treating heart conditions and improved the experience of patients in equal measure. Heart disease has been the leading cause of death in the U.S. since 1921, according to the Centers for Disease Control and Prevention, making it a major focal point in the medical community.
Prevention is key – high blood pressure, high cholesterol, and smoking are all important indicators of potential risk for heart disease, so exercising regularly and eating healthy are essential to maintaining a healthy lifestyle. However, with approximately one quarter of all U.S. deaths attributed to heart disease, treatment becomes paramount. Researchers, surgeons and other medical practitioners work not only to treat patients, but to build upon prior knowledge and increase the possibilities of treatment.
A Brief History
At the dawn of the 20th century, Franck’s idea of operating on the heart remained largely a hypothesis. It would require several decades of research until John H. Gibbon Jr., MD, performed the first open-heart procedure that bypassed, or stopped, the heart – though it’s worth noting that Daniel Hale Williams, MD, performed an open-heart procedure in 1893 that repaired damage to the outer sac of the heart from a stab wound, which didn’t involve stopping the heart.
Gibbon’s procedure used a heart-lung machine to continue blood flow throughout the body and maintain oxygen levels while the patient’s heart was stopped for the operation, a method still used today, though with updated technology. In the 1960s, several surgeons successfully performed variations of the procedure we now commonly refer to as open-heart surgery.
Some of the key pioneering work on this operation took place in Ohio at the Cleveland Clinic. Argentinian surgeon René Gerónimo Favaloro, MD, came to the Cleveland Clinic in 1962 at a pivotal time in the evolution of heart surgery. Following the work of his colleagues at the Cleveland Clinic and around the world, Favaloro began performing open-heart surgeries himself by the mid to late 1960s.
“Although not the first to perform this operation, René Favaloro was the first to systematically perform coronary artery bypass grafting (CABG) with reproducible results,” a 2013 article in the European Heart Journal states. “He is considered the ‘father’ of bypass surgery and is acknowledged for his tremendous contribution in the field of surgical revascularization.”
Favaloro helped write one of the first major studies on these procedures, analyzing the first 150 patients to undergo them at the Cleveland Clinic. In that analysis, Favaloro and his colleagues found a mortality rate over 9 percent, before patients left the hospital. With modern developments, the mortality rate for CABG is now generally observed between 1-3 percent.
Advancements In Surgery
Favaloro continued to contribute to the field of cardiac surgery for much of the 20th century as it progressed toward a modern form. Writing what would be one of the final extensive documents of his career, Favaloro described developments in the field from broader observations, like the realization that shorter operating times decreased the risk of damage to the heart, to specific advancements in technology, such as the Cell Saver machine, which helps to recover and re-infuse blood lost during a procedure.
Favaloro noted that though mortality rates had already decreased significantly, the field had expanded to operate on more complex, severe cases. Improvements in a surgical team’s ability to monitor a patient’s parameters, deliver anesthesia and complete sutures paired with new medications for cardiovascular stability and technology like the Cell Saver, produced greater success rates. These advancements also helped to shorten recovery time and decrease the frequency of future hospital visits.
Among all these progressions, Favaloro picked out myocardial protection – meaning the methods of preventing damage to the heart while blood flow is stopped for a procedure – as the most significant.
“If I had to choose one contribution that has changed our lives as cardiovascular surgeons, undoubtedly it would be myocardial protection,” he wrote in his 1998 article for the Journal of the American College of Cardiology.
Beyond advancements in CABG, new alternatives to the procedure have developed that give patients and medical teams more options for treatment. Percutaneous coronary intervention became popular in 1980 and offered a non-surgical treatment for narrowing arteries. In that procedure, a catheter is inserted to inflate a balloon and push away artery blockage such as plaque. Small mesh-like devices called stents can be used to help keep the arteries clear.
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Future of Heart Surgery
While open-heart operations such as CABG require large incisions to the chest, the more recent innovation of minimally invasive cardiac surgeries now presents another treatment possibility. Minimally invasive procedures involve much smaller incisions and generally result in shorter hospital stays and recovery periods. These procedures have been augmented by robotic-assisted surgical technology which allow surgeons to control thin robotic arms to perform extremely complex surgeries.
The increased number of treatment options for heart disease has allowed medical teams to choose treatment plans that best suit a given case. Different procedures can better suit a situation when a patient’s medical history, related health issues or concerns, and the experience and preferences of a surgical team are considered. Ultimately, all of these developments lead to more effective procedures and longer, healthier lives for patients.
Did you know…
- Heart disease causes 1 in 4 deaths in the U.S.
- An American suffers a heart attack approximately every 40 seconds
- Nearly half of all cardiac deaths occur outside of a hospital
- There are around 500,000 openheart surgeries performed each year in the U.S.
Cameron Carr is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
