NOVA: INTO THE HEART: PIONEERS OF SURGERY (TV)

Summary

One in this series of science documentaries. This documentary details the history of modern heart surgery techniques and technologies. In World War II, surgeons devised a number of new techniques in medicine, such as antibiotics and blood transfusions. Heart surgery was unknown at this time, as it was considered too delicate to operate on. Early attempts at heart surgery all ended disastrously. Conditions such as congenital heart defects and rheumatic fever were, for a long time, considered untreatable. The heart is prone to a number of difficulties in its tissues and valves. In Britain after the end of World War II, many wounded soldiers were still being treated, some having sustained shrapnel lodged in their bodies. United States army surgeon Dwight Harken made attempts to remove shrapnel fragments and bullets from soldiers’ hearts using highly risky surgical techniques. His early attempts were unsuccessful, but soon perfected the technique, allowing his patients a high rate of survival. Dr. Harken and Philadelphia surgeon Charlie Bailey hoped to use his findings to operate on patients with mitral stenosis, which prevented the heart valve from opening and closing properly. Although the early attempts were unsuccessful, Dr. Harken soon learned a great deal from the patients who died, and refined the process to have a high success rate. The technique, known as “closed heart surgery” proved to be quite successful, although it did nothing to help children with congenital heart defects, particularly “blue babies” suffering from a combination of debilitating defects. Baltimore surgeon Alfred Blalock devised a surgical technique to bypass obstructed arteries and shunted blood to the lungs, but it proved to only be a temporary measure. A few surgeons attempted the immense risk of performing open heart surgery, i.e. opening the heart and operating directly on its internal structure. Owen Wangensteen of the University of Minneapolis led the way in early research into open heart surgery, gathering a team of surgeons to research the problem. Surgeons such as Walton Lillehei and Bill Bigelow were especially influential in helping to develop techniques to allow the patient to survive the opening of the heart. Bigelow was inspired by hibernating animals to employ cooling techniques to increase the amount of time before the patient expired, thus allowing operations to be performed successfully. On September 2nd, 1952, Lillehei and his colleague Dr. John Lewis performed the first successful human open heart surgery on a little girl, successfully sewing up a hole in her heart chamber and restoring her to health. The cooling of the body, inducing hypothermia, slowed the body’s vital processes down, meaning that the brain and heart required far less oxygen. However, the risk existed that a heart cooled to great would cease to function altogether. The technique was effective in repairing relatively small defects, but complex defects were still beyond the reach of the hypothermic approach. Some surgeons, such as John Gibbon, proposed another approach involving using a mechanical device to replicate the heart’s functions during surgery to allow for more complex and precise operations. Gibbon’s early prototypes were unwieldy and dangerous, but the idea showed promise and others worked to further develop the concept. These “heart-lung machines” saw their first success in 1953, when one of them aided Gibbon in closing a hole in the heart of a young woman. However, the success rate of the machines proved to be low; many surgeons believed that hearts damaged to that extent were too weak to endure any surgical operation. In 1954, Lillehei saved the life of Michael Shaw, a boy with a serious congenital heart defect. He used a revolutionary new “cross circulation technique,” in which another patient, Howard Holtz, essentially used his own body to supplement Michael’s heart during surgery, allowing him to survive long enough for his heart to be repaired and restarted. However, the operation was highly risky, as Holtz’s life was also in danger. Others were also saved by the cross circulation technique, but was too controversial to gain widespread acceptance in the medical community, particularly due to the legal ramifications of potentially harming a healthy donor. However, other surgeons were inspired to continue Gibbons’s work into creating a viable heart-lung machine, and many surgeons flocked to the University of Minneapolis to learn these new techniques. A large number of patients did not survive these early tests owing to complications such as embolisms. By 1958, technology had improved enough to allow surgeons to broadcast an open heart surgery on United States television, hosted by surgeon Denis Melrose. The intent was to demonstrate the complexity and nature of these new medical techniques. The operation went successfully, and garnered a great deal of attention from the television audience. Lillehei proposed a technique for a safer heart-lung machine, by “bubbling” oxygen into the bloodstream, and a machine was constructed by Dick de Wall to introduce and extract the oxygen. Melrose also invented a way to stop the heart entirely, thus giving them free reign to correct the most complex defects in a way not possible before. That year, leading figures in the field gathered in Brussels for a conference, discussing their advances in the field. Soon advents such as artificial heart valves were introduced, allowing hearts with badly damaged valves to continue functioning normally. The advances in technology in heart surgery had an impact on other forms of surgery as well, improving the nature of documentation and instrumentation in surgical techniques. In Houston, Texas, Michael DeBakey transformed the local Methodist Hospital into one of the largest heart surgery centers in the world. Heart disease was becoming more noticed by surgeons, who worked to revolutionize techniques for combating it in the burgeoning field of cardiovascular surgery. He supervises a televised operation on an aortic aneurysm, replacing the artery with an artificial component. The Duke of Windsor famously sought out DeBakey to repair his aneurysm; heart surgeons became more prominent in popular media, achieving a sort of celebrity status. Techniques were developed to bypass coronary arteries, becoming a commonly performed operation. Other doctors were able to adapt the philosophy of heart surgeons to their own fields, making a number of major medical advances. The final problem to be solved was that of replacing a defective heart entirely, and doctors Norman Shumway and Christiaan Barnard advocated the use of an already-existing heart to serve that purpose. Dr. DeBakey made his own attempt to implant an artificial device in a patient in 1966 temporarily to help their own heart in its recovery.

Details

• NETWORK: PBS WGBH Boston, MA
• DATE: September 13, 1988 9:00 PM
• RUNNING TIME: 0:57:33
• COLOR/B&W: Color
• CATALOG ID: B:44702
• GENRE: Public affairs/Documentaries
• SUBJECT HEADING: Public affairs/documentaries
• SERIES RUN: PBS - TV series, 1974-
• COMMERCIALS: N/A

CREDITS

• Paula S. Apsell … Executive Producer
• John Palfreman … Producer, Director, Writer
• Roger Limb … Music by
• Daniel Kane … Music by
• Mason Daring … Theme Music by
• Martin Brody … Theme Music by
• Will Lyman … Narrator
• Adrian Kantrowitz … Interviewee
• Francis Moore … Interviewee
• Denis Melrose … Interviewee
• Dwight Harken … Interviewee
• C. Walton Lillehei … Interviewee
• Michael Shaw … Interviewee
• Howard Holtz … Interviewee
• Norman Shumway … Interviewee
• Christiaan Barnard … Interviewee
• Michael E. DeBakey … Interviewee
• Charlie Bailey
• Bill Bigelow
• Alfred Blalock
• Dick de Wall
• John Gibbon
• Harry Reasoner
• Owen Wangensteen