History: cardiac surgery


Last week, we took our readers in a journey back to year 1628, almost 400 years ago, when blood circulation, as we know it today, was “discovered,” understood, and accepted by medical science for the first time. This fundamental information inspired and led to cascading advances, one after the other, in medicine as a whole, and in cardiovascular medicine and surgery in particular. One discovery enabled the invention of more sophisticated diagnostic and therapeutic measures or procedures. The cutting-edge and state-of-the-art medical and surgical procedures available to patients today were made possible and ushered in by those past proven concepts and evidence-based discoveries.

The first right heart angiography in human was done in 1929 by Werner Forssmann on himself. He was derided as crazy but was awarded the Nobel Prize in 1956, which he shared with Andre Cournand and Dickinson Richards, who introduced diagnostic cardiac catheterization in the early 1940s. Selective coronary angiography, which is used today worldwide to diagnose coronary artery disease (which causes heart attack), was introduced by Mason Sones of the Cleveland Clinic in the 1960s. Rene Favaloro of Argentina, also on the staff at the Cleveland Clinic, pioneered in the technique of coronary bypass surgery in the early 60s, which is used today with refinements.

In 1962, autogenous saphenous vein grafts were used for coronary bypass by D. Sabiston. The first reported use of Internal Mammary Artery (from behind the breast bone) as coronary grafts was performed by R. Goetz in 1960 using sutureless technique. Four years later, V. Kolessov did the first sutured IMA as coronary bypass grafts. IMA grafts are superior to veins grafts.

It was not until the early 70s that the full impact of Forssmann discovery was realized when Marcus De Wood, M.D., of Spokane, Washington, used coronary angiography to search for blockages in the coronary artery. As late as that time, the accepted concept was that heart attacks were “merely the last gasp of a dying heart,” a gloomy and hopeless situation that could not be treated or altered or improved. His concept and research were ostracized and derided. In 1980, De Wood was able to prove by angiography his theory that virtually in every heart attack there was a clot blocking the artery. This was a revolutionary change in cardiology which has led to the modern clot-dissolving therapy to prevent a full-blown heart attack and save heart muscles and save lives. This has dramatically improved survival from heart attack.

Angioplasty opens new horizons

In 1977, the first angioplasty was performed by Andreas Gruentzig, M.D., of Zurich, Switzerland, to “open up” a tight blockage in a coronary artery.  This was improved on by the invention of “stent” (a tiny mesh tube of coiled spring, like car shock absorbers) to keep the angioplastied artery from re-collapsing and re-closing. The stainless steel stents were then improved on with the introduction of drug-coated stents that keep the angioplastied artery patent (open) much longer.

Robotic heart surgery

In May 1998, the first coronary bypass using the da Vinci robot was performed with a mini-chest incision. A year later, the first totally endoscopic da Vinci robotic coronary bypass surgery was accomplished with no chest incision, except for small holes, through which instruments were inserted and manipulated. With the more sophisticated da Vinci robots today, cardiac surgery and other specialty surgeries are routinely performed.

There are at least 21 industrial robotic firms and 11 surgical robotic companies in the United States. Robotic surgery is a standard part of the surgical residency training today. It is evident that the use of robots is the trend for most surgeries. The widespread use in the industrial arena is far ahead compared to that in surgery for obvious reasons.

About 400,000 coronary artery bypass graft surgeries (CABG) are performed annually in the U. S. The past decade has seen about 30 percent decrease in CABG operations because of the minimally invasive option called coronary angioplasty and stenting. Around 700,000 coronary angioplasties and more than 1,700 robotic cardiac surgeries are done annually in the U.S. alone.

TAVR: Hope for the rejected

Another more recent advance in cardiac surgery is Transcatheter Aortic Valve Replacement (TAVR) or Implantation (TAVI), which was first performed by Cribier and associates on April 16, 2002. This is a much less invasive procedure to replace a severely diseased aortic valve (with no chest incision) among old, high-risk patients with other major illnesses, who were, before TAVR was developed, deemed inoperable and hopeless.

The past half a century brought us life-saving knowledge and discoveries in cardiovascular medicine and surgery. Since then, the mortality rate from coronary heart disease, among other illnesses, has coasted down in a steep plunge, from its record peak in the early 1960s. People today are healthier and live longer — thanks to all the dreamers, explorers, and brilliant minds in the various sectors of sciences and technologies. With the mind-boggling advances in computers, it is apparent that the best is yet to come.

No one discovery or invention could be awarded all the credit for improving the standard of care. Most of the new innovations have built upon, and improved on the ones before them. Each technology – from computer science to medical science – has made possible the development of better, safer, and more effective diagnostic procedures and/or therapies.

“Insanity and audacity”

Many of the great minds in medicine who dared to espouse new concepts or to alter the “status quo” had faced ridicule and contempt of their peers who thought their “ideas and concepts” were inspired by “misinformation”, if not by “insanity and stupid audacity.” However, as medical history shows, these pioneering physicians were vindicated, and humanity was the better for their vision and courage to risk their name and reputation to venture into the world of possibilities to help mankind.

However, the potential positive impact on mankind of all these cutting-edge technology and state-of-the-art evidence-based medicine and surgery are dependent on the wisdom, will, personal behavior, and lifestyle of the individual. Beneficial information and bountiful resources are only useful when taken advantage of and wisely utilized to the fullest for ourselves and our family.

As always, our health is, to a significant degree, in our hands.


Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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