First Successful Open-Heart Surgery Using the Heart-Lung Machine

Before 1953, surgeons who tried to repair defects inside the heart had very little time. Several atrial septal defects had been closed by cooling the patient and briefly stopping blood flow into the heart, but longer repairs were out of reach. John Gibbon, a 26-year-old research fellow at Massachusetts General Hospital, had conceived of an external machine to take over heart and lung function in 1931, after watching a patient die of a massive pulmonary embolus that surgeons could not remove in time.

Working with his wife, Mary Hopkinson Gibbon, he built pump-oxygenator prototypes from 1934, and by 1942 cats were surviving after bypass on them. From 1950 IBM supported the building of a larger machine for his work at Jefferson Medical College in Philadelphia. Others failed first: in April 1951 Clarence Dennis attempted bypass on a 6-year-old girl, who died. On May 6, 1953, Cecelia Bavolek, an 18-year-old woman with a large atrial septal defect, was connected to Gibbon's Model II machine while he closed the defect. Problems with the bypass circuit nearly caused a disaster, and quick action by the team saved her. She recovered.

Gibbon lost three of his four patients with congenital heart defects in this period, and he stopped using the machine for heart surgery. The machine itself, however, had shown that the idea worked.

John Kirklin and the team at Mayo Clinic took up a modified Gibbon-type machine in 1955 and made cardiopulmonary bypass reproducible in other hands and at other institutions. In Minneapolis, C. Walton Lillehei had in 1954 begun repairing heart defects with controlled cross-circulation, using a parent as the living oxygenator. Within five years, surgical correction of tetralogy of Fallot, mitral valve disease, and other structural cardiac conditions became technically feasible.

The early record shows how hard the start was: Lillehei's review of open-heart operations using mechanical bypass at six centers from 1951 to 1955 found that 17 of 18 patients had died. Gibbon's screen oxygenator gave way to Richard DeWall's bubble oxygenator of 1956 and later to membrane oxygenators. Coronary artery bypass grafting, valve replacement, and repair of complex congenital heart disease all came to depend on the heart-lung machine.