The earliest operations on the
pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by
Francisco Romero (1801)
Dominique Jean Larrey,
Henry Dalton, and
Daniel Hale Williams. The first surgery on the heart itself was performed by
Norwegian surgeon
Axel Cappelen on 4 September 1895 at
Rikshospitalet in Kristiania, now
Oslo. He
ligated a bleeding
coronary artery in a 24-year-old man who had been stabbed in the left
axilla and was in deep
shock upon arrival. Access was through a left
thoracotomy. The patient awoke and seemed fine for 24 hours, but became ill with increasing temperature and he ultimately died from what the
post mortem proved to be
mediastinitis on the third postoperative day. The first successful surgery of the heart, performed without any complications, was by
Ludwig Rehn of
Frankfurt,
Germany, who repaired a stab wound to the right
ventricle on September 7, 1896. Surgery in
great vessels (
aortic coarctation repair,
Blalock-Taussig shunt creation, closure of
patent ductus arteriosus) became common after the turn of the century and falls in the domain of cardiac surgery, but technically cannot be considered heart surgery. One of the more commonly known cardiac surgery procedures is the
coronary artery bypass graft (CABG), also known as "bypass surgery."
Early approaches to heart malformations In 1925 operations on the
heart valves were unknown.
Henry Souttar operated successfully on a young woman with
mitral stenosis. He made an opening in the appendage of the left atrium and inserted a finger into this chamber in order to palpate and explore the damaged mitral valve. The patient survived for several years but Souttar's physician colleagues at that time decided the procedure was not justified and he could not continue. Cardiac surgery changed significantly after
World War II. In 1948 four surgeons carried out successful operations for
mitral stenosis resulting from
rheumatic fever.
Horace Smithy (1914–1948) revived an operation due to Dr
Dwight Harken of the
Peter Bent Brigham Hospital using a punch to remove a portion of the
mitral valve.
Charles Bailey (1910–1993) at the
Hahnemann Hospital,
Philadelphia,
Dwight Harken in
Boston and
Russell Brock at
Guy's Hospital all adopted Souttar's method. All these men started work independently of each other, within a few months. This time Souttar's technique was widely adopted although there were modifications.
Open heart surgery Open heart surgery is a procedure in which the patient's heart is opened and surgery is performed on the internal structures of the heart. It was discovered by
Wilfred G. Bigelow of the
University of Toronto that the repair of intracardiac pathologies was better done with a bloodless and motionless environment, which means that the heart should be stopped and drained of blood. The first successful intracardiac correction of a
congenital heart defect using
hypothermia was performed by
C. Walton Lillehei and
F. John Lewis at the
University of Minnesota on September 2, 1952. The following year,
Soviet surgeon
Aleksandr Aleksandrovich Vishnevskiy conducted the first cardiac surgery under
local anesthesia. Surgeons realized that the limitations of hypothermia – complex intracardiac repairs take more time and the patient needs blood flow to the body, particularly to the
brain. The patient needs the function of the heart and
lungs provided by an artificial method, hence the term
cardiopulmonary bypass.
John Heysham Gibbon at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an
oxygenator, but he abandoned the method, disappointed by subsequent failures. In 1954 Lillehei realized a successful series of operations with the controlled
cross-circulation technique in which the patient's mother or father was used as a '
heart-lung machine'.
John W. Kirklin at the
Mayo Clinic in Rochester, Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and was soon followed by surgeons in various parts of the world.
Nazih Zuhdi performed the first total intentional hemodilution open heart surgery on Terry Gene Nix, age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a success; however, Nix died three years later in 1963. In March, 1961, Zuhdi, Carey, and Greer, performed open heart surgery on a child, age , using the total intentional hemodilution machine. In 1985 Zuhdi performed Oklahoma's first successful heart transplant on Nancy Rogers at Baptist Hospital. The transplant was successful, but Rogers, who had
cancer, died from an infection 54 days after surgery.
Modern beating-heart surgery Since the 1990s, surgeons have begun to perform "
off-pump bypass surgery" – coronary artery bypass surgery without the aforementioned
cardiopulmonary bypass. In these operations, the heart is beating during surgery, but is stabilized to provide an almost still work area in which to connect the conduit vessel that bypasses the blockage; in the U.S., most conduit vessels are harvested endoscopically, using a technique known as
endoscopic vessel harvesting (EVH). Some researchers believe that the off-pump approach results in fewer post-operative complications, such as
postperfusion syndrome, and better overall results. Study results are controversial as of 2007, the surgeon's preference and hospital results still play a major role.
Minimally invasive surgery A new form of heart surgery that has grown in popularity is
robot-assisted heart surgery. This is where a machine is used to perform surgery while being controlled by the heart surgeon. The main advantage to this is the size of the incision made in the patient. Instead of an incision being at least big enough for the surgeon to put his hands inside, it does not have to be bigger than "pencil-sized" holes for the robot's much smaller "hands" to enter a surgical patient's body. In September 2024, the first successful fully robotic heart transplant took place at
King Faisal Specialist Hospital and Research Centre in
Riyadh, led by surgeon
Feras Khaliel, head of the hospital's cardiac surgery and director of its Robotics and Minimally Invasive Surgery Program. In December 2024, the first robotic surgery for a combined robotic
aortic valve replacement (AVR) and
coronary artery bypass grafting (CABG) was successfully performed through one small incision at
West Virginia University, led by surgeon
Vinay Badhwar, who is the executive chair of the
WVU Heart and Vascular Institute and a vice president of the
Society of Thoracic Surgeons.
Pediatric cardiovascular surgery Pediatric cardiovascular surgery is surgery of the heart of children. The first operations to repair cardio-vascular defects in children were performed by
Clarence Crafoord in Sweden when he repaired coarctation of the aorta in a 12-year-old boy. The first attempts to palliate congenital heart disease were performed by
Alfred Blalock with the assistance of William Longmire, Denton Cooley, and Blalock's experienced technician,
Vivien Thomas in 1944 at Johns Hopkins Hospital. Techniques for repair of congenital heart defects without the use of a bypass machine were developed in the late 1940s and early 1950s. Among them was an open repair of an atrial septal defect using hypothermia, inflow occlusion and direct vision in a 5-year-old child performed in 1952 by Lewis and Lillihei. Lillihei used
cross-circulation between a boy and his father to maintain perfusion while performing a direct repair of a ventricular septal defect in a 4-year-old child in 1954. He continued to use
cross-circulation and performed the first corrections of tetralogy of Fallot and presented those results in 1955 at the American Surgical Association. In the long-run, pediatric cardiovascular surgery would rely on the cardiopulmonary bypass machine developed by Gibbon and Lillehei as noted above.
Risks of cardiac surgery The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low ranks. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is the incidence of
neurological damage.
Stroke occurs in 5% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. A more subtle constellation of
neurocognitive deficits attributed to
cardiopulmonary bypass is known as
postperfusion syndrome, sometimes called "pumphead". The symptoms of postperfusion syndrome were initially felt to be permanent, but were shown to be transient with no permanent neurological impairment. To assess the performance of surgical units and individual surgeons, a popular risk model has been created called the
EuroSCORE. This takes a number of health factors from a patient and using precalculated logistic regression coefficients attempts to give a percentage chance of survival to discharge. Within the UK this EuroSCORE was used to give a breakdown of all the centres for cardiothoracic surgery and to give some indication of whether the units and their individual surgeons performed within an acceptable range. The results are available on the CQC website. The precise methodology used has however not been published to date nor has the raw data on which the results are based. Infection represents the primary non-cardiac complication from cardiothoracic surgery. Infections include mediastinitis, infectious myo- or pericarditis, endocarditis, cardiac device infection, pneumonia, empyema, and bloodstream infections.
Clostridioides difficile colitis can develop when prophylactic or post-operative antibiotics are used. Post-operative patients of cardiothoracic surgery are at risk of nausea, vomiting, dysphagia, and aspiration pneumonia. == Thoracic surgery==