Heart Surgeon and Public Servant in the USSR

The initial drive to develop heart surgery was a worldwide effort, with doctors in North and South America, Europe, the U.S.S.R., and elsewhere all pushing towards open heart surgery and techniques to correct many forms of heart disease. In the former Soviet Union, Dr. Nikolay Amosov became one of the leading surgeons of his day. In a recent Interview, Amosov remembered his introduction to medicine and his early days as a surgeon.

"I had been interested in medicine since my childhood," Amosov said. "However, I happened to choose the only post-graduate degree available in the medical school in Arkhangelsk, and this was military surgery. There I began my surgical career. I spent only one year in post-doctoral training and

went to the city of Cherepovets, where I worked as a surgeon for a year before World War II broke out. They were recruiting to the military field hospital in Cherepovets, where there was a need for a chief surgeon. I was offered the spot and served in this hospital throughout the war."

Amosov's workload was enormous. His two-hundred-bed hospital with only five doctors treated forty thousand wounded Russian soldiers throughout the war.

By 1953, after additional, non-wartime surgical experience in Moscow, Amosov moved to the Ukrainian capital of Kiev and became chairman of the Department of Surgery in the Kiev State Medical School. Like other surgeons around the world, he performed heart operations such as opening narrowed mitral valves and placing the Blalock-Taussig shunt for tetralogy of Fallot. These operations did not require a heart-lung machine.

"Of course, I had never been out of the country and had never seen heart surgery done by someone else," he said. "Mostly, I used books to educate myself. It was very difficult to start."

In 1957, Amosov traveled with a group of Russian surgeons — including Dr. Boris Petrovsky, a prominent pioneer chest surgeon and minister of health of the U.S.S.R. for sixteen years — to the Mexico International Congress of Surgeons. There, for the first time, he saw an operation performed with a heart-lung machine.

"When we came back, I wanted to start that kind of surgery, but I did not have the opportunity to buy a heart-lung machine. But, because in addition to medical school, I also had a degree in engineering, I created a heart-lung machine myself in 1958. A local factory built it. In 1959, we did our first case of tetralogy of Fallot using our own heart-lung machine."

Slowly, Amosov and his team advanced into more complicated cases. Nevertheless, their surgical results were very good, and in 1962, his team in Kiev was the first in the U.S.S.R. to replace a mitral valve with nylon leaflets. Interestingly enough, he used nylon from a shirt he had bought in the United States.

Throughout his career, Amosov was widely recognized for his standing as a world-class heart surgeon. Even the Communist Party leadership admired the doctor, who had never been a member of the Communist Party, and named him to the Supreme Soviet.

"It was important for the Party bosses to have somebody in the Supreme Soviet who was popular in the public eye," he said. "People supported me, and I was elected unanimously. But then, everyone was elected unanimously. I was not attracted to being a deputy in the Supreme Soviet, but you could not refuse this kind of offer. You might lose your job. The Supreme Soviet had its sessions biannually. Every vote was unanimous. Debates were not too long. I made a speech once. I spoke about health care and was very critical. In 1979, after seventeen years on the Supreme Soviet of the Soviet Union, my services there came to an end."

By the late 1980s, the volume at the Institute of Cardiovascular Surgery in Kiev grew to about five thousand surgical cases a year, making it one of the busiest cardiovascular centers in the world.

"In 1988, when I became seventy-five, I decided it was inappropriate for me to continue as director of the Cardiovascular Institute. An election was held at the Institute, and Dr. Gennady Knyshov was elected my successor. And then I made one more call to public service in 1989. Everyone had so much enthusiasm that our country would be a democracy. Employees of our institute nominated me. Elections were held, but on a democratic basis and without interference. On election day, 60 percent of the ballots were cast for me. This time when I was elected to the Supreme Soviet, it was organized like a real parliament. However, all my hopes to improve the health care system never succeeded.

"In December 1992, the Soviet Union ceased to exist. With its demise, my public service ended."

This text was based on an interview conducted for this book by Dr. Gennady Knyshov, director, Cardiovasculair Institute, Kiev, Ukraine, and translated by Dr. Vitaly Piluiko.

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