The Heart Lung Machine

From these early operations into the twentieth century, the development of heart surgery did not move very quickly until a single innovation, the heart-lung machine, ushered in the age of modern heart surgery. Before the invention of the heart-lung machine, surgeons confronted a very simple yet seemingly insurmountable problem. If the heart was stopped and opened so the surgeon could see it directly, the patient died. The heart-lung machine finally allowed physicians to stop the beating heart yet keep their patients alive.

The solution to this great riddle came in the years after World War II. Teams of doctors at major hospitals enlisted the help of teams of engineers, in some cases at the country's largest corporations, and the race was on to develop a heart-lung machine that could support circulatory function while doctors stopped the heart.

The effort involved many doctors, yet from a research point of view, a young doctor named Dr. John Gibbon contributed more to the development of the heart-lung machine than anyone else. His interest began one October night in 1930 while at Massachusetts General Hospital in Boston. A patient was suffering from a blood clot in the lungs and was in shock. Gibbon was supposed to record blood pressure every fifteen minutes until either the patient recovered or her condition deteriorated to the point at which a high-risk operation would have to be attempted to remove the blood clot. Her condition worsened, and the operation was performed. Unfortunately, the patient did not survive the operation, but Gibbon learned an important lesson. He realized that if there were a way to keep the blood oxygenated while the surgeon operated on the lung, many people suffering from this condition might be saved.

Three years later, while he was a research fellow in surgery at Harvard Medical School, Gibbon began experimental work on the heart-lung machine. His wife, Mary, was his research assistant. His research continued at the University of Pennsylvania in Philadelphia when he became the Harrison Fellow in Surgical Research in 1936.

By 1937, he was able to demonstrate that life could be maintained with an artificial heart and lung and that an animal's own heart and lungs could later resume function when the machine was turned off. In his first demonstration, however, only three animals resumed breathing adequately after he used a primitive heart-lung machine to bypass their hearts and lungs, and even these animals died within a few hours.

His work steadily progressed, however, and by 1939, Gibbon reported at the annual meeting of the American Association for Thoracic Surgery that three cats whose circulation had been totally supported by the heart-lung machine had survived more than nine months after the surgery. Dr. Clarence Crafoord, chief of thoracic surgery at the prestigious Karolinska Institute in Stockholm, said Gibbon's report was "a pinnacle of success in the progress of surgery." Dr. Leo Eloesser, a prominent chest surgeon from San Francisco, said the work reminded him "of Jules Verne's dreamlike visions, regarded as impossible at the time but later actually accomplished."

Gibbon's work was interrupted in 1942 by World War II but resumed after the war ended and he was appointed professor of surgery and director of the surgical research laboratory at Jefferson Medical College in Philadelphia. During his tenure there, Gibbon met Thomas Watson, chairman of International Business Machines (IBM) Corporation. Watson was fascinated by Gibbon's research and promised to help

In the 1930s, Dr. John Gibbon was among the first doctors to begin building a heart-lung machine. His first device served as a model for later, successful cardiopulmonary bypass machines.

An early roller pump that was used to move blood through the first heart-lung machines.

him. Shortly afterward, a team of IBM engineers arrived at Thomas Jefferson University and built a heart-lung machine based on knowledge gained from Gibbon's earlier machine. It contained a rotating oxygenator apparatus and a modified rotary blood pump. The pump was based on one developed earlier by Dr. Michael DeBakey.

Gibbon successfully used the new IBM heart-lung machine for the repair of heart defects in small dogs and had several long-term survivors. The blood oxygenator, however, was too small for humans. The team soon developed a larger oxy-genator that IBM engineers incorporated into a new machine.

By 1949, Gibbon's mortality in animals was 80 percent (meaning that only

20 percent survived the surgery), but it was improving, and he was ready to move to human patients. His first human patient was a fifteen-month-old girl with severe heart failure. She didn't survive the procedure; at autopsy, an unexpected congenital heart malformation was found.

Gibbon's second patient was an eighteen-year-old woman also with heart failure due to a congenital defect. On May 6, 1953, Gibbon successfully repaired the defect with the Gibbon-IBM heart-lung machine. The woman recovered, and several months later, the defect repair was confirmed repaired by cardiac catheterization. Unfortunately, Gibbon's next two patients did not survive operations using the heart-lung machine.

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