The Doric Column

July 12, 1999

A Heart Operation: Perspective from a Playground
"C. Walton Lillehei, a Leader in Open-Heart Surgery, Dies at 80"
"My Magical Metronome"
A Walk to the Car

A Heart Operation: Perspective from a Playground

If my memory is right, and I admit to some slippage on that front, it was 40 years ago that extra prayers were said in a small town church for a boy whose life was on the line.

That means it was 1959. Our nuns, Sisters of Notre Dame, entreated us to pray for the boy, one of our school classmates. He was the younger brother of one of my best friends. That day he was having a heart operation at the University of Minnesota Hospital.

I remember the day and some of the details. I'm standing on the school playground after lunch, looking toward the church across the street, not feeling much like playing. Some kids are playing, on the swings, the monkey bars, the merry-go-round, the softball field, but not as many as usual. This was not just another school day. The anxiety was palpable.

I'm standing there on the playground trying to come to grips with the possibility that someone I know pretty well might die. I thought of him asleep on the operating table, wondering if he would wake up from that altar. I didn't know that the historical experience of most children with his defect, at that point, was quite predictable, even with human interference. It had been that way from the beginning.

I had experienced death only once, the death of my grandfather three years before. He was old and senile. Doug was younger than me. Plus he was the brother of one of my best friends. What would I say to Dan if Doug didn't make it?

I told this story to Doug's surgeon, Clarence Walton Lillehei, at Lillehei's 80th birthday celebration at International Market Square in Minneapolis last October. I caught up with him toward the end of the evening, after the dinner, the keynote by former Vice President Walter Mondale, and the tributes by his colleagues and students from around the world. I could see that he was tired, but he was all ears for my little story. He said he appreciated my telling it and that he'd "always remember the story" about the boy, the special prayers in a small town church, and young people on the playground anxious about their classmate.

Doug is alive and well today. Today, July 9th, the day of Lillehei's funeral and burial. One wonders how many of Lillehei's pediatric patients are alive and well thanks to his brilliance, dexterity, and sheer will. No need to do the numbers. Let's just say that one of them who I knew back then is alive today and in good health, after several more operations and the installation of a pacemaker. He knows who saved him.

That night at the banquet I purloined an extra bronze medal honoring Lillehei, in its little velvet bag with a drawstring, and I mailed it to Doug, together with the program. He phoned me a short time later and thanked me over and over for the gesture, saying how much it meant to him and his family.

Then he told me the story of attending a meeting of the local chapter of the American Heart Association. The guest speaker that evening was Ernesto Molina, a University professor of surgery. After Molina's talk Doug introduced himself. Molina knew all about Doug's case and noted that his medical chart is one of the biggest on file.

It is a chart that reaches back to the early years of a 20th century medical miracle, a chart that holds the notes of the man most responsible for giving life to open-heart surgery and enabling those who needed it to survive, C. Walton Lillehei.

"C. Walton Lillehei, a Leader in Open-Heart Surgery, Dies at 80"

The day Lillehei died, July 5th, I was visiting with a close relative of his on a lake in northern Minnesota. My brother had bought property on the lake, and the relative is one of his neighbors.

"Walt's not doing too well," he told me. "He said he wishes he was still 79."

World-renowned surgeon as wit. I was reminded of Lillehei's response when he was presented with one his numerous honors. He quoted comedian Jack Benny: "I don't deserve this award. But I've got arthritis and I don't deserve that, either."

Today, his obituary in the New York Times recounts his accomplishments.


The New York Times

July 9, 1999

C. Walton Lillehei, a Leader in Open-Heart Surgery, Dies at 80


C. Walton Lillehei, a pioneer in open-heart surgery, valve replacement and the electronic pacemaker, died on Monday at his home in St. Paul. He was 80.

The cause was cancer, said St. Jude Medical Inc. in St. Paul, the medical equipment manufacturer where Lillehei had worked as a division medical director since 1979.

Among his peers, Lillehei (pronounced LILY-high) was often referred to as the "father of open heart surgery," responsible for many implements used in the operation. At the University of Minnesota, where he was a medical school professor, he was a leader in developing techniques that first made surgery within the human heart possible.

His work was instrumental in making almost commonplace critical operations on the heart that had been considered impossible.

As late as 1950, there was no workable substitute for the natural process that places oxygen into the bloodstream and circulates blood throughout the body. Heart surgery was thus limited to disorders that could be remedied without entering the heart itself.

Lillehei cleared that obstacle, initially trying "cross circulation," in which the bloodstream of the patient undergoing surgery was linked by tubes to that of a healthy donor. It worked, but only at some risk to the donor, and the process was later abandoned.

The turning point came in 1955 when Lillehei and a colleague, Dr. Richard A. Wall [correction: Richard A. DeWall], succeeded with a heart-lung machine, called a helix reservoir bubble oxygenator, which bubbled oxygen through the blood during an operation.

Lillehei played a prominent role in other breakthroughs that made treatments of once-fatal heart conditions possible. Once [sic] such condition is known as heart block, in which the body fails to produce the small electrical signals that regulate the heartbeat.

By 1957, Lillehei and his colleagues in Minnesota had worked out a method of hooking wires directly into the living heart, supplying the electrical signals from outside the chest and taking the place of the lacking natural ones.

The signals were generated by a battery-powered electronic device, a pacemaker, small enough to be worn under the clothing and providing electrical pulses for a firm, steady heartbeat. Lillehei introduced it at a conference on cardiovascular surgery, sponsored by the New York Heart Association, the following January.

In May 1960, he reported in The Journal of the American Medical Association on the condition of 66 patients who by then carried their pacemakers in shoulder holsters. The device, the size of a pack of cigarettes, proved effective not merely as a temporary aid after surgery, but also for long-term maintenance of nonsurgical heart patients.

In 1967, he introduced a new type of compact artificial heart device without valves or other interior moving parts. It consisted of a multilayer sandwich of plastic sheets and silicone rubber membranes and was intended as a booster pump to assist disease-weakened hearts.

Lillehei and his associates contributed to the design of four prosthetic heart valves, including the widely used St. Jude Mechanical Heart Valve.

Lillehei, as chief surgeon at New York Hospital in 1969, led the team that did the first transplant of the heart and both lungs to be performed there. In that procedure the organs of a 50-year-old woman were transplanted into a 43-year-old man suffering terminal lung and heart failure from chronic emphysema. It was the second such operation, and the patient survived for one week.

Lillehei trained some 1,000 doctors in heart surgery and contributed hundreds of papers and articles. Among his students at Minnesota were Dr. Christiaan N. Barnard, the South African who in 1967 performed history's first heart transplant, and Dr. Norman E. Shumway, who devised the technique for such transplants.


Copyright (c) The New York Times


"My Magical Metronome"

"What mankind can dream
research and technology can achieve"

   Memorial tribute to C. Walton Lillehei, Ph.D., M.D.
   October 23, 1918 - July 5, 1999

Let it be noted that on the day of Lillehei's funeral and burial, July 9, 1999, British pop star Elton John, 52, had a pacemaker installed to correct an irregular heartbeat. He is expected to be back on stage next month.

It is easy to forget, in this time of the Human Genome Project and other scientific wonders of the age, that open-heart surgery and the biomedical technologies that flowed from it have been responsible for saving more lives than molecular biology, monoclonal antibody technology, genetic engineering, genetic therapy and any number of other fantastic developments in biomedical science over the past half century.

These developments will have their day in the clinic. In some cases they have already begun to. Someday they may eliminate the need to cut into the body at all, let alone into the heart. But in practical terms, the 20th century is the province of blood grouping, antibiotics, insulin, vaccines, heart disease prevention, and heart surgery.

It is the territory of the pioneers of heart surgery and the organ transplanters, of people like Alexis Carrel, Charles Bailey, C. Walton and Richard Lillehei, John Gibbons, Michael De Bakey, Christiaan Barnard, Robert Good, Norman Shumway, John Najarian, Thomas Starzl, David Sutherland, Joseph Murray, Thomas Donnall, and many others. And of the inventors whose ideas surgical breakthroughs made possible or helped bring to life.

Lewis Thomas, the renowned physician-writer and philosopher of science, once expressed skepticism of the technological offspring of heart surgery, which he considered "halfway technologies" against the likes of, say, an effective vaccine. But he later recanted.

In the early 1950s, when Lillehei was leading the development of open-heart surgery, Thomas was right next door directing the pediatric research laboratories at the University of Minnesota Heart Hospital. Thirty years later, a pacemaker in his chest, Thomas wrote: "I am exceedingly pleased with my machine-tooled, obedient, responsive self. I would never have thought I had it in me, but now that I have it in me, ticking along soundlessly, flawlessly, I am subject to waves of pure vanity."

In a chapter entitled "My Magical Metronome" in his book Late Night Thoughts on Listening to Mahler's Ninth Symphony, Thomas confessed that he wasn't really interested in how a pacemaker works. "As long as it works, and it does indeed, I prefer to be as mystified by it as I can be. ...I suppose I should be feeling guilty about this. In a way I do, for I have written and lectured in the past about medicine's excessive dependence on technology in general, and the resultant escalation in the cost of health care. I have been critical of what I have called 'halfway technologies,' designed to shore things up and keep flawed organs functioning beyond their appointed time.

"And here I am, enjoying precisely this sort of technology, eating my words."

A Walk to the Car

I had two private one-on-one dealings with the great surgeon, one by letter and one on foot.

In 1991, I received a letter from Lillehei. He had just seen the brochure I had written and produced for the University's Biomedical Engineering Center.

In a friendly tone, he observed that he liked the brochure but found an error he thought he should bring to my attention. Next to a small photograph I had written: "The helical reservoir bubble oxygenator and its inventor, Richard DeWall."

Lillehei want me to know that he was co-inventor of the bubble oxygenator with DeWall. If I had any doubt, I should refer to the patent, a copy of which was attached. In my response to him I acknowledged the error and promised to "set the record straight" in any future publicity.

Richard DeWall's comparatively simple machine was the key to open-heart surgery. He and Lillehei and other University physicians reported their success in an article entitled "Total Body Perfusion for Open Cardiotomy Utilizing the Bubble Oxygenator" which was published in the Journal of Thoracic Surgery in November 1956.

The article began: "Since May, 1955, a simple disposable bubble oxygenator has been utilized together with a pump in 80 patients to permit intracardiac reparative surgery under direct vision by totally by-passing the heart and lungs."

That was the true beginning of open-heart surgery. Interviewed a few days after Lillehei's death, former Washington Post science editor Victor Cohn said on Minnesota Public Radio that the bubble oxygenator really brought open-heart surgery to medicine as a whole. Without it, the whole field would have stalled.

The "on foot" component of my interaction with Lillehei came two years ago. I took Lillehei around the Medical School and Mayo Memorial Building to the sites of his operating rooms and research laboratories. Accompanying him was G. Wayne Miller, a staff writer for the Providence Journal who was writing a book about open-heart surgery and Lillehei's pioneering work. Last January the Journal ran a nine-part series by Miller entitled "Into the Heart: A Medical Odyssey." [The Minneapolis StarTribune ran the series a few months later.] This is from the introduction:

"Into the Heart: A Medical Odyssey"

by G. Wayne Miller

Less than 50 years ago, no one had ever opened a living heart without killing the patient. The heart was impregnable; only dreamers believed that surgery inside this most fundamental part of the body would ever be possible.

Today, in this country, more than 125,000 open-heart operations take place each year. Another 600,000 life-saving coronary-bypass procedures are done. And more than 2,000 hearts are transplanted. In short, heart surgery now seems almost as commonplace as an appendectomy.

This nine-part serial by G. Wayne Miller, which appeared in The Providence Journal from Jan. 10 through Jan. 18, 1999, is the story of that daring quest -- a journey into the heart.

Copyright (c) The Providence Journal

Miller's book, King of Hearts, will be published by Random House in February 2000. From the story he told in his series, it will be well worth the purchase price.

I wish I could remember details of the conversation I had with Lillehei as the two of us walked several blocks to his car that gorgeous summer day. I do remember that he kept insisting he could find his car on his own. "I've been around here a long time, you know." Beginning ten years before I was born, to be exact.

Victor Cohn, who covered the surgical breakthroughs at University Hospital for the Minneapolis Tribune before moving over the Washington Post, told Minnesota Public Radio about the time he accompanied Lillehei to the bedside of one of his patients, a child, and of the compassion he showed there. Lillehei was out to prove that the "impossible" was possible. In such circumstances, time and numbers are everything and sometimes patients can get shorted. But not by Lillehei.

You can see the same compassion in the famous cover photograph of the Saturday Evening Post, March 4, 1961, with Lillehei examining a boy named David Williams who is holding the pacemaker that is keeping him alive.

We walked north along Oak Street until Lillehei spotted his car. It was just where he had left it. We shook hands, and off he went.

I looked up and saw a church across the street. The sight of it transported me, for a brief moment, back to the school playground of my youth and the church across the street and the hope and prayers of that one day many years ago.

    --William Hoffman

Disclaimer: The opinions expressed herein are the writer's own.

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The Doric Column



C. Walton Lillehei in 1997 at the site of Operating Room J, where he and his colleagues pioneered open-heart surgery at the University of Minnesota Hospital. The room is now used for pediatric rehabilitation. In this room, Lillehei attached the first transistorized wearable pacemaker to a patient in February, 1957. The pacemaker was put together in six weeks by his equipment repairman, Medtronic co-founder Earl Bakken. Photo by William Hoffman