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A potted history of cardiac surgery. Chris Munsch Yorkshire Heart Centre, Leeds. Christian Bilroth 1897. “Surgery of the heart has probably reached the limits set by nature to all surgery…”

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a potted history of cardiac surgery

A potted history of cardiac surgery

Chris Munsch

Yorkshire Heart Centre, Leeds

christian bilroth 1897
Christian Bilroth 1897
  • “Surgery of the heart has probably reached the limits set by nature to all surgery…”
  • “Any surgeon who wishes to preserve the respect of his colleagues would never attempt to suture the heart”
problems and solutions 1
Problems and solutions (1)
  • Surgery on the heart will impair the circulation
  • Use a temporary artificial circulation
  • The lungs get in the way
  • Use temporary artificial oxygenation
  • Cardiopulmonary bypass
problems and solutions 2
Problems and solutions (2)
  • The heart is full of blood, it beats and is difficult to operate on.
  • Cross clamp the aorta and deprive the heart of its blood supply
problems and solutions 3
Problems and solutions (3)
  • The beating heart will only tolerate 15 minutes of ischaemia at normothermia
  • Arrest the heart and make it hypothermic, and preserve its energy supplies
  • Hypothermic cardioplegic arrest
joseph priestley 1733 1804
Joseph Priestley – 1733 -1804
  • Born in Birstall Leeds.
  • Linguist,anatomist, astronomist, grammarian,, historian, preacher and scientist.
  • Identified new gas as an element and named it “Oxygen” also identifying eight distinct gases in air
  • Blamed for the Priestley Riots in Birmingham due to his support for French and American revolutions.
the leeds legacy
The Leeds Legacy
  • 1956 - first heart lung machine purchased for LGI
  • First successful repair of Mitral Valve in February 1957 ( 50% mortality)
  • Later expanded cardiac surgery in LGI with Mr. Marian .I. Ionescu.
  • Porcine Aortic valve in humans Mitral position (1966)
  • Titanium stented porcine aortic valves in all cardiac positions (1967)
  • Autologous stent mounted fascia lata valves (1969).
  • Heterologous pericardium frame mounted as heart valve substitutes (1971)
leeds and mr ionescu
Leeds and Mr.Ionescu

1971 – Ionescu pericardial valve

First clinical use of stented, gluteraldehyde treated bovine pericardium for heart valve replacement.

“desperation (not necessity!) is the mother of invention” – Marian I. Ionescu (2004)

the future of cardiac surgery
The future of cardiac surgery

…the future ain’t what it used to be!

new emerging or developing procedures
New emerging or developing procedures
  • AF surgery
  • Heart failure surgery
  • Endovascular surgery
  • Minimal access and robotic surgery
  • Coronary artery surgery!
return of coronary artery surgery
Return of coronary artery surgery?
  • CABG is the best treatment for severe CAD (no question)
  • DES kill people
  • Clinical outcomes or commercially sensitive information
slide52

Evidence based medicine and informed consent

or

Billion dollar industry and the cowboy effect

subspecialties in cardiothoracic surgery
Subspecialties in Cardiothoracic Surgery
  • Cardiothoracic surgery
  • Cardiac surgery
  • Thoracic surgery
  • Congenital cardiac surgery
  • Oesophageal surgery
  • Intrathoracic transplantation
  • Aortovascular surgery
  • (Academic cardiothoracic surgery)