For centuries, the human heart was considered an untouchable mystery, but in six decades, it became a surgeon's domain.
The history of cardiac surgery is a story of daring innovation, relentless perseverance, and the audacity to defy medical dogma. For much of recorded history, the heart was seen as the sacred seat of the soul, an organ beyond the reach of the surgeon's knife. As famously quoted by the influential surgeon Theodor Billroth in 1881, "No surgeon who wished to preserve the respect of his colleagues would ever attempt to suture a wound of the heart"1 . Yet, just fifteen years later, the first successful heart wound repair would mark the dawn of a new medical era, launching a voyage that would conquer once-fatal conditions and redefine the possible.
Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided but unethical1 . This profound resistance was rooted in the heart's unique status and the immense technical challenges involved. Any breach of the heart seemed to guarantee immediate, fatal bleeding, and the constant, vital motion of the organ made delicate repair work seem fantastical.
In 1896, the same year that Stephen Paget declared in his textbook that surgery of the heart had probably reached "the limit set by nature," a German surgeon named Ludwig Rehn would prove otherwise2 .
On September 4, 1895, in what is now Oslo, Axel Cappelen performed the first documented surgery on a human heart, ligating a bleeding coronary artery in a stabbing victim. Though the patient ultimately died from infection days later, the attempt was groundbreaking4 .
In 1896, Ludwig Rehn of Frankfurt successfully repaired a stab wound to the right ventricle of the heart. The patient survived2 . Rehn went on to compile a summary of 124 cases of cardiac wound repair, reporting a remarkable survival rate of 40% for that period1 . The impossible had been made possible. The era of cardiac surgery had definitively begun.
With the heart itself still largely off-limits for complex procedures, early pioneers developed ingenious "closed-heart" or extracardiac procedures. These operations were performed on the great vessels near the heart or by working blindly through the heart's chambers, relying on the surgeon's tactile sense and anatomical knowledge.
First successful heart wound suture. Proved the heart could be surgically repaired2 .
First finger operation on a mitral valve. Inserted a finger into the heart to open a narrowed valve; was not permitted to repeat it4 .
First ligation of a patent ductus arteriosus. First successful surgery for a congenital heart defect1 .
First Blalock-Taussig shunt for Tetralogy of Fallot. Palliative procedure for "blue babies" that ushered in modern pediatric cardiac surgery4 .
One of the most significant closed-heart techniques was the mitral commissurotomy, developed to treat mitral stenosis—a narrowing of the heart's mitral valve. Surgeons like Charles Bailey, Dwight Harken, and Russell Brock led this charge. The procedure was audacious: without directly seeing the valve, the surgeon would make an incision in the side of the heart, insert a finger to locate the calcified, narrowed valve, and then use a special knife or dilator to forcibly open it1 . While often successful, it was a crude and risky maneuver. If the valve was torn too much, the patient could be left with severe and lethal regurgitation1 . The limitations of these blind procedures were clear, driving the field toward a singular goal: opening the heart for direct, precise repair.
To perform complex repairs inside the heart, surgeons needed two things: a bloodless field and a still heart. They also needed a way to keep the patient's brain and body alive while the heart was stopped. Two radical approaches emerged to solve this problem.
Building on the observation that cooled tissues require less oxygen, Dr. Wilfred G. Bigelow of the University of Toronto proposed using hypothermia in cardiac surgery4 . On September 2, 1952, at the University of Minnesota, Dr. F. John Lewis performed the first successful intracardiac repair of a congenital heart defect using hypothermia.
The patient was a five-year-old girl with an atrial septal defect (ASD), a hole between the heart's upper chambers4 1 . Lewis cooled the child to around 28°C (82°F), which slowed her metabolism enough to allow him to briefly clamp the vessels entering her heart, open it, and suture the hole closed—all within a five-to-six-minute window1 4 . This groundbreaking operation proved that direct-vision intracardiac surgery was feasible.
Even with hypothermia, the time available for surgery was dangerously short. Dr. C. Walton Lillehei at the University of Minnesota pioneered a more daring solution: controlled cross-circulation1 .
In this procedure, a parent or relative of the patient was used as a biological oxygenator. Their circulation was connected to the patient's; their healthy lungs oxygenated the patient's blood while the surgeon repaired the child's heart1 . Between 1954 and 1955, Lillehei performed 45 operations using this technique, primarily to repair complex defects like ventricular septal defects, with excellent long-term outcomes1 .
While ethically fraught and risky for the donor, cross-circulation demonstrated that prolonged, complex open-heart surgery was possible, paving the way for the final, crucial innovation.
While hypothermia and cross-circulation offered temporary solutions, the ultimate key to open-heart surgery was a mechanical device that could take over the functions of the heart and lungs entirely. This was the lifelong mission of Dr. John Heysham Gibbon.
Gibbon's quest began in 1931 after losing a young patient from a pulmonary embolism. He reasoned that if a machine could temporarily take over cardiopulmonary function, such lives could be saved. For the next two decades, working first at Massachusetts General Hospital and later at Jefferson Medical School in Philadelphia, Gibbon and his wife, Mary, conducted thousands of experiments on cats and dogs to develop a pump-oxygenator.
The core components of his system were:
The heart-lung machine temporarily takes over the function of the heart and lungs during surgery, allowing the heart to be stopped for repair.
After years of refinement, Gibbon was ready for a human trial. On May 6, 1953, he operated on an 18-year-old woman with a large atrial septal defect. He connected the patient to his heart-lung machine, stopped her heart, and under direct vision, successfully sutured the hole in her heart1 4 . The table below summarizes the core data from this landmark case.
| Parameter | Detail |
|---|---|
| Patient | 18-year-old female |
| Condition | Large Atrial Septal Defect (ASD) |
| Machine Used | Gibbon Model II Pump-Oxygenator |
| Time on Cardiopulmonary Bypass | Approximately 26 minutes |
| Surgical Time with Heart Open | Approximately 19 minutes |
| Outcome | Successful; patient recovered fully |
This single successful procedure was the culmination of over 20 years of work. However, Gibbon was unable to replicate this success in his next few patients and, disheartened, abandoned the procedure1 4 . The baton was passed to others, most notably Dr. John Kirklin at the Mayo Clinic, who, using a modified version of Gibbon's apparatus, performed the first successful series of open-heart operations in 19551 . Concurrently, Richard DeWall at the University of Minnesota developed a much simpler, disposable bubble oxygenator, which greatly increased the practicality and accessibility of open-heart surgery1 . The floodgates were now open.
The success of open-heart surgery hinged on a suite of technologies, each solving a critical physiological challenge.
The lowering of body temperature to reduce metabolic rate and the body's demand for oxygen, providing an additional safety margin during bypass1 .
An anticoagulant drug. It was essential to prevent the patient's blood from clotting as it passed through the foreign surfaces of the heart-lung machine.
Used to cannulate (connect) the great vessels (vena cava and aorta) to the heart-lung machine, creating a closed circuit for blood flow.
Invented by Willem Einthoven in 1902, it allowed for continuous monitoring of the heart's electrical activity during the stressful perioperative period3 .
A range of specialized surgical tools were developed for cardiac procedures, including vascular clamps, specialized needles, and retractors.
The period from 1896 to 1955 represents the heroic age of cardiac surgery. It began with a single, life-saving suture on a wounded heart and culminated in the development of a machine that could temporarily replace the heart's function altogether. This journey was driven by pioneers who refused to accept the limitations of their time, who innovated in the face of skepticism, and who took monumental risks to save lives.
The closure of the first atrial septal defect using Gibbon's machine was not just one successful operation; it was the key that unlocked the door to treating a vast array of congenital and acquired heart diseases. By 1955, the foundation was firmly laid. The stage was set for the next revolutions: artificial heart valves, coronary artery bypass grafting, and ultimately, heart transplantation, all built upon the courage and ingenuity of these early trailblazers.