Interactive Cardiovascular and Thoracic Surgery 2:217-218(2003)
© 2003 European Association of Cardio-Thoracic Surgery
From the magic mountain to rocket science in thoracic and cardiovascular surgery
Ludwig K. von Segesser, Editor-in-Chief*
Department of Cardio-vascular Surgery, Centre Hopitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011, CHUV, Lausanne, Switzerland
* Tel.: +41-21-314-2280; fax: +41-21-314-22-78
ludwig.von-segeser{at}chuv.hospvd.ch
Homer's Ikaros, Leonardo da Vinci's (1452–1519) drawings of flying machines, and Otto Lilienthals gliding flights since 1891, all paved the way for the first motor powered flight, which was realized 100 years ago on December 17 1903, by Orville and Wilbur Wright near Kitty Hawk in North Carolina. That first flight lasted 12 seconds and covered a distance of 120 feet. But Orville and Wilbur tested their machine three more times that day and the Flyer remained in the air up to 59 seconds. That past century has been marked with milestones above the ground including Charles Lindbergh crossing of the Atlantic in 1927, Antoine de Saint-Exupéry's postal flights and disappearance in 1944 during a reconnaissance flight, Yeager braking the sound barrier in 1947, Armstrong's first visit of the moon in 1969, commercial supersonic flights with the Concord since 1976, and led to today's Jumbo Jets and Airbusses, which are now almost ubiquitous.
There is little doubt that the changes in medicine during that same period of time have been quite spectacular too, and this can be traced in the literature. Thomas Mann (1875–1955) described the decline of a business family in his novel ‘Buddenbrooks’ in 1901, and following a stay in Davos, Switzerland in 1921, he published ‘The Magic Mountain’ in 1924, which among other things, reflects the most popular way to deal with tuberculosis at his time. Paul de Kruif's ‘Microbe Hunters’ appeared in 1926 and preceded the application of antibiotics by A. Fleming in 1929. Interestingly enough, Charles Lindbergh, the aviator, was also involved in the development of the pump-oxygenator (Time Magazine, 1938). Fifty years ago, followed the discovery of the double helix structure of the DNA by Watson and Crick, which appeared in Nature in April 1953. By the middle of the 20th century, thoracic surgery, vascular surgery and anesthesiology (Video 1, endo-tracheal intubation in the forties by A.P. Naef: help yourself!; http://www.icvts.org/elan/169/naef.rm) had also made sufficient progress to take up a new challenge: open heart surgery. Within a few years, A.M. Dogliotti in Torino performed the first clinical partial cardio-pulmonary bypass (August 9, 1951), F.D. Dodrill realized the first successful left heart bypass (July 3 1952), J. Gibbon performed the first open heart operation with the heart–lung machine on May 6, 1953, and C.W. Lillehei operated on March 26, 1954 the first patient with cross-circulation. There can be no doubt that open-heart surgery, as we know it today, started to fly at that time. Although the more recent history of medicine was marked by progress made in other fields, like genomics and proteomics, it remains to be seen whether the ongoing developments in rocket science [1,2] and/or the more recent developments in nano-technology [3] will allow for the next quantum leap in surgery.
In 1998, this author learned about the first ligature of a patent ductus arteriosus in Switzerland, which was performed by Professor Andreas P. Naef in Lausanne in 1948 [4] (http://www.hospvd.ch/chuv/ccv). At that time he selected for this procedure a posterior thoracotomy approach. Interestingly enough this route has been promoted again more recently for superior cosmesis in pediatric cardiac surgery. Professor Naef (Fig. 1) also performed the first closed mitral commissurotomy in Switzerland on August 20 1951, a successful procedure in a patient who is still alive today. Later he had a very impressive career in thoracic surgery with patient referrals from far beyond the Swiss frontiers, an activity which kept him extremely busy for more than 40 years. The success in the field of thoracic surgery in conjunction with the fact that as a boy, he lived some time in Davos with his father, a medical doctor who took care of patients with pulmonary tuberculosis may explain why Professor Naef did not further pursue the adventure of heart surgery, which he had pioneered in Switzerland. Instead, he focused his activity to the introduction of ever new techniques in pulmonary and tracheo-bronchial surgery—first segmentectomies for tuberculosis, bronchoplasties as well as extensive tracheal resections/reconstructions. Thus, professor A.P. Naef is not only an eyewitness of the mid-century revolution in thoracic and cardio-vascular surgery, but he also knew personally, most of the main players in this challenging field active on both sides of the Atlantic half a century ago. The fascinating story of ‘The mid-century revolution in thoracic and cardio-vascular surgery’ by A.P. Naef will be published now as a series of contributions in Interactive Cardiovascular and Thoracic Surgery. Those who were there, and those who were not, should read on [5] and join the discussions at www.icvts.org!
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Appendix A.
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doi:10.1016/S1569-9293(03)00140-3
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References
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- Kolff WJ, Hiller KW, Seidel W, Molopoulos S, Akutsu T, Mirkovitch V, Topaz SR. Results obtained with artificial hearts driven by the NASA Servomechanism and the pathologic physiology of artificial hearts. Trans Am Soc Artif Organs. 1962;8:135
- Kawahito K, Damm G, Benkowski R, Aber G, BacaK J, Tasai K, Shimono T, Takatani S, Nose Y, Noon GP, De Bakey ME. Ex vivo phase 1 evaluation of the DeBakey/NASA axial flow ventricular assist device. Artif Organs. 1996;20:47–52[Medline]
- von Segesser LK. Surgical technique versus technology for surgery: a plea for an open mind towards new technology. Interactive Cardiovasc Thorac Surg. 2002;1:1–3[Free Full Text]
- Naef AP. 50 ans de chirurgie cardiovasculaire à Lausanne (rétrospective–prospective). Rev Méd Suisse Romande. 1999;119:149–152
- Naef AP. The mid-century revolution in thoracic and cardiovascular surgery. Interactive Cardiovasc Thorac Surg 2003;2:219–226.
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L. K. von Segesser
"Out of nothing comes nothing"{alpha} versus "Perpetual flux"{beta}: {alpha}Epicurus of Samos (341-270 BCE); {beta}Heraclitus of Ephesus (535-475 BCE)
Eur. J. Cardiothorac. Surg.,
September 1, 2003;
24(3):
341 - 342.
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Appendix A.
References