Asian Cardiovasc Thorac Ann 2001;9:78
© 2001 Asia Publishing EXchange Pte Ltd
King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery
Harinder Singh Bedi, MCh
authored by G Wayne Miller
ISBN 0-8129-3003-7 • List Price US$25.00
Time Books, New York, USA
This book is a gripping account of the life and times of C Walton Lillehei, the daring (some called him "mad") surgeon who defied death from a lymphosarcoma and major surgery to be a world leader and pioneer in the field of open heart surgery.
Heart surgery today is almost as commonplace and safe as removing an appendix. However, most of us are not really aware of what daring, innovation, and gigantic leaps of faith were required by the numerous cardiac surgeons who carried out this heroic effort with a motivation that kept them going even when so many children died — literally in their hands. Lillehei stood out in an astounding galaxy of pioneers, which included such giants as Clarence Dennis, John Gibbon, Robert Gross, Charles Bailey, Richard Varco, F John Lewis, Wilfred Bigelow, William J Mustard, Vincent L Gott, Dwight Harken, Lord Russell C Brock, George Trusler, Denton Cooley, Christian Barnard, and Norman Shumway.
At the age of 35, Lillehei carried out his first human cross-circulation case on March 26, 1954 (at a time when probably most of us were not even born) on Gregory Glidden, a 13-month-old boy with a ventricular septal defect. The importance of having a mind open to ideas is brought forth clearly when we learn how open heart surgery started. The motivation to develop a simple way to perform open heart surgery came to Lillehei when he repaired an atrial septal defect at autopsy and remarked: "Any seamstress could have sewn that up in 5 minutes. If only we could get inside the living heart." After the initial failures of the heart lung machine (by Clarence Dennis), Lillehei realized that he had to develop a simple way and avoid the "confounded machine". The idea of cross-circulation came during a talk with his resident whom he had congratulated on learning that his wife was pregnant. From this came the idea to plug a patient into something like a placenta. The hardware used was a clear beer hose and a milk pump. The concept of azygos flow, on which basis cross-circulation was possible, came to him while reading of an experiment on dogs in the British Journal of Surgery in 1952. He is also credited with using a large country dog's lungs as oxygenator in 12 patients, with some survivors. The importance of having an open mind is again exemplified by the fact that as soon as he had modified a cheap oxygenator, the DeWall, to the Lillehei bubble oxygenator that cost him $15, he stopped using cross-circulation although he was the inventor of that technique.
The book also tells us of the obstacles placed in his way by the chief of medicine who thought that cross-circulation was madness as it was the first time in history that an operation had the potential to kill 2 people. Even in his own department, he was initially told to wait as it was another surgeon's "turn" to be the first to repair a ventricular septal defect.
Dr. Lillehei was a versatile genius. He also invented the pacing wire (with Vincent Gott) and the portable pacemaker (with Earl Bakken, with whom he formed the company Medtronic). He was president of the American College of Cardiology and was nominated for a Nobel Prize many times. He trained 138 surgeons, a number of them from Asia. His reputation suffered a major blow when he was indicted on charges of tax evasion. He died at home on July 5, 1999.
The book is ultimately a story of triumph against all odds and of the innovations and courage that have revolutionized open heart surgery. The book is properly and meticulously referenced and researched. Lillehei's motto in life: "work hard, play hard" can be a source of inspiration for us. The book is a must-read for cardiac surgeons of any age. To us, the family of cardiac surgeons, he has undoubtedly earned the title of "The Father of Cardiac Surgery".
