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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. “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

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  1. A potted history of cardiac surgery Chris Munsch Yorkshire Heart Centre, Leeds

  2. 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”

  3. DanielHale-Williams, 1893

  4. 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

  5. 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

  6. 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

  7. 1977 - 2003 1977

  8. Its not all about us!

  9. 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.

  10. 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)

  11. The G.H.Wooler Legacy

  12. Wooler AnnuloplastySince 1957

  13. Splitting of the papillary muscleEarly 1960s

  14. 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)

  15. The Ionescu Shiley pericardial Xenograft

  16. Applications To Thoracic Surgery Resident Programs1993-2009 Source: NRMP *As of May 19, 2008

  17. The future of cardiac surgery …the future ain’t what it used to be!

  18. New emerging or developing procedures • AF surgery • Heart failure surgery • Endovascular surgery • Minimal access and robotic surgery • Coronary artery surgery!

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