60 years ago, a witness to medical history

I was first introduced to Dr. John Heysham Gibbon in 1948, when I became a resident at Thomas Jefferson Medical College Hospital. As my principal teacher in surgery, he was a great influence.

Gibbon was a pioneer investigator in the heart-lung machine. I first heard of the machine in 1946, when Gibbon came back to Jefferson. By that time, he had been working on the idea for 16 years. He first thought of the idea in 1930, while working in Massachusetts with Dr. Edward Churchill, the famous Boston surgeon.

At the time, there was little doctors could do to treat patients with a pulmonary embolism (a blockage of the main artery to the lung). Surgery was tried, but when the chest was opened to get the clots out of the pulmonary artery, the patients would not survive because there was no way to take over the functions of the heart and lungs. If a machine could function for the heart and lungs, Gibbon thought, patients with these ailments could survive.

During World War II, Gibbon served as chief of surgery of an Army general hospital in the South Pacific. After his service, he returned to Philadelphia and, in 1946, was appointed professor of surgery and chairman of surgical research at Jefferson. When I started my training in general and thoracic surgery in 1948, I was fortunate to be appointed to his surgical residency program.

My civilian training was interrupted by a two-year stint in the U.S. Air Force (1950-52), but I returned to Philadelphia to finish my residency with Gibbon. He felt it was important for his residents to serve their country, as he did during World War II.

During this time, Gibbon was doing laboratory work with the heart-lung machine. By early 1953, he felt the time had come to use his machine in human beings. His success rate using medium-sized dogs had risen remarkably and his confidence in his machine and his surgical team was at an all-time high. Gibbon's dream was about to be reached.

Gibbon was consulted by the physician of a girl with a large interatrial heart defect. Gibbon recommended a surgical procedure to correct the defect, which would require the use of a heart-lung machine.

The patient was 18-year-old Cecelia Bavolek, a student from Wilkes-Barre, who accepted the proposed procedure.

I was a surgical resident assigned to the women's surgical ward, and admitted Bavolek to the hospital. The surgery was scheduled for May 6, 1953, and that day a combination of excitement and nervousness filled the air at Jefferson.

The heart-lung machine was roughly the size of a grand piano. It was primed with heparinized blood obtained from donors the night before. Gibbon was assisted in the operation by Drs. Frank Albritton, Bernard Miller, George Haupt, Robert K. Finley Jr., and Thomas Nealon, and myself. When Miller had to drop out to fix a hitch in the machine, Gibbon asked me to "scrub in."

The patient was connected to a heart-lung machine for 45 minutes. For 26 of those minutes, she was on total cardiopulmonary bypass, meaning the machine was functioning as her heart and lungs. The operation was a success, and she was discharged with complete correction of her cardiac defect. She is known to have recovered and done well, cardiac wise, for more than 25 years after the operation.

In the 60 years since that first operation, Gibbons and his heart-lung machine have been responsible for saving many lives of individuals who would not have been able to survive certain cardiac conditions. Technological advances have improved the quality of surgery and outcomes for patients, but no single surgery has been as important as the one done on May 6, 1953, in Philadelphia.