Open heart surgery represents one of the most significant achievements in modern medicine. This kind of operation requires the heart to be still and empty, which necessitates temporarily taking over the functions of the heart and lungs with a machine. Answering the question of when open heart surgery started requires acknowledging a series of breakthroughs that gradually transformed a once-impossible procedure into a life-saving intervention.
Early Attempts at Cardiac Repair
Before true open heart surgery was possible, surgeons began making tentative forays into the chest cavity. The first successful suturing of a stab wound to the heart’s pumping chamber was performed by German surgeon Ludwig Rehn in 1896. This landmark event initiated the field of cardiac surgery.
The 1920s saw procedures that accessed the heart without full visualization of the interior, often called “blind” or closed-heart techniques. In 1925, British surgeon Henry Souttar performed the first successful valve operation, using his finger inserted through the left atrial appendage to correct a narrowed mitral valve. Later, in the 1940s, pioneering operations like the Blalock-Taussig shunt were developed to treat congenital defects by rerouting blood flow outside of the heart chambers. These early procedures provided symptomatic relief for patients but could not directly repair complex structural problems within the heart itself.
The Technological Breakthrough: Heart-Lung Bypass
The central problem for surgeons was the need for a bloodless, motionless field to repair defects inside the heart. The solution lay in developing a machine that could perform the work of both organs outside the body.
American surgeon John H. Gibbon began experimenting with the concept in the 1930s, eventually collaborating with IBM to build a mechanical pump-oxygenator. The machine was designed to divert deoxygenated blood from the patient, enrich it with oxygen, and then pump it back into the circulatory system.
As Gibbon refined his machine, other surgeons sought alternative, albeit temporary, methods to access the heart’s interior. In 1952, F. John Lewis performed the first successful intracardiac repair of an atrial septal defect (ASD) using controlled hypothermia, which involved cooling the patient to briefly slow metabolism and circulation. A more controversial approach was C. Walton Lillehei’s use of “cross-circulation” in 1954, where a parent was temporarily connected to the child’s circulation to act as a living heart-lung machine, proving that complex internal repairs were indeed possible.
Establishing the First Successful Open Procedures
The historical moment that definitively marks the start of open heart surgery using the enabling technology occurred. On May 6, 1953, John H. Gibbon successfully used his CPB machine to close a large atrial septal defect in an 18-year-old woman named Cecelia Bavolek. This case, where the patient was on total cardiopulmonary bypass for 26 minutes, was the first successful mechanical heart-lung bypass operation.
Gibbon’s initial success was difficult to replicate, and it was the work of C. Walton Lillehei and his colleagues in Minnesota that truly demonstrated the potential for complex defect repair. Using the cross-circulation technique in 1954, Lillehei successfully repaired a variety of severe congenital defects, including the first closures of ventricular septal defects and the full repair of Tetralogy of Fallot. These operations proved that even the most complicated heart conditions could be corrected under direct vision.
The widespread adoption of open heart surgery was cemented by John W. Kirklin at the Mayo Clinic, who refined Gibbon’s original machine into the more reliable Mayo-Gibbon apparatus. Kirklin’s team performed the first sustained series of successful open heart operations starting in March 1955, systematically demonstrating that intracardiac surgery could be performed safely and reproducibly. This combination of Gibbon’s initial breakthrough and Kirklin’s systematic success transformed the procedure from a rare experiment into a practical surgical option.
Standardization and Specialization
Following these early successes, the field of open heart surgery experienced explosive growth and refinement. A major practical improvement came in 1955 when Lillehei and Richard DeWall introduced the clinically successful bubble oxygenator, a simpler and more affordable alternative to the complex Gibbon machine.
This innovation made cardiopulmonary bypass technology accessible to hospitals across the world, significantly increasing the number of centers able to perform the procedure. Mortality rates dropped rapidly as surgical techniques were standardized and technological support improved.
The focus soon expanded beyond repairing congenital defects to treating acquired heart disease in adults. In 1960, the first successful mechanical heart valve replacement was performed by surgeon Albert Starr, offering a permanent solution for damaged heart valves. The development of Coronary Artery Bypass Grafting (CABG) in the 1960s, pioneered by surgeons like René Favaloro, further revolutionized the field by directly addressing the blockages that cause heart attacks.