Heart surgery did not begin with a single invention but evolved over more than a century of medical innovation. The journey progressed from a procedure deemed impossible to one that is nearly routine today. Early attempts focused on emergency trauma repair, eventually leading to planned corrective procedures that required new technologies to visualize and repair the heart’s interior. This timeline reveals how surgical access progressed from blind manipulation to precise, open-heart repair.
Early Attempts and the Doctrine of Impossibility
For centuries, the medical community viewed the heart as untouchable, adhering to a consensus known as the “Doctrine of Impossibility.” Prominent surgeons famously believed that any attempt to operate directly on the heart would result in immediate death for the patient, and they publicly discouraged such efforts. The high risk of infection and the difficulty of operating on a constantly beating organ made elective heart surgery unthinkable throughout the 19th century.
The first successful intervention was born of emergency, challenging this belief. In 1896, German surgeon Ludwig Rehn successfully repaired a stab wound to the right ventricle of a 22-year-old patient. Rehn stitched the wound shut, saving the patient’s life and proving the heart could sustain surgical manipulation. This landmark operation was reserved only for immediately fatal trauma, not for planned corrective treatment. Anesthesia and antiseptic principles, though rudimentary, were instrumental in making these trauma attempts survivable.
The First Successful Interventions (Closed-Heart Surgery)
The shift toward planned, corrective surgery began in the 1920s. These “closed-heart surgery” procedures were limited because they were performed on the beating heart without directly visualizing the interior chambers. Early corrective efforts primarily targeted mitral stenosis, a narrowing of the heart’s mitral valve often caused by rheumatic fever.
In 1925, British surgeon Henry Souttar performed a pioneering closed procedure. He inserted his finger through the left atrial appendage to explore and dilate the stenotic mitral valve, a technique known as digital valvulotomy. This demonstrated that the heart could be manipulated to correct acquired defects, though the technique was not widely adopted until after World War II.
Following the war, surgeons like Dwight Harken and Charles Bailey further refined the closed valvulotomy technique in the late 1940s. These procedures were limited, however, because the surgeon worked essentially by feel, or “blindly,” through a small incision. This inability to see the interior of the heart meant that complex defects, such as holes between the heart chambers or severe valve damage, remained impossible to repair.
The Breakthrough of Open-Heart Surgery
Modern heart surgery became possible with the invention of technology that could temporarily take over the functions of the heart and lungs. This required stopping the heart safely to allow surgeons time and visibility for precise, internal repair. The solution was the heart-lung machine, also known as cardiopulmonary bypass (CPB).
Dr. John Gibbon, Jr. spent over two decades developing the CPB machine, which mechanically oxygenates and circulates a patient’s blood outside the body. His persistence culminated in the first successful open-heart procedure using the machine on May 6, 1953, to repair an atrial septal defect in a young woman. Gibbon’s invention was revolutionary because it bypassed the heart and lungs, allowing the surgeon to operate on a motionless, bloodless heart for an extended period.
The successful application of the CPB machine in the 1950s allowed surgeons to move beyond external manipulation and address complex congenital and acquired defects. This technology opened the door for corrective surgeries on the heart’s valves and internal walls, rapidly expanding the scope of cardiac surgery and leading to its widespread adoption globally.
Refinement and Specialization in Modern Cardiology
With the heart-lung machine established, the field of cardiac surgery rapidly expanded into specialized, complex procedures. The late 1960s saw the introduction of two procedures central to modern cardiac care.
On November 23, 1964, a team led by Dr. Michael DeBakey performed one of the earliest successful coronary artery bypass graft (CABG) procedures. This procedure, which reroutes blood flow around blocked coronary arteries, became the standard treatment for severe coronary artery disease. The same decade marked another milestone when South African surgeon Christiaan Barnard performed the first human heart transplant in December 1967. These complex operations, built on the reliability of the CPB machine, confirmed cardiac surgery as a highly specialized field.
The evolution continues today with a trend toward less invasive techniques, reducing the reliance on full open-heart access. Minimally invasive approaches and catheter-based interventions, such as angioplasty and stenting, allow surgeons to repair heart damage through small incisions or via vessels in the groin. These advancements move surgery from the impossible to the routine, and now to the least disruptive means possible.