(Circulation. 1999;100:1364-1365.)
© 1999 American Heart Association, Inc.
In Memoriam |
C. Walton Lillehei, the "Father of Open Heart Surgery"
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Introduction |
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 Top Introduction |
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On July 5, 1999, Clarence Walton Lillehei, one of the world's foremost cardiac surgeons, researchers, and educators, died at his home in Minneapolis, Minnesota, of prostate cancer at 80 years of age. Because Dr Lillehei pioneered a direct, safe approach to open heart operations in the 1950s, he was known as the "father of open heart surgery." Indeed, hardly any other cardiac surgeon has introduced a greater number of innovative techniques and concepts.
Born in Minneapolis in 1918, Walt Lillehei spent most of his life in
his hometown, helping to establish its reputation as a center of
biomedical excellence. When he was a boy, his surgical skill was
foreshadowed by his technical dexterity in taking apart and rebuilding
a Model-T Ford. Walt received his premedical and medical training at
the University of Minnesota, earning an undergraduate degree in
1939, an MD in 1942, a master's in physiology, and a doctorate
in surgery in 1951.
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During World War II, Dr Lillehei served in the Army Medical Corps in Europe, rising to the rank of lieutenant colonel and earning a Bronze Star for meritorious services. In 1945, he returned to the University of Minnesota and completed his residency under the direction of Dr Owen Wangensteen, then chairman of the Department of Surgery. Wangensteen promoted close collaboration between surgeons and physiologists and insisted that all surgeons participate in laboratory research. During his tenure as chairman, his department provided a stimulating creative environment that attracted many brilliant young surgeons. Wangensteen became Walt Lillehei's special mentor and champion.
In 1949, Dr Lillehei became a full-time instructor of surgery at the University of Minnesota Medical School, eventually working his way through the ranks to become a clinical professor. In mid-1950, however, his career was interrupted by a devastating health crisis: at age 31, he was diagnosed with lymphosarcoma of the parotid gland and was given a 5% to 10% chance of surviving for 5 years. The day after he completed his senior residency, he underwent head and neck surgery and mediastinal exploration by Drs Wangensteen and Richard Varco. After subsequent radiation therapy, Walt Lillehei recovered slowly but completely, exhibiting a remarkable degree of courage and tenacity. Unfortunately, his neck remained slightly disfigured for the rest of his life.
On regaining his health, Dr Lillehei focused his efforts on cardiac surgery, particularly the development of open heart operations. In 1953, Dr John Gibbon of Philadelphia successfully closed an atrial septal defect using a complex screen oxygenator and roller pumps. However, the mortality of open heart surgery remained high, mainly because of oxygenator-related problems, and many surgeons despaired of ever being able to correct complex intracardiac defects. This situation was changed in March 1954 when Dr Lillehei and his associates—Morley Cohen, Herb Warden, and Richard Varco—used controlled cross-circulation to correct a ventricular septal defect in an 11-year-old boy. The boy's anesthetized father served as the oxygenator. Blood flow was routed from the patient's caval system to the father's femoral vein and lungs, where it was oxygenated and then returned to the patient's carotid artery. The cardiac defect was repaired with a total pump time of 19 minutes. Over the ensuing 15 months, Lillehei operated on 45 patients with otherwise irreparable complex interventricular defects; most of these patients were less than 2 years old. Although cross-circulation was a major advance, it was not adopted for widespread use because it posed a serious risk to the "donor." Nevertheless, this method paved the way for the open heart surgery era. It also won Drs Lillehei, Cohen, Warden, and Varco the 1955 Albert Lasker Award in medical research.
That same year, Dr Richard A. DeWall and Dr Lillehei introduced the first clinically successful bubble oxygenator, which remained the standard for extracorporeal circulation until the late 1970s. Dr Lillehei also helped pioneer hemodilution and moderate hypothermia techniques for open heart surgery. In 1957, with Earl Bakken (the cofounder of Medtronic), he introduced the first transistorized, wearable permanent cardiac pacemaker for clinical use. In addition, he developed 4 prosthetic heart valves, including the Lillehei-Kaster and St. Jude Medical prostheses. Over the years, all of these contributions have yielded enormous benefits to humanity.
In 1967, Dr Lillehei was appointed professor of surgery and chairman of the Department of Surgery at Cornell University Medical Center and surgeon-in-chief at New York Hospital. There he undertook a series of multi-organ transplants, including the second clinical transplant of a heart and both lungs (1969). However, he continued to view the Midwest as home, and in 1975 he returned to Minneapolis. Unfortunately, because of deteriorating vision related to his 1950 cancer radiation treatment, he had to end his surgical career at age 55. Nevertheless, he remained active as a lecturer, writer, and consultant. In 1979, he became medical director of the St. Jude Medical Heart Valve Division, a position which he held until his death.
Through the years, Dr Lillehei received many honorary degrees and international awards. He belonged to numerous honorary and scientific societies, including the American College of Cardiology, of which he was a past president. He also authored or coauthored hundreds of scientific publications. As one of cardiac surgery's most productive innovators, he will be remembered for his ingenuity, imagination, and boldness. Because he tended to challenge established beliefs and was his "own man," he was sometimes a target for critics. However, he was also warm, sociable, and friendly, with enormous energy and concern for his patients. Indeed, he was remarkably generous to many patients who could not afford his services. Moreover, he successfully blended the academic and industrial aspects of surgery in his work with Medtronic and later St. Jude Medical.
Like his mentor Owen Wangensteen, Dr Lillehei was "a truly visionary surgeon who created a favorable environment uncluttered by the cobwebs of tradition." Approximately 1000 cardiothoracic surgeons, residing in numerous countries worldwide, can trace their preceptorial lineage to him. Many of these surgeons (including Christiaan Barnard and Norman Shumway) later headed well-known cardiothoracic programs of their own. First- and second-generation Lillehei trainees have developed important techniques in transplantation, perfusion, coronary artery bypass, prosthetic valves, and congenital heart surgery. As Wangensteen himself declared, Walt Lillehei is "one of the surgical immortals."
I am privileged to have counted Dr Lillehei as a personal friend. At the 1955 meeting of the American Association of Thoracic Surgeons, I watched a film of him performing open heart surgery with the aid of cross-circulation. I was so fascinated that I persuaded my colleague, Dan G. McNamara, a pediatric cardiologist, to go with me to Minneapolis, where we watched Dr Lillehei correct a ventricular septal defect using cross-circulation and later saw a demonstration of the DeWall-Lillehei oxygenator. This experience inspired me and my Houston team to produce a similar machine so that we could perform our own open heart operations. Therefore, I have always owed Walt Lillehei a special debt because he served as a role model for investigators.
Dr Lillehei is survived by his wife of 52 years, Kay Lindberg Lillehei, as well as a daughter, 2 sons (a third son died in 1997), 7 grandchildren, and 2 great-grandchildren. On behalf of the entire cardiac surgery community, I gratefully salute the memory of this outstanding surgeon and innovator.
Denton A. Cooley, MD
Texas Heart Institute
Houston, Texas
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