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A Hundred Years of Heart

Historic highlights in cardiac surgery and the rise of cutting-edge care in Sarasota.

Did you know that the earliest evidence of medical surgery dates all the way back to the Stone Age? That's more than 30,000 years ago! But it's true.

In 2022, a team of anthropologists in Borneo discovered the skeletal remains of a young adult whose foot was successfully amputated 31,000 years ago—without modern anesthetic or even metal tools. And as far back as 6500 BCE, prehistoric surgeons in France practiced trepanning, drilling holes in the skull to relieve pressure (or release spirits), as treatment for head injuries and mental illness. Even plastic surgery dates all the way back to 650 BCE, where an Indian physician named Sushruta invented rhinoplasty.

But there was one organ surgeons dared not touch: the heart. This would not change until 1896 and the efforts of a young German surgeon named Ludwig Rehn. And that changed everything.

Achieving the Impossible: A Stabbing on the Road, a World War Gamble, & the Cold-Blooded Birth of Open-Heart Surgery

For the majority of human history, conventional wisdom told physicians and surgeons that operating on the human heart was impossible. As the circulatory engine keeping the rest of the body alive, it was simply too delicate and entirely too dangerous. Someone should have told Ludwig Rehn.

It was September 1896, when a 22-year-old man arrived at Rehn’s hospital. He had been stabbed in the chest and left for dead on the road. He was deathly pale. Rehn brought the man to surgery, not to operate on his heart, but to treat a hemothorax, or pooling blood trapped between the chest wall and the lung. But in the process, the damaged membrane around the heart fell away and Rehn saw something no one had ever seen before: a patient’s beating heart. He also saw a 1.5cm wound in the right ventricle, where the knife had pierced. With needle and silk, Rehn stitched the wound shut, saving the man’s life. Cardiac surgery was born.

By 1907, Rehn would perform 124 such operations, with a 60% mortality rate—a marked improvement over the pre-surgical 90% mortality rate. But beyond that, cardiac surgery did not progress much until the 1944 invention of the Blalock-Tausig-Thomas shunt, which alleviated a then-fatal congenital cardiac defect known as tetralogy of Fallot, and the wartime actions of a 35-year-old American surgeon named Dwight Harken.

Harken was in charge of a field hospital in England and his most challenging patient was an infantry sergeant named Leroy Rohrbach, who had been wounded at Normandy and left with a shrapnel in his heart. Twice Harken operated and twice the shrapnel slipped from his grasp. Doctors agreed it was safer to leave it lie than undergo another surgery, but Rohrbach begged Harken to try again. He agreed to a third and final attempt.

In a hut crammed with state-of-the-art equipment, an unconscious Rohrbach, and an audience of curious British surgeons, Harken used a scalpel to open Rohrbach's chest under the left nipple, a retractor to pry his ribs apart, and exposed the man's heart. It was beating fast, agitated by the disturbance. Harken had three minutes to operate before the patient died.

With control sutures in place to guard against bleeding, Harken cut into Rohrbach's heart and prepared to grab the shrapnel with his forceps. Before he could, the heart's own pressure fired the offending piece of metal out like a cannon. Blood followed. Too much. An assistant tightened the control sutures but Harken ultimately corked the bleeding with his finger. He sutured the wound shut, freed his glove from where he had accidentally stitched it into the patient's heart, and began closing him up. It took about three minutes.

Harken went on to great success In a tub of ice, doctors lower a patient’s body temperature to achieve deep hypothermic circulatory arrest before surgery. helping wounded soldiers, but the evolution of cardiac surgery remained constrained to that three-minute window. And there was no way to open the heart itself and perform surgery. This was soon to change, as Canadian surgeon Wilfred Bigelow suggested an approach that could perhaps be described as cold-blooded.

Bigelow theorized that lowering the patient’s temperature would lessen the body’s need for oxygen and slow or even stop blood circulation, giving surgeons more time to operate. Studies of hibernating groundhogs proved less than fruitful but, in 1949, Bigelow successfully tested his hypothermia theory on a dog, slowing its circulation for 15 minutes and performing open-heart surgery, before reviving the unharmed animal. This became known as deep hypothermic circulatory arrest. (In more daring experiments, Bigelow also discovered he could restart a dog’s stopped heart with an electrical probe, eventually leading to his invention of the pacemaker.)

Bigelow’s discovery caught the attention of American surgeon F. John Lewis, who, in 1952, used the technique to induce total circulatory arrest and stop a 5-year-old girl’s heart for five minutes, while he repaired an atrial septic defect.

It is widely known as the first successful open-heart operation.

But while Bigelow's hypothermic technique was a life-saving discovery, it had its drawbacks, namely cerebral complications and the possibility of fatal embolisms. In the following years, several physicians and surgeons pioneered new techniques. A doctor and nurse prepare a heart-lung machine, c. mid-1950s

There was Dr. John Gibbon, who sustained a total cardiopulmonary bypass for 45 minutes through a heart-lung machine of his own invention. He compared looking into the empty and open heart to "drying out a well to do some work on the bottom of it." And there was Dr. C. Walton Lillehei, who pioneered a technique called cross-circulation, wherein a donor, usually a parent, would serve as the patient’s living heart-lung machine. It was successful, but physicians were wary of any procedure with a potential 200% mortality rate. Building on their work, a surgeon named Richard DeWall invented the bubble oxygenator in 1955, which was safer, more effective, and cost less than $1,000 to assemble. It remained in use through the 1970s.

However, while great strides were being made in cardiac surgery, these open-heart procedures were still only available in two places in the nation-Minneapolis and Rochester-and both in Minnesota. And by the 1950s, coronary heart disease had become a nation-wide problem, as had heart valve disease. So in 1956, the newly dedicated Sarasota Memorial Hospital opened its first cardiac care center.

Expanding the Possible: A National Health Crisis, A Surgical Solution, & Sarasota Memorial Steps Up

As the world of cardiac surgery began to evolve by leaps and bounds, so did Sarasota Memorial Hospital. Only two years after opening its first cardiac care center, SMH cut the ribbon on a $2-million expansion housing a state-of-the-art intensive care unit described in the press as the first of its kind south of Hartford, Connecticut. Unfortunately, in 1958, the state of the art still dictated a largely palliative approach to coronary heart disease and valve disorders, and the incidence of death due to heart disease would continue to rise.

This would finally begin to change in 1960, when an American surgeon named Albert Starr invented the first prosthetic valve (assisted by retired inventor M. Lowell Edwards) and developed the surgical procedure for its insertion. Within the year, he had performed the first successful mitral valve replacement. At the same time, surgeons in Canada, France and the Soviet Union were independently developing what would become coronary artery bypass surgery. Argentine surgeon René Favaloro would finally standardize the procedure in 1967, fundamentally changing the treatment of coronary heart disease.

These discoveries finally gave surgeons the tools they needed to turn the tide on a national health crisis and hospitals across the country mobilized to take advantage. Sarasota Memorial emerged at the forefront. Sarasota Memorial’s open-heart surgery team in action in 1983.

In 1974, SMH opened its Cardiac Intensive Care Unit, becoming one of the first general hospitals in the nation to provide that service, followed by the opening of a specialized cardiac care unit two years later. And in 1978, Sarasota Memorial doubled down with the creation of a cardiac rehab program and the opening of the region's first diagnostic cardiac catheterization laboratory, giving physicians accurate data in real time, so they can immediately determine the best course of treatment, whether that be a simple diet change or open-heart surgery. And with the purchase of its first CAT scanner in 1979, Sarasota Memorial began laying the groundwork to become a local leader in open-heart surgery.

As the 1980s rolled around, more than 200 patients were leaving Sarasota each year to receive open-heart surgery elsewhere. This would change in 1983, when Sarasota Memorial unveiled the area's first open-heart surgery unit. By 1984, surgeons at Sarasota Memorial had performed more than 550 open-heart surgeries, and patients traveled from cities in every direction to take advantage. A second open-heart surgery suite was swiftly added. Only eight years later, Sarasota Memorial would be known as one of the top 20 hospitals in the nation for open-heart surgery.

Sarasota Memorial’s Dr. Thomas Kelly practices with the Zeus robotic surgery system. At the same time, physicians at Sarasota Memorial were embracing new technologies that allowed patients to avoid open-heart surgery by using less invasive techniques. This included balloon angioplasty, wherein a physician uses a catheter to insert and inflate a small balloon inside a blocked artery and restore blood flow, and laser-assisted angioplasty. And in 1999, the same year that SMH was recognized as one of the top 20 hospitals in the nation for the number of open-heart surgeries performed, it also became only the second hospital in the nation approved to perform open-heart surgery with the Zeus robotic surgery system.

Ironically enough, Zeus would eventually lead to its replacement in 2006, the da Vinci robotic surgery system, which would usher in a new age of minimally invasive surgery, further reducing the need for open-heart procedures.

Today, the multi-disciplinary heart team at Sarasota Memorial includes cardiologists, interventional cardiologists, electrophysiologists, cardiac surgeons, thoracic surgeons, vascular surgeons, interventional radiologists, cardiac intensivists and other critical care specialists, as well as specially trained clinicians.

They work in state-of-the-art facilities, including operating rooms equipped with robotic surgery suites and catheterization suites, fully integrated electrophysiology suites offering the latest navigation and treatment technologies, a multidisciplinary valve clinic and structural heart clinic, and specialized outpatient disease management clinics to help patients manage risks related to congestive heart failure, stroke, diabetes and other chronic conditions.

And as new breakthroughs and discoveries are made, the SMH heart team remains on the forefront.

They pioneered the latest treatments for failing valves, including transcatheter aortic valve replacement (TAVR), transcatheter mitral valve replacement (TMVR), and more, making SMH the first hospital in Southwest Florida to earn TAVR certification from the American College of Cardiology, and among the first offering the newly FDA-approved transcatheter tricuspid valve replacements (TTVR), giving patients options where previously there were none.

SMH cardiac surgeons are utilizing the Florida Sleeve to offer faster, safer treatment options for potentially deadly aortic root aneurysms and aortic valve disorders, while SMH electrophysiologists are pioneering the use of different types of pulsed field ablation to treat patients with atrial fibrillation. And this year, the SMH cardiac/electrophysiology team was ranked #1 among the world's leading WATCHMAN programs protecting people with atrial fibrillation.

In 2024 alone, SMH participated in more than 30 cardiac-related studies and clinical trials.

It’s all part of the mission—and the promise—to deliver world-class care, close to home.

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