FIFTEEN
Surgery of the Heart
In 1896, Stephen Paget, a renowned British surgeon claimed, “Surgery of
the heart has probably reached the limits set by nature to all surgery; no
new method, and no new discovery, can overcome the natural difficulties
that attend a wound of the heart.”^1
The story of the first implantable cardiac device is typical of the
advancement of science and medicine, with early disappointment,
courageous explorations upon sacrificially willing patients, catastrophic
failure, renewed investigations, and eventual triumph by a small group of
investigators with almost pathological determination.
Electronics were, for decades, only utilized in cardiac medicine,
starting in the 1950s. Today, implantable electronic devices enjoy
widespread use in general surgery, urology, otolaryngology, neurosurgery,
orthopedics, and even gynecology. The story of their implantation is a
synthesis of improved surgical techniques, advanced anesthesia,
antibiotics, upgraded metallurgy, and modern electronics, and particularly,
the development of the transistor.
Even as surgical treatment of gastrointestinal and musculoskeletal
issues was improving in the 1930s, no one dared operate on the heart. Risk
of brain damage, sudden death, and failure of surgery was so grave that
surgery was simply untenable. In 1938, Robert Gross at the Boston
Children’s Hospital performed ligation of the ductus arteriosus—the small
artery that connects the pulmonary artery and the aorta in utero, helping
the fetus bypass the nonfunctioning lungs; it should spontaneously close in
the days following birth, but its ongoing patency is debilitating to an
infant.