Medtronic now has a traditional request of every patient who has
benefited from one of their devices, a sense of obligation to “pass it on” in
a meaningful way. Earl repeats this entreaty to me as our interview ends,
imploring me to, “Live on! Give on!”
In a sense, that is the purpose of this book, to illuminate the
contributions of the pioneers who have made modern life so less risky and
human existence so much more enjoyable. We all benefit from the
advances in medicine and surgery (as imperfect—even perilous—as it can
be), and for those whose lives have been enriched and lengthened, there is
a compulsion to “pay it forward.”
The story of the pacemaker, is, of course, only one small part of the
story of heart surgery. Prior to the heart-lung bypass machine, it was
unfathomable that any cardiac defect or heart valve surgery could be
considered. As noted earlier, it was the pioneering work of Minnesota
surgeons that opened the door to the heart, and over the course of the
1950s, defect closure and valve repair became predictable and effective.
The first forays into valve surgery were rapid-fire incursions in which
Mayo surgeons John Kirklin and Henry Ellis made small incisions in the
side of a beating heart, working blindly with a specialized knife attached
to the end of the surgeon’s finger. The device was repeatedly and
forcefully plunged into the diseased and constricted aortic valve.^15 The
sobering reality is that the mortality rate in those early days was 20
percent, and was somehow deemed acceptable.
Dr. Lillehei achieved much greater success (in nearby Minneapolis)
when he operated on diseased aortic and mitral valves while using a heart-
lung machine. Instead of operating on a beating, blood-filled heart,
Lillehei had the advantage of looking into the inner cavity of the heart and
attempted to partially resect tightened and diseased valves, or to repair
flimsy, incompetent valves.
The first artificial valve operations occurred in 1960, and with no
device clearance needed, there was a “dizzying pace of progress” among
cardiac surgeons in America.^16 The first valve replacement devices were
silicon-covered Lucite balls contained in a stainless steel cage; the ball
was designed to bob back-and-forth at the site of the resected valve.
Although blood clots, arrhythmias, and sudden death were always a risk,
lives were being saved and the quality of life for hundreds of patients was
dramatically improving. “Open-heart surgery had evolved from an