Pioneers of Cardiac Surgery

Christiaan Barnard, MD, PhD

440 Pioneers of Cardiac Surgery Christiaan Barnard, MD, PhD (b. 1922) During my stay in Richmond, I heard that Dr. Richard Lower was doing heart transplants on dogs, and I went to the experimental lab to watch him do a cardiac transplant on a dog. — On how he became interested in cardiac transplantation Teleconference on September 15, 2000* I am often asked, “What are the ingredients for success?” My reply is that I think there are four. They are opportunity, imagination, ability, and the last one is luck. I have been fortunate to have a little bit of each, but I have been especially lucky in that I have had many opportunities, and I have had a lot of luck. Let me explain to you what I mean by this. Let’s take opportunity. Often when young surgeons from Europe or some other country are trained in the United States and they go back home, the head of the department finds it very difficult to give them opportunities to explore what they have learned and what they can do. Usually the head of the department wants to be the one to do the heart surgery. I have seen this happen in many parts of Europe and it has really retarded programs of heart surgery, this attitude of the head of the department. I was fortunate that my head was Professor Louw, and when I returned from Minneapolis in 1958 I said to him, “Professor Louw, we can do the heart surgery together,” and he said, “No, no, I am not going to do it. You have been trained to do heart surgery; you go ahead.” He gave me all the opportunities to explore certain aspects of heart surgery in the laboratory, and then when I thought I was ready, he approved our clinical program, so I have had ample opportunities to do what I had learned in Minneapolis in Dr. Wangensteen’s department. As far as luck is concerned, my whole career has been guided by unexplained and unexpected events. I will give you a few examples. I was studying general surgery at the University of Cape Town in 1957. I came back from lunch and I bumped into Professor John Brock in the parking lot. He said to me, “I have just come back from Minneapolis . I met Professor Wangensteen and he was very impressed by the training of South African doctors.” He was referring to Alan Thal. He told me that Professor Wangensteen said that he would like to have another South African surgeon in his training program , and he asked me if I would like to go to Minneapolis and train there. I didn’t even know where Minneapolis was, since I knew so very little about the United States, but I went home that night and talked with my wife, Louwtjie, and we decided we would go. It was so fortunate that I went there because, as you know, it was one of the first centers in the world where open-heart surgery was developed. At first, after I arrived in Minnesota , I was doing general surgery, working in the laboratory on intestinal atresia. One day I walked past an open door and saw some- * Reprinted from a talk given by Dr. Barnard at Foxwood , Connecticut, on September 15, 2000. Used with the permission of John A. Elefteriades, MD, and the Yale University School of Medicine. Transplant—Artificial Heart 441 body working at the operating table. It was Vince Gott. He looked up and asked, “Have you something else to do right now?” I said, “No.” He asked that I scrub and give him a hand. I scrubbed immediately and helped him as best I could. He was working with the heart-lung machine, using a bubble oxygenator , and for the first time I saw what extracorporeal circulation could do. One could exclude the heart and the lungs from the circulation and work inside the heart. I was immediately fascinated by this and decided that this was the direction that I would like to take. I went to see Professor Wangensteen and told him that I wanted to give up my work in general surgery and change over to cardiac surgery. He was not very happy with this but eventually allowed me to change. I was very fortunate to work with Dr. C. Walton Lillehei and his associates for the next few months, and also to learn how to run the heart-lung machine. Eventually I...