King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery (review)

G. Wayne Miller. King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery. New York: Times Books, 2000. xv + 302 pp. Ill. $U.S. 25.00; $Can. 38.00.

It is generally agreed that one of the great medical achievements of this past century was the development of safe open-heart surgery. The distinguished Viennese surgeon Theodore Billroth had stated in 1883 that "a surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues." ¹ Even as recently as 1953, Billroth's admonition seemed to have a ring of truth. John Gibbon of Jefferson Medical College in Philadelphia had worked for almost twenty years to develop a safe, functional heart-lung machine. After one unsuccessful operation in 1953, he successfully corrected an atrial septal defect using his heart-lung machine in a fifteen-year-old girl. Tragically, Gibbon's next four patients did not survive surgery, and he was so despondent that he never again attempted open-heart surgery.

The pervasive feeling among thoracic surgeons and cardiologists in 1953 was that patients surviving open-heart surgery would require support on the heart-lung machine for at least a week because of the presumed "sick heart syndrome." This, then, was the general feeling in the spring of 1954 when C. Walton Lillehei stunned the medical world with his successful repair of a ventricular septal defect in a three-year-old girl using the girl's parent as a living heart-lung machine. With this technique of cross-circulation, Lillehei carried out total correction of ventricular septal defect, tetralogy of Fallot, and atrio-ventricular canal in forty-five infants and young children; remarkably, two-thirds of these patients survived.

G. Wayne Miller does an exceptional job of describing the pioneering groundwork of Gross, Bailey, Harken, Lewis, and Gibbon leading up to Lillehei's monumental achievement. He then carefully details the remarkable successes and extremely discouraging failures that occurred during the fourteen-month period in the mid-1950s when Lillehei was the only surgeon in the world performing open-heart surgery. The era of Lillehei's cross-circulation ended in May 1955 when one of his residents, Dr. Richard DeWall, made a major breakthrough: the development of a safe, simple bubble oxygenator using disposable plastic tubing. The same surgeons who had come to watch Lillehei do cross-circulation returned to Minneapolis in 1955 to watch him repair these complicated defects using DeWall's bubble oxygenator. Most of these surgeons returned to their hospitals with DeWall's oxygenator and commenced their own open-heart programs. Within a very few years there were hundreds of open-heart programs around the world, all utilizing the bubble oxygenator and the new techniques they had first seen at the University of Minnesota Hospital. I had the privilege of participating as an intern on Lillehei's first cross-circulation case and then spending eighteen months in his cardiac research laboratory.

The depth and extent of Miller's research for this very complex story are impressive. He interviewed hundreds of individuals, including patients and their family members, members of Lillehei's surgical and research team, and cardiac surgeons from around the world. Most important, he had extensive discussions with Dr. Lillehei. It is surprising that for a topic as important as the development of open-heart surgery, there has been a paucity of books written for the general public. Miller's is assuredly the best to date. In addition to documenting Lillehei's remarkable achievements, he thoroughly covers the surgical events leading up to cross-circulation. He also describes, in excellent detail, subsequent landmark achievements such as heart transplantation and the development of the cardiac pacemaker.

The title of Miller's book hints that Lillehei, like many other "scientific groundbreakers," had personal traits and frailties that set him apart from...