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CHAPTER 3 HEART SURGEONS REDEFINE CARDIAC PACING Reports of Paul Zoll’s success at resuscitating patients from standstill of the heart both encouraged others to experiment with cardiac pacing and freed them to do so. Within a few years, many physicians reported in print on their own experience either with the Electrodyne pacemaker or similar devices built for them. By the end of the decade, pioneer open-heart surgeons and a handful of tiny manufacturing firms had also interested themselves in cardiac pacing. These new participants began to reshape the pacemaker and redefine its uses. In the process, they drove pacing a considerable distance from what Paul Zoll had originally had in mind. Even at this early point in its history, ‘‘cardiac pacing’’ had a quicksilver quality. In the mid-1950s, the meaning of terms like pacing and pacemaker began to undergo a process of redefinition that is still under way. THE VARIETY CLUB HEART HOSPITAL Around 1956–58, the first open-heart surgeons decided that cardiac pacing might solve a hitherto unknown complication that they were encountering in their surgical cases. In adapting Zoll’s original idea to their needs, the surgeons invented a radically new version of acute cardiac pacing. The idea of implanting part of the pacemaker emerged first in the Department of Surgery at the University of Minnesota Medical School in Minneapolis. Events at Minnesota between 1944 to 1960 were typical of the kinds of changes underway in many academic medical centers.1 During the war, several surgeons at Minnesota had become interested in heart surgery and had learned new procedures developed elsewhere. By 1944, it was apparent that if Minnesota was to become a center for research in heart surgery and postoperative care, the medical school must build a larger and more modern hospital. A development campaign got under way in January 1945 when the Minneapolis chapter of the Variety Club, a service organization for people in the entertainment industry, offered to raise at least $150,000 toward a new heart hospital. With the announcement of the Blalock-Taussig HEART SURGEONS REDEFINE CARDIAC PACING 59 operation for improved blood oxygenation at Johns Hopkins in mid-1945, the campaign in Minnesota gained momentum. The Variety Club eventually raised more than $500,000, the university added $400,000, and the federal government provided $600,000 under the 1946 Hill-Burton Act for hospital construction. The University of Minnesota opened its Variety Club Heart Hospital in 1951—the first hospital in the United States set up to focus on acute care for heart disease.2 Owen Wangensteen, the chief of surgery at Minnesota from 1930 until 1967, trained not just surgeons but surgical researchers: he insisted that every academic surgeon pursue some program of research and that every surgical resident contribute as an apprentice investigator. One resident recalled that ‘‘everyone, all residents, had some kind of research project that they either were interested in or gave lip service to because of Dr. Wangensteen ’s influence. I mean, if you were going to get anywhere around that department, you had to have . . . some kind of research interest. And then you could get tremendous distances.’’ Norman Shumway, who later developed the heart-transplant program at Stanford University, remembered his residency at Minnesota in the same way: ‘‘We used to say . . . [that] you had to invent an operation to get on the operating schedule! And of course, that’s just what many of the staff members did.’’3 With the new hospital ready for patient care and with funding available for research from the American Heart Association and NIH, Wangensteen pressed his surgeons and trainees to transform the department into an important center for innovation in heart surgery. He understood that new surgical procedures would be possible only with the support of new technology . Surgery within the heart seemed tantalizingly close, but a major roadblock remained: finding some way to stop the heart from beating and clear it of blood while still keeping the patient alive. Efforts had been under way in the United States and elsewhere since the 1920s to build an artificial blood oxygenator, a machine that could maintain the circulation of blood through the surgical patient’s lungs to the organs of the body while bypassing the heart itself, but investigators had not reported much success.4 Looking for a way to put Minnesota’s program in heart surgery on the map, Wangensteen first threw his support behind a large project to build a...

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