Pioneers of Cardiac Surgery

Francis Robicsek, MD, PhD

316 Pioneers of Cardiac Surgery Francis Robicsek, MD, PhD (b. 1925) The use of muscle flaps has greatly reduced the mortality of sternal wound infections. The surgeons who first described the use of muscle flaps should get the Nobel Prize, and every cardiac surgeon should mention their names in evening prayer. — On sternal wound infection Interviewed April 19, 1999 When I talk about my life, I have to be a little bit schizophrenic. This is because my life has been divided into four segments: one, before the war in Hungary; two, during the war in Hungary; three, after the war in Hungary ; and four, finally in the United States. Each segment somehow has very little to do with the others. I have the feeling that I have had four lives, and I hope that I am like a cat and have a few more left. I was born in a small town in Hungary in 1925. My father was a Shell Oil executive and my mother was an English teacher; she was educated at Oxford. Early in my life we moved to Budapest, and it was there that I went to medical school. In Europe, as you know, students finish high school and then go directly to medical school. I guess this is true in every country except the United States. Anyway, I received my MD degree at age twenty-two and my PhD at age twentyfour . By the time I was twenty-eight, I was an associate professor in charge of cardiac surgery at the University of Budapest. This was not because I was that smart, but because we grew up faster. Cardiac surgery was just beginning, and I was just beginning also. I happened to be at the right place at the right time. We were doing only closed procedures, but there was an inexhaustible supply of patients with rheumatic heart disease, and so we did two or three mitral commissurotomies a day. We did coarctation repair using French-eye needles, which was very interesting . We did Blalock-Taussig shunts and, of course, repaired patent ductus. In 1955 I went to Sweden and spent some time at the Karolinska Institute in Stockholm. I watched Ake Senning do his second open-heart operation using a pumpoxygenator , a left ventricular aneurysm repair. Their heart-lung machine looked like a little washing machine and the oxygenator had rotating discs. Clarence Crafoord was the chief and he had with him Viking Björk and Ake Senning; they hated each other. Björk wouldn’t let Senning in the research lab and Senning wouldn’t let Björk in the operating room. Crafoord was just leaning back and laughing at both of them; it was an interesting time. I went back to Hungary and built my own heart-lung machine. It was an interesting contraption made mostly of glass. We used a bacterial filter for the oxygen and this turned the blood into foam, which overflowed like the magic porridge in the children’s fairy tale. To everyone’s horror, it almost filled the room. I began doing heart surgery, if you could call it heart surgery, Valvular Heart Surgery 317 without much experience. I had books and journals and had had a brief trip to Sweden. When I went to Sweden in 1955, I saw what was outside of Hungary, and I decided then and there that I would get the hell out of Hungary. In 1956 I received an invitation to move to East Germany. All of the surgeons in East Germany had fled to the West, and they wanted someone who was versatile in cardiac surgery. They asked me to establish a cardiac surgery unit in a university in East Germany, but the Hungarian Revolution broke out and all travel came to a halt. When the Russian troops came back into Hungary, I told my wife, “That’s enough. We are leaving.” We packed up; my wife was six months pregnant. I had papers to get us as far as East Germany, and we crossed over into Berlin. My East German friends told us to take the subway and as soon as we saw a Life magazine in the newsstand to get off, and we would be in West Berlin. From there we went to West Germany and on to the United States. I had some of my publications, but we left almost everything else behind. When we first reached West Berlin, I decided that I was not going to...