Heartfelt Thanks

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"Leland C. Clark and Frank Gollan: Bubble Oxygenators and Perfusion Hypothermia" by Robert S. Litwak, in Annals of American Thoracic Surgery (Aug. 2002), Elsevier Science, P.O. Box 945, New York, N.Y. 10159–0945.

Hundreds of thousands of people around the world have a special anniversary to mark next year: the debut in 1953 of the basic heart-lung machine used in open-heart surgery. Every year, some 750,000 Americans undergo such surgery, from relatively routine bypasses to more complex procedures; without it, virtually all would die. (Even so, heart disease remains the number one cause of death in the United States.)

Litwak, a professor of cardiothoracic surgery at Mount Sinai Medical Center in New York, is careful to note that the machine’s makers stood on the shoulders of others. Still, the efforts of Leland C. Clark, head of the biochemistry department at Antioch College’s Fels research institute, and physician-investigator Frank Gollan were seminal: Much of their "technical and conceptual" work "is being used today."

The basic task of a heart-lung machine is to oxygenate and circulate the patient’s blood while the heart is stopped during surgery. The design that Clark and Gollan pioneered, the "bubble oxygenator," called for exposing the patient’s venous blood to oxygen forced under pressure through a porous disk. But the process created bubbles that had to be eliminated before the blood could be returned to the patient’s body, a problem that defied solution. A key to Clark and Gollan’s success was their decision to pass the oxygenated blood through a chamber containing glass beads coated with a new "defoaming" resin created by Dow Corning Laboratories. The first use of such a machine came in 1953. Only 14 years later, Christiaan Barnard, a U.S.-trained physician in South Africa, performed the first human heart transplant.

A second feature of heart-lung machines is their ability to cool the body and reduce its need (especially the brain’s need) for oxygen. Normal body temperature is 37.5º C; most ordinary bypass operations are conducted at a body temperature of 30–32º C, but more serious procedures, such as the replacement of the aortic arch, can require temperatures down to 12º C. Surgeons had resorted, without much success, to ice packs and other techniques; Clark helped pioneer methods that allowed heart-lung machines to pass the blood through a heat exchanger, similar in concept to a car radiator (the first one actually was built by a manufacturer of auto radiators).

For all the tedious labor of research, great passions were at work. Addressing a new generation of heart researchers, Gollan once quoted the 1859 words of Antioch College president Horace Mann: "Be ashamed to die until you have won some victory for humanity."

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