"One of the unsung heroes of cardiac surgery of the twentieth century"Lillehei the Educator
Dr. C. Walton Lillehei died at his home in St. Paul, Minnesota on July 5, 1999. He was 80 years old and the cause of death was cancer.
Dr. Lillehei is generally considered as the individual who initiated the whole field of open heart surgery with his landmark intraventricular operations in 1954 and 1955. Dr. John F. Lewis had closed simple atrial septal defects using immersion hypothermia in 1952 and Dr. John H. Gibbon, Jr. had successfully repaired an atrial septal defect in 1953 in one patient using a screen oxygenator. Progress in open heart surgery was totally stalled following Gibbon's successful operation by repeated failures with pump oxygenators and by the widespread acceptance of the "sick human heart" theory. Most authorities at the time felt that open heart surgery would be impossible without an artificial heart to support postoperative recovery. This then was the atmosphere of despair existing when cross-circulation so startled the medical world by repeated successes in very sick patients with complex intraventricular lesions. These successes with cross-circulation, as developed by C. Walton Lillehei, virtually overnight changed widespread pessimism to one of optimism for the future of open heart surgery. Dr. Lillehei and his team first repaired a ventricular septal defect at the University of Minnesota on March 26, 1954.
First cross-circulation case to repair ventricular septal defect March 26, 1954 - University of Minnesota Hospital, Minneapolis, Minnesota. Dr. Lillehei is on patient's left with headlight, Dr. Richard Varco is first assistant across table. Arterial and venous cannulae from father's groin seen on right.
During the next fifteen months, 45 patient with major intracardiac malformations, not previously correctable, underwent repair utilizing cross-circulation between the patient and parent. These first successful operations by Dr. Lillehei for complicated intracardiac congenital defects initiated the whole field of open heart surgery as we know it today.
Because Dr. Lillehei was the only surgeon in the world operating on these complicated intracardiac defects using cross-circulation, he was able to use the opportunity to develop many other new techniques and devices to permit a more successful outcome for these patients. Heart block was a major cause of death in the initial patients undergoing repair of ventricular septal defects; Dr. Lillehei then developed a technique of direct myocardial stimulation with an external pacemaker and a myocardial electrode. The first human use of this pacemaker system by Dr. Lillehei occurred on January 10, 1957 at the University of Minnesota Hospital. Dr. Lillehei also initiated research on the use of a small portable external pacemaker for these patients with heart block. This ultimately led to the development of the billion-dollar pacemaker industry. Working with Dr. Richard A. DeWall, Dr. Lillehei developed the first clinically successful bubble oxygenator which supplanted the use of cross-circulation in 1955. The availability of the simple Lillehei-DeWall oxygenator allowed for tremendous growth of open heart surgical programs the world over.
With the early availability of the Lillehei-DeWall oxygenator, Dr. Lillehei pioneered the surgical management of acquired valvular heart disease. For the first time, regurgitant valves could be repaired and stenotic lesions could be opened more completely and precisely. At the same time, diseased valves that defied reconstruction were encountered that stimulated laboratory research to invent artificial valve replacements. There have been several mechanical heart valves designed and developed in Dr. Lillehei's laboratory that have been commercially manufactured for clinical use. These include the Lillehei-Kaster pivoting disk valve and the Kalke-Lillehei bileaflet cardiac valve that was the forerunner of the St. Jude valve.
Dr. Lillehei expanded his contributions to medical science with the training of 134 cardiothoracic surgeons at the University of Minnesota Hospital and an additional 20 surgeons at the Cornell Medical Center. Trainees came from all areas of the world and included Dr. Norman Shumway who later devised the surgical technique for heart transplant operation, Dr. Christian Barnard who performed the first successful heart transplant operation in 1967 and Dr. Richard DeWall with whom Dr. Lillehei developed the simplified heart-lung machine based on bubble oxygenation. Twenty-three of the 154 surgeons that Dr. Lillehei trained became program directors of cardiothoracic programs and, in turn, trained 477 additional surgeons. As of 1988, a total of at least 820 cardiothoracic surgeons residing in 36 countries could trace their preceptoral lineage back to Dr. Lillehei. Very likely several hundred more surgeons around the world can now, 11 years later, trace their training lineage back to Dr. Lillehei.
Dr. Lillehei's many achievements have been recognized with numerous international awards and honors. Foremost among these honors was the Lasker Award in 1955 for "Outstanding Contributions to Cardiac Surgery." Dr. Lillehei shared this award with Drs. Richard Varco, Morley Cohen, and Herbert Warden. Other outstanding achievements (among 90 major awards) include the Harvey Prize in Science and Technology awarded by Technion in Israel in 1996 and the Hektoen Gold Medal of the American Medical Association in 1957 for his contributions to "Direct Vision Intracardiac Surgery." Dr. Lillehei was also the only living surgeon to be recognized by a festschrift issue of the Journal of Thoracic and Cardiovascular Surgery. This special festschrift issue published in November 1989 contained scientific papers presented on the occasion of his 70th birthday in October 1988. Also at that time, his former students and associates established the C. Walton and Richard C. Lillehei Professorship in Cardiovascular Surgery at the University of Minnesota.
Dr. Lillehei was a member of 45 scientific societies and was president of the American College of Cardiology. He also held an honorary membership in 33 foreign societies and honorary doctorates in five international universities. Dr. Lillehei had been nominated for the Nobel Prize in Medicine on several occasions.
Dr. Lillehei was born in Minneapolis on October 23, 1918, attended West High School in Minneapolis, and graduated from the University of Minnesota in 1939 with distinction. He graduated from the University of Minnesota Medical School in 1942 and received his Ph.D. in Surgery from the University of Minnesota Graduate School in 1951. He served in the U.S. Army between June 1942 and February 1946, entering the service as a 1st lieutenant and departing as a lieutenant colonel. He served in the African and Italian theaters and received the Bronze Star for "Meritorious Services in Support of Combat Operations" in Anzio, Italy. Dr. Lillehei completed his surgical training under Dr. Owen H. Wangensteen at the University of Minnesota and became a clinical instructor in the Department of Surgery at the University of Minnesota Medical School in July 1951. He became a professor in the Department of Surgery, University of Minnesota Medical School in June 1956 and then, in November 1967, was appointed as the Lewis Atterbury Stimson Professor of Surgery and Chairman, Department of Surgery, The New York Hospital - Cornell Medical Center, a position he held until 1974. He returned to Minnesota and was appointed as clinical Professor in the Department of Surgery, University of Minnesota Hospital in 1986. In 1970, he was appointed as Director of Medical Affairs for St. Jude Medical, Incorporated, a position he held until his death.
Dr. Lillehei was honored last October with an 80th Birthday Festschrift in Minneapolis. At that time, many of Dr. Lillehei's trainees, colleagues, friends, along with family gathered to pay tribute to the man who had impacted their lives to such a great extent. The scientific papers presented at the Lillehei 80th will be published later this year in a special issue of The Annals of Thoracic Surgery.
Dr. Lillehei is survived by his wife of 52 years, Kaye Lindberg Lillehei; a daughter, Kimberle Loken of Duluth, Minnesota; two sons, Dr. Craig Walton Lillehei, Assistant Professor of Pediatric Surgery at Boston Children's Hospital, and Dr. Kevin Owen Lillehei, Associate Professor of Neurosurgery at the University of Colorado; and a brother, Dr. James P. Lillehei, retired internist of Mendota Heights, Minnesota. A memorial service is scheduled for Dr. Lillehei in the Twin Cities on August 5, 1999, time and place to be decided.
Dr. Lillehei was truly a "surgical giant" of the 20th century - he will be greatly missed by his family, friends, colleagues and trainees. Thousands of cardiac surgeons the world over are indebted to Dr. Lillehei for his monumental contributions; also the millions of patients around the world with implantable pacemakers and artificial valves can thank Dr. Lillehei for these same contributions. Denton Cooley said it best when he stated in his discussion of Dr. Lillehei's Chamberlain Award paper at the 1985 S.T.S. meeting - "Walt, you provided the can-opener for the biggest picnic cardiac surgeons have ever known."
