The term “Golden Age” seemed to permeate multiple domains in the 1950s, almost to the point of triteness. The field of cardiac surgery, however, deservedly earned the term as pioneer after pioneer introduced innovation after innovation that advanced the specialty. Walter Lillehei in Minnesotta, Wilfred Gordon Bigelow in Toronto, William Chardack in Buffalo, and Ake Senning in Stockholm were just some of the trailblazers of that era.
The four surgeons also shared something else in common: They all worked closely in partnership with gifted engineers/inventors. The relationships were almost informal — even when the engineers were employed by their companies and were providing a service to the hospital — as they collaborated on creating devices and techniques to make open heart surgery possible. Lillehei worked with Earl Bakken who ran an electronics and TV repair shop out of his garage, Bigelow partnered with John Hopps of the National Research Council of Canada, Chardack collaborated with inventor Wilson Greatbatch, and Senning relied on Rune Elmquist of Jahrns-Elektriska and Elema-Schonander.
The pairs worked throughout the fifties on developing the pacemaker. Bigelow and Hopps designed an external cardiac pacemaker-defibrillator as an essential tool used in conjunction with their experiments on hypothermia during cardiac surgery. Lillehei asked Bakken, who at the time was repairing hospital equipment and fashioning customized electronics for the doctors, to create a portable pacemaker for post-cardiac surgery patients who developed heart blocks. The external pacemakers at the time were bulky machines on rolling trollies, and relied on AC power. Patients were tethered to the machines making a stroll down the hallway an exercise in logistics. They were in constant threat of electrocution or pacemaker failure if the power went out. In fact, the 1957 Halloween blackout in Minnesota prompted Lillehei to ask Bakken for a portable version.
Senning had visited Lillehei in 1957 and was aware of the external pacemakers. Senning’s main concern was that the transcutaneous leads always got infected. He realized that implanting the entire pacemaker was the next logical step. In 1958, Senning and Elmquist were still studying portable versions on dogs when a desperate wife pleaded with Senning and Elmquist to save her husband who was dying from severe heart block. Elmquist assembled the first implantable pacemaker within two weeks, and Senning attached the device to the dying man’s heart on October 8, 1958. Chardack in New York was not aware of the Stockholm experience when he and Greatbatch were working on their implantable version. Chardack implanted their first pacemaker in 1959.
The path from invention to clinical application was short in those days. In some instances there were hardly any testing before the medical devices were used on patients — often in dire situations where no other alternatives existed. I asked Dr. Lars Ryden, pioneer Swedish cardiologist and professor emeritus at the Karolinska Institute regarding the current state of innovation and relationships between physicians and medical technology companies. He said times are more difficult now, and the relationship between physician-researchers and technical companies are not as well established, limited by more formalities and restrictions. He thought that companies are more interested in what may be marketable rather than doing research for its own sake. He believes this hampers progress when studies are stopped without a sound scientific reason, and that study protocols are influenced more by marketing considerations rather than scientific merit.
Rod Tanchanco is an internal medicine physician and a writer. He blogs at Tales in Medicine and can be reached on Twitter @rodtmd.
