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rofessor AE Freddie Wood, Cardiothoracic
Surgeon, RCSI Council Member and President of
the Medical Council, delivered the 49th Doolin
Memorial Lecture, entitled `The patient, the
surgeon and the regulator', which detailed the
development of cardiothoracic surgery in Ireland
over the last 50 years. In this extract, Professor Wood outlines
the history of cardiac surgery in Ireland, the development of
the National Cardiac Unit and the establishment of transplant
programmes, concluding with a look to the future and some
crucial questions about training and the European Working Time
Open-heart surgery was first performed in the US in September 1952
by Dr John F Lewis using in-flow occlusion and hypothermia. This
required the patient to be cooled in an ice bath to 30C, removed,
then operated upon. The surgical team had 10 minutes to complete
the operation on a beating heart if the patient was to survive without
brain or organ injury. After achieving his first success, Dr Lewis never
conducted another heart operation.
His colleague Dr Walt Lillehei (the father of open-heart surgery) used
cross-circulation (using the patient's mother or father with the same
blood group), to successfully close a hole in the heart (atrial septal
defect [ASD]) three weeks after Lewis. Over the next 18 months,
Lillehei successfully treated and operated upon patients with major
congenital heart conditions. After nearly losing one of his donor
patients, he turned to the use of the artificial heart lung machine, as
we know it today.
In Ireland, former RCSI President, Professor Eoin O'Malley, began
a successful series of ASDs in the Mater Misericordiae University
Hospital, using hypothermia and in-flow occlusion in the late 1950s.
Mr Keith Shaw and Professor O'Malley separately began using the
artificial heart-lung machine for valve replacement (rheumatic fever
was still rife) and correction of congenital defects.
In 1968/69, in an unprecedented move, the senior members of the
profession approached the then Minister of Health, with a proposal
to centralise expertise. This required extraordinary foresight, and
was to have a lasting effect on what was to be provided over the next
50 years. It was agreed by all that expertise would be centralised in
the Mater Hospital (it had a large school of nursing) and Mr Shaw,
with his heart-lung technical scientists, moved to the Mater to
operate. Thus, the National Cardiac Surgical Unit was created. The
Government invested 600,000 to build two new theatres specifically
for cardiac surgery and the unit was opened in 1971 with the
appointment of Mr Maurice Neligan. Children's open-heart surgery
was to be performed in the Mater and Our Lady's Children's Hospital,
Crumlin (OLCHC). It was decided, initially, to refine surgery and
surgical technique in the Mater before restarting open-heart surgery
in Crumlin.
In spring 1974, I assisted Mr Neligan in operating on a child with
an ASD, where the heart was opened and beating throughout while
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