C. Walton Lillehei, MD, PhD: a father of open-heart surgery

Abstract

The challenge of performing heart surgery has both fascinated and intimidated surgeons. At the end of the 19th century, leaders in surgery and medicine pronounced that surgeons who tried to suture the heart would lose the respect of their colleagues and that no method or discovery could alter the problems associated with repair of the heart (Theodor Bilroth, 1883, and Stephen Paget, 1896). With the gauntlet laid down, the combined dictums fell to the successful repair of a cardiac injury in 1896 by Ludwig Rehn. However, the problems of elective operations within the heart remained a challenge for another half a century. The ultimate successes of a number of pioneers opened wide a new era in open-heart surgery, enabling corrections of both congenital and acquired heart defects. A giant among those giants was C. Walton Lillehei. Clarence Walton Lillehei was born in Edina, Minnesota, on October 23, 1918. His father was a dentist, and his mother was a professional pianist. C. Walton was the eldest of 3 sons. He had such dexterous skill that he reportedly built a motorcycle from spare parts and took apart and reassembled the engine of a Model T Ford without the assistance of an instruction manual. Despite skipping 2 years of elementary school, Lillehei was, at best, a mediocre student in high school. He nearly failed chemistry. Some of his instructors predicted poor college performance. Yet, after entering the University of Minnesota in the fall of 1935, he graduated in 1939 with distinction and went on to the University of Minnesota Medical School. There, Lillehei excelled academically, with the exception of 3 C’s, including 1, ironically, in his surgery clerkship. Throughout his college and medical school career, Lillehei adopted the motto “Work hard, play hard,” a philosophy to which he adhered throughout the rest of his life. Lillehei was a second-year medical student when he met Dr. Owen H. Wangensteen, the young chief of surgery with a passion for research and experimentation. Medical school education was accelerated during World War II, and by 1942, Lillehei graduated with both a medical degree and a master’s degree in physiology. After completing his internship, he began military service as a first lieutenant in the Army Medical Corps and was sent to Europe. By the time he returned in 1945, he was a lieutenant colonel and had received the Bronze Star for “Meritorious Services in Support of Combat Operations” in Anzio, Italy. After making but 1 application to surgical residency—the University of Minnesota, under Wangensteen—Lillehei began his formal surgical training in 1946. During the next few years, Lillehei met and worked with Dr. Richard Varco, the department’s closed-heart specialist (Figure 1). Lillehei recognized the difficulties, limitations, and excitement of operating on the closed, beating heart, but before he was able to pursue his interest, his life and career took an unexpected turn. In late 1949 Lillehei noted a small mass just anterior to his left ear that he presumed to be harmless and benign. He put off its excision until February 1950. Dr. David State removed it along with a portion of the parotid gland. Wangensteen and State were shocked with the final pathology report—lymphosarcoma. Incredulous, Wangensteen had the specimen evaluated at 4 other institutions, but all the “second opinions” concurred. Wangensteen finally disclosed this information to Lillehei after about 4 months’ delay. The prognosis for lymphosarcoma was dismal in those pre-chemotherapy days, and perhaps somewhat in desperation, Lillehei agreed to undergo further resection by Wangensteen. After a radical transmediastinal