Blood and Guts: A History of Surgery (2008) s01e02 Episode Script
Bleeding Hearts
This programme contains some scenes which some viewers may find upsetting.
This is a real human body, beautifully dissected to show the arteries and veins.
In fact, each one of us has nearly 75,000 miles of blood vessels in our bodies.
That's enough to go round the world three times.
And at the centre, the pump, the force that is driving it all.
The heart.
The heart possesses a mystique, a romance that sets it apart from every other organ.
This deference helped make heart surgery an extremely dangerous procedure.
Not just for the patient Suddenly, catastrophe struck.
And we could see the blood beginning to froth, bubbles forming and starting to go towards the top of the lung.
.
.
but also for any surgeon prepared to operate on it.
One received almost daily death threats.
I had to have police escorts to take my children to school.
I've traced the cardiac surgery's journey, from the daring but deadly early operations to today.
Cardiac surgery at the extreme.
Sophie has no heartbeat.
Her brain trace is almost completely flat.
She has virtually no blood in her body, and she is now as cold as a corpse.
How are you feeling this morning? I've met a man whose heart flatlines.
And I'm going to repeat some classic experiments on myself.
Jeez! Jeez! What I need to know, Jin, is where do the vessels to the head come off? Cardiac surgeon Stephen Westaby is about to perform one of the most astonishing operations I have ever seen.
What you're gonna see is a patient who is put on a bypass machine, cooled down to 18 degrees, the circulation is stopped and all the blood emptied out of the body, so we can do a careful and very structured operation on the heart.
How extraordinary.
You're actually going to empty all the blood out of her system? Yes.
That opens all the blood vessels up, so that I can see from the inside and work on them and be very precise.
So you're a bit like a plumber? Yeah, I think certainly heart surgeons are plumbers.
You have to get the blood out of the way in the same way as you have to switch the water off before you change the pipes.
Right.
While attempting to mend his patient's heart, Stephen Westaby will effectively be operating on a bloodless, lifeless body.
Who's that? His patient is 34-year-old Sophie Clarke.
She was born with multiple life-threatening heart defects.
She's gonna be having an operation soon.
Sophie looks so well, it's hard to believe her life hangs in the balance.
Do you want to take that with Daddy? Hello.
Hello.
How are you feeling? Very, very nervous.
I haven't slept very much at all last night.
I'm not at all surprised.
No.
These electrodes will monitor Sophie's brain activity while she lies chilled and bloodless on the operating table.
Do you get sort of periods of blankness? I get dizziness.
I've had lots of the heart symptoms.
Palpitations, sweating, pain on exertion.
After that, I've also had neurological symptoms.
I've had slurring of speech and co-ordination problems and muscle control problems.
I mean, you look extraordinarily well on it, is all I can say, you know.
It's the make-up.
So what does your son think about all this? I don't know how much of it he really understands.
My husband's been trying to explain to him that Mummy will be away for a little while.
They've said it could be a week.
So I've just been trying to make the most of this last bit of time this morning.
Getting lots of cuddles.
The walls of Sophie's main artery, her aorta, are weak and could burst at any time.
The operation to replace it is complex and risky.
Bye-bye, Mummy.
Give Mummy a kiss.
See you in a few hours.
Love you, babe.
See you in a few hours, all right? Soon they will chill her, stop her heart, drain her blood.
They will be taking Sophie to the edge of what the human body can survive.
So how did cardiac surgeons master the elements that make up this drastic and dramatic procedure? This is the Royal College of Surgeons.
If these books could talk, they would tell of the glorious history of surgery.
Of heroic surgeons who performed delicate, life-saving operations on the heart.
Or not.
They tried but they failed.
And some of them took it extremely badly.
One man, in 1881, having killed a patient on the operating table, shot himself in the head two days later.
No-one else dared touch the heart.
Then along came Stephen Paget.
In 1896, Paget wrote an acclaimed textbook on surgery of the chest.
But some of his statements were, well, less than accurate.
He firmly declared that heart surgery had "reached the limits set by nature".
It's a case of famous last words, because just one year later, a German surgeon called Ludwig Rehn did actually successfully operate on a young man who had been stabbed in the heart.
It is the first case we know of of somebody whose heart is operated on who actually survives.
But Rehn didn't dare try it again.
And others who did often wished they hadn't.
Whether they were trying to repair hearts damaged by the sword or the bullet, their patients almost always died.
Surgeons became dispirited, almost paralysed with the fear of failure.
For decades they made fantastically little progress.
Why? How hard can operating on the heart really be? Hello there, Jonathan.
Hello, Michael.
Yes, how do you do? 'Jonathan Hyde trains cardiac surgeons.
'Today he has created a bullet wound for me to repair.
' I've lodged a foreign object deep within the ventricle.
And you're going to try to get it out.
OK.
'After I've done that, I'll have to sew up the hole.
'I'm operating on a pig heart, which is almost identical in structure to a human one.
'To make it more realistic, this pig heart is rigged up to a pressurised container of blood.
' The urgency of the situation is all related to how fast the blood loss is.
OK.
We'll give it a go.
I'm not wildly confident about this, I have to say.
OK.
Any other questions? Um, millions, but I don't imagine any of them I must admit I'm quite nervous.
Well, I have a stopwatch here.
On your marks, get set, go! OK, pig.
I'm just going to try and unlodge it.
Oh, nice it's beginning to bleed.
That is a catastrophic haemorrhage now.
They're dead, are they? That size jet would be enough to kill the patient within minutes.
'The heart pumps over five litres of blood a minute, 'which makes cardiac surgery a particularly messy business.
' I've managed to get it out, there we go.
Quite a big bit.
I've got an enormous hole.
You should have your finger on the hole.
So I'm trying to stitch while .
.
While blood's coming out of the heart.
'In a lifetime, the human heart pumps enough blood to fill a football stadium.
' Can you put your finger in the hole? I can.
And at that end.
That would be even better, thank you.
Marvellous.
With that amount of bleeding, there's no way of keeping up with that.
No, that would cause death.
Oh, my heart's going, I have to say This is one hell of a hole.
Anyway, your time is running down, you've had two-and-a-half minutes.
Ah, God, I just stabbed myself! You can use forceps if you wish.
I don't really have time for forceps at the moment.
OK, now I just need to relax.
I can feel my hand shaking, as the adrenaline goes shooting through.
So you're in a bad situation.
The amount of blood and that size of a hole, the heart has almost certainly stopped.
That was a real buzz, and I can still feel the adrenaline going through me.
I also understand now just why it was that surgeons found the heart so difficult to operate on.
I think it's probably time to go and get cleaned up.
For many years, heart surgery remained more fatal than useful.
And the heart remained feared and sacrosanct.
An organ of mystery and reverence.
As the 20th century unfolded, Einstein came up with the theory of relativity.
The television was invented.
And the world went to war.
Again.
MUSIC: "In The Mood" by Glenn Miller and his Orchestra By the early 1940s, surgeons were routinely operating on almost every organ in the body, from the bowels to the brain.
But the heart remained feared and untouchable.
In 1944, a young, tempestuous American was about to make surgical history in a field, near here, in southwest England.
Dwight Harken was dynamic, ambitious.
He thrived in the upheaval of war.
All sorts of horrific casualties came back from the front.
Army surgeons did what they could in often primitive settings.
But there was one group of men they would not operate on.
Those with shrapnel in their hearts.
The conventional wisdom was that you left shrapnel in place because the risks of operating were far too great.
But Harken didn't believe in conventional wisdom.
35-year-old Harken really couldn't see what the fuss was about.
Shrapnel was plainly a surgical problem so he would attack it surgically.
What I find interesting is that Harken wasn't driven to do this by any great new surgical innovation or any great insight he had.
He simply did it because he couldn't see a reason not to do it.
He had what many great surgeons have, the courage to fail.
I'm meeting Dwight Harken's son, Alden, a cardiac surgeon from California.
Hello there.
Hello, good morning.
Nice to see you.
Hop in.
I hope you've dressed up warm.
There may be a horrible clashing of gears.
GEARBOX CRUNCHES There it is! 'I'm taking him to the site of a Second World War field hospital.
' So this is where your dad was operating way back in 1944.
It is remarkable.
It's a thrill for me to see this.
And you still can see some old remnants of foundations.
'After more than 60 years, only one of the huts remains standing.
' I think just through the trees here you can see Oh, there it is.
Isn't that amazing? That is remarkable.
Dwight Harken spent months experimenting on animals.
The night before his first attempt to do heart surgery on a soldier, he wrote nervously to his wife.
He said, "If I succeed, we will have developed the future of cardiac surgery.
"If I fail, my career and our lives are over.
" So it had to be a terrifying experience.
Harken had the foresight to film one of his operations.
This footage is a remarkable record of a ground-breaking chapter in cardiac surgery.
Here we make incisions through the pericardium and the myocardium.
When you make an incision in a high pressure chamber, blood shoots out.
It's just like puncturing a water balloon.
A huge amount of blood or water just comes shooting out.
While the patient's blood was gushing out, Harken tried to find the metal fragment.
He knew the bullet was inside the heart, but of course he couldn't see it.
He then takes a clamp, blind, and fishes around inside this ventricle with blood shooting out, and grabs the bullet.
We grasped over and over.
The missile entwined and entangled in the chordae tendineae.
The first time he pulled it out, he dislodged it at the edge of the heart.
Darn! Second time, third time, fourth time.
Again it escapes.
Finally, Harken got a firm hold of the fragment, and it popped out like a champagne cork.
There it is, and the missile goes out in the left upper corner.
By now, the patient had lost copious amounts of blood and needed a massive transfusion.
But if you just drip the blood in, it doesn't go in fast enough.
So they had big blood bags and these glass bottles.
So they put little tubes up in the top of these glass bottles, pump high pressure into the top of the bottles.
Then they'd clamp the tubes, and as soon as they needed the blood, they'd take the clamps off.
The problem is, every once in a while they'd get too much pressure in the top of the blood and the glass bottle would explode with bloody glass all over the operating room.
The first 14 I operated on all died.
The second, seven of the 14 died.
The third, two of the 14 died.
I was getting better.
But the fourth 14 all survived.
And the only difference between these first three groups and the fourth group was that these were all animals and the 14 in the final group were all American soldiers, and they all survived.
Harken had broken the taboo.
He had proved that the heart could in fact be operated on.
He went on to perform this operation on more than 130 soldiers, and every one survived.
Were you proud of your dad? Tremendously proud, tremendously proud.
And actually I was more proud when I saw him do some of the operations and saw the gratitude of the patients.
They couldn't breathe before the operation because their lungs filled up with fluid, and after the operation, he would, with great ceremony, he had a lot of PT Barnum in him, march them out to the bottom of a set of stairs.
And he'd say, "Walk up those stairs," and they'd say "I can't.
" And he'd say, "No, go ahead.
" And they would walk up the stairs, and at the top, they just routinely burst into tears.
It was gratifying.
As a little kid, to watch that, I thought that all fathers did that.
I didn't know that he was unique.
What Dwight Harken achieved in these buildings was the first consistently successful heart operation.
Cardiac surgery had finally begun.
Now surgeons all over the world began to attack the heart.
As well as simple wounds, they attempted to repair congenital heart defects.
But this was no golden era.
In fact, it must have been very depressing to be a cardiac surgeon, because the body count remained distressingly high.
By now, surgeons were no longer having to race against the clock to get the operation done before the patients bled to death.
They had solved that particular problem by clamping off the major vessels around the heart.
But this in turn created another problem.
Clamping the blood supply also stopped oxygen in the blood from reaching the brain.
And certain brain cells are extremely sensitive to lack of oxygen.
Without oxygen, the brain will die in as little as four minutes.
Hardly enough time to mend any sort of heart defect.
Cardiac surgeons found themselves constantly up against a four-minute deadline.
They had to find a way to slow the fatal stopwatch, to buy themselves more precious time.
But how could this be done? They were facing a massive biological challenge.
Finding a way to cut the body's oxygen demands.
If you could drop the oxygen consumption of the tissues, not just the heart but the brain and kidneys, et cetera, then the heart could be stopped for a longer period than the traditional three to four minutes.
In Canada, a surgeon called Bill Bigelow had an interesting idea.
He wondered if hypothermia, an extreme and often fatal loss of body temperature, might be the way to advance heart surgery.
None of his colleagues thought it would work.
I'm on my way to test out Bigelow's theory.
Superficially at least, it all seems incredibly plausible.
Cooling does slow down metabolic processes.
But does it really work that way in humans? I'm about to find out.
The quickest way to cool a human body down is to immerse it in cold water.
Now, it's a very brisk winter's morning, and the water temperature is, I'm told, just a few degrees above freezing.
When I was a medical student, I did research into hypothermia, but I never thought I would be the subject.
Bigelow's hypothesis was that, if you cool somebody down, then everything sort of slows down and their consumption of oxygen will also drop.
But does it work in reality? And I've got Ben, who's going to measure my oxygen consumption when I go into the icy-cold water.
'My oxygen consumption while sitting on the side is less than half a litre a minute.
' OK.
Bloody hell! Bloody hell.
Bloody hell! Jeez! Jeez! Ow! Guh! Guh! Guh! Bloody hell.
Right.
Ow, thathurts.
Thatreallyhurts! One of the things, apparently, that happens when you get hypothermia is you're no longer able to do that.
There's also a thing called paradoxical undressing, which means when people get really cold they get really confused and they take all their clothes off.
So if I start to do that, Ben, can you get me out of the water? I've been in now for five minutes and I've begun to shiver quite uncontrollably.
And I'm beginning to lose the ability to do that.
My oxygen consumption has more than doubled, to well over a litre a minute.
Ooh, God! I'm not sure how much more of this I can actually tolerate.
So what's actually happened is that my consumption of oxygen has shot up rather than dropped down, as Bigelow had predicted.
In fact, the exact opposite.
And in a way it was sort of obvious, because what's happening is, I'm shivering because my body is trying to keep my core temperature up.
And when I shiver I really burn up oxygen because all my muscles are just going.
So, not the result that Bigelow was hoping for at all.
I'm going to go and get changed now.
'It seemed that cold was not the answer to the heart surgeon's time problem.
'But Bigelow refused to give up.
' Bigelow realised if he was ever going to make hypothermia work in humans, then he was going to have to abolish the shivering.
And he came up with an elegant solution.
Ether.
It's a general anaesthetic, but it also relaxes the muscles.
So he detryded He decided to try it out in his dogs.
This time, success.
Cold did work, so long as he also stopped the shivering.
Bigelow and his colleagues found that by surface cooling and decreasing the dogs' temperature by 7 degrees centigrade, that they could decrease the oxygen need, or oxygen consumption, by 50%.
In 1952, Bigelow decided he was finally ready to use hypothermia on his first cardiac patient.
He'd been working on this problem now for over ten years.
All he needed was the right patient.
What he didn't know is his moment of glory was about to be stolen from him by an ambitious American team.
Unfortunately for Bigelow, the Americans did have a suitable patient ready and waiting.
On September 2 1952, five-year-old Jacqueline Johnson was wrapped in a cooling blanket.
It took them over two hours to get her core temperature down to 28 degrees.
This was as low as Bigelow's dog experiments had suggested it was safe to go.
At this temperature, her heart rate was half what it had been before they started cooling her.
The two surgeons, John Lewis and Walt Lillehei, clamped the vessels around Jacqueline's heart.
Her blood could no longer circulate.
Even with Jacqueline's body cooled right down, they calculated they had at most six minutes.
Lillehei started the stopwatch.
The lead surgeon, John Lewis, cut into the right atrium.
He became the first person we know of ever to look inside a beating human heart.
He looked inside and he realised that the thing that was causing Jacqueline all her problems was a hole between two chambers of the heart.
He started to sew.
Lillehei was anxiously watching the clock.
They were four minutes in.
This is the point at which normally a human brain would start to die from lack of oxygen.
Lewis continued to calmly stitch away, closing the defects in the heart.
Lewis, under intense pressure, finishes his stitching.
But he's got to test it.
He injects in some saline.
It leaks.
Five minutes.
He's running out of time.
Lewis puts in another couple of stitches.
But he's got less than one minute to go.
He stitches the atrium wall.
The big question is, will it hold? Has his repair actually worked? They have no time left.
They released the clamps.
The blood flows back into the heart, and thankfully there is no leak.
'But Jacqueline was not safe yet.
' They pick the young girl up and put her into a warm bath and slowly warm her up.
This is a really critical moment because, will her heart restore to its normal beat rate? Will she die? Will she leak? What would happen? Nobody knows because nobody has ever done an operation like this before.
Slowly, her temperature rises.
And slowly, her heart becomes stronger.
Jacqueline will live.
Amazingly, just 11 days later, Jackie was well enough to go home.
Bigelow had been absolutely right.
Hypothermia could slow the fatal stopwatch.
And hypothermia had also achieved another breakthrough.
Previously restricted to blindly poking around inside the heart, surgeons now had the time to open the heart, look right inside and actually see what they were doing.
This, in 1952, was the first genuine open-heart surgery.
As the technique was improved, the stopwatch was extended further, up to ten minutes.
Hypothermia allowed the surgeon access inside the heart, for eight to ten minutes.
Safely.
Hypothermia would go on to save thousands of lives and is widely used in cardiac surgery today.
Hypothermia was a real achievement, but ten minutes was not long enough, not nearly long enough, if you wanted to do complex surgery.
They had to find something more dramatic, something which would really slow the stopwatch and extend time.
To mend major defects, what surgeons really needed was a way of keeping the body alive while the heart was operated on.
Walt Lillehei, who had assisted in the first hypothermia operation, thought he had the perfect solution.
Lillehei's idea was one of the most inspired and frankly demented I have come across in my researches.
It was also brilliantly simple.
Imagine it.
This is the patient.
He's got a dodgy heart.
I am brave volunteer.
What Lillehei proposed was connecting the femoral artery and vein from the patient to my artery and vein.
Then my heart and lungs would drive fresh oxygenated blood round not only my own body but also the patient's body.
While that's going on, Lillehei would be able to isolate and operate on the patient's heart.
Brilliant! The idea utterly appalled Lillehei's colleagues.
Taking risks with a healthy person violates the Hippocratic oath, where doctors swear, above all, to do no harm.
But Lillehei was a born risk-taker and he went ahead anyway.
10-year-old Michael Shaw had a huge hole in his heart.
It was an operation ideally suited to Lillehei's new technique.
But Michael also had a very rare blood type.
His parents' blood didn't match.
None of his siblings or relatives matched either.
They had to look outside the family.
I got a call from the American Legion commander and he says that they've checked the records and found out that I've got AB negative blood, and there's a young boy that needs an operation, and that's the type of blood that he's got.
Howard Holtz decided to help.
I mean, they were desperate.
And they just had to go out and see if they could find somebody that would have this type of blood and would go along with it to save his life.
Lillehei discussed with Howard the risks he would face.
"I hope that it all pans out OK.
" I said, "You know, I got a wife and three little boys at home and one on the way.
"I wanna be around!" Howard put his faith in Walt Lillehei.
In a crowded operating theatre, these tubes connected Howard's blood vessels to the young boy's.
Howard's heart pumped AB negative blood around both their bodies.
Howard's heart was keeping Michael alive.
Well, hello there, Mike! How are you? It's good to see you! It's been a while, that's for sure.
How are you doing? After the operation, they both made a full recovery.
A connection made between strangers in the operating room has lasted a lifetime.
Knowing the risks involved, I cannot imagine volunteering for such a procedure, but Howard is humble about his contribution.
I'm just thinking, if I can help this young fella out, I sure would do it, you know.
I had three children.
And if something was wrong with my boys, I'd sure appreciate if someone did something like that for me.
Amazing.
Well, here's to you, Mike.
Here's to you, Howard.
Thank you very much for what you've done.
I was happy I could do it.
Things went pretty good.
Saved his life.
Very happy for him.
Mike and Howard survived.
Others were not so lucky.
One in three of the patients died.
But then again, they might have died anyway.
Lillehei repeated this procedure more than 40 times.
But it was when one of the healthy volunteers suffered severe brain damage that intense pressure was put on Lillehei to stop this procedure.
But there was also still intense pressure to find an alternative way to keep oxygenated blood circulating around the patient's body.
Some surgeons tried using animals.
This contraption involves monkey lungs in jars being pumped full of oxygen.
More than 15 children died connected to it.
These were desperate times.
If they couldn't find an answer, cardiac surgery would be limited to operations that could be done in less than ten minutes.
The problem they faced was that the human body is extremely good at extracting oxygen from the air and into our blood.
I want to show you just how good it is, and therefore how difficult it is to replicate.
I've got in my pocket here something called a pulse oximeter.
And I can just put it on my finger.
'It indicates the amount of oxygen in my blood.
'It's shown as a percentage of how saturated with oxygen my blood cells are.
' So currently my saturation levels are around 98-99%, which is normal.
Let's see what happens when I cut off the supply.
To do that I need one of these, which is a nose-peg.
Elegant.
And I think probably this as well, to give me an incentive.
The stopwatch.
OK, so all I'm going to simply do is try and hold my breath, and hold it for as long as possible, and see what happens to my oxygen saturation levels.
OK.
HE STARTS STOPWATCH 'Blood is flowing round my body but oxygen is not getting into my blood.
'I start to get dizzy as my brain is starved of oxygen.
'My lungs are burning.
'My body is crying out, "Breathe! Breathe!" 'After a minute-and-a-quarter, the urge to breathe becomes overwhelming.
' God that hurt.
That really hurt.
'There is a time lag as the unoxygenated blood travels from my lungs, down my arm to the sensor.
' That really, really hurt.
78%.
77%.
Phew.
It's actually taking a little while to catch up as the blood reaches my finger.
So I took it down to 77%, which is pretty damn low.
Any more than that and I think I would have passed out.
'But what is remarkable is how quickly 'my oxygen levels returned to normal as soon as I started breathing again.
' It's now quickly coming back.
You can see the numbers rising again.
It's back up to 98% and I'm feeling better.
My oxygen levels took a minute and a quarter to drop and only 20 seconds to return to normal.
Human lungs are fantastically efficient at oxygenating blood.
This is partly because the surface area of the lungs is vast, about the size of a tennis court.
If cardiac surgeons were to progress, they'd have to find a way to cram a tennis court into an operating theatre.
As a young surgeon, John Gibbon watched a patient die from a blood clot in the lungs.
This event seems to have triggered his quest to replace the human heart and lungs with a machine.
For over a decade, Gibbon and his wife Maly worked on various designs.
His wife may have shared his vision, but his colleagues did not.
They called him fanciful, mad.
In the end, his quest would nearly destroy him.
He tinkered, tested, adjusted, until, after 18 long obsessive years, he finally had a machine that could keep a cat alive for 100 minutes.
But Gibbon soon discovered that, to scale it up for a human, he'd need a machine three storeys high.
No matter.
Try again.
Fail again.
Until finally he got there.
This is a Gibbon heart-lung machine, one of the few that is still in existence, and it's rather elegant, don't you think? The blood comes in here, into this pump, which is the heart.
From there, it goes into the mechanical lungs, if you like.
The blood runs down parallel mesh screens which give the maximum surface area in the smallest space.
Gibbon's version of a tennis court in a box.
Looks very simple, but there are lots and lots of things that can go wrong.
In the pump you can get the blood cells getting mashed up.
You might get clotting, bubbles in the blood, which, if they get into the patient, will cause brain damage, even death.
The first human use of a heart-lung machine took place in 1953.
But a misdiagnosis meant that Gibbon was searching for a hole in the heart which wasn't there.
The patient died.
But Gibbon's machine had performed as planned.
Shaken, but undeterred, Gibbon decided to try again.
He assembled the best team he could.
My role for the operation was I was in charge of the machine, along with Jo-Anne Corothers.
And we had to be sure everything worked well with the machine.
That was my primary concern.
And I remember very vividly wheeling this huge machine, which was about the size of a baby grand piano, through the hallways, from the research laboratory into the operating room.
On May 6th 1953, 18-year-old Cecelia Bavolek was brought into theatre.
When Gibbon opened her chest, he discovered her heart was massively enlarged, clear signs of a serious problem.
The vessels to her heart were clamped shut, and her blood diverted to the machine.
Cecelia was now being kept alive by Gibbon's invention.
He was then able to see this hole in her heart, in the upper chambers, the size of a silver dollar.
As the surgery proceeded, it was going along fairly well.
Suddenly, catastrophe struck.
Suddenly, the blood began to build up, and we could see the blood beginning to froth, bubbles forming and starting to go towards the top of the lung.
It was getting ready to spill out.
I remember jumping up on the stool, trying to hold the lid down on top.
The blood inside the artificial lung was clotting and blocking the exit tubes.
I was afraid the pressure might grow up so much, it'd blow the whole top of the artificial lung off.
And you'd have blood all over the operating room, and the patient losing all their blood.
Dr Gibbon turned around to Dr Miller and said "BJ, get out there and do something!", and, of course, he was really the mechanical brains behind this artificial heart and lung.
And so he dropped out of the operation, came over, cut off the circulating machine, therefore giving the amount of blood back she needed and getting her the oxygen needed.
As quickly as he could, Gibbon closed the massive hole inside her heart, and finished the operation.
Incredibly, Cecelia survived.
But Gibbon's next two operations ended in the patients dying.
Gibbon felt he had opened some terrible Pandora's Box.
He declared a moratorium on the use of his machine.
Utterly disheartened, Gibbon never returned to cardiac surgery.
He later died, ironically enough, from a heart attack, on a tennis court.
CONTINUOUS BEEP Gibbon died never knowing what a massive breakthrough he had actually achieved.
He had proven it was possible to artificially oxygenate blood.
And over the years, many other people would refine and improve the heart-lung machine.
With these machines, the time pressure on cardiac surgeons eased.
We were able to open a heart and operate in a relaxed atmosphere.
You didn't have the pressure, gotta get in and out.
Thanks to Gibbon and the heart-lung pioneers, the tyranny of the stopwatch was finally over.
In fact, the heart-lung machine allowed surgeons to stop the clock entirely.
The human heart normally beats 100,000 times every single day.
And the constant movement makes delicate heart surgery tricky.
On bypass.
OK.
But with the patient being kept alive by a heart-lung machine, surgeons can inject potassium chloride into the heart, which will slow it until it stops completely.
This heart is now just an inert piece of muscle.
It was the final piece of the jigsaw.
Most heart repairs could now be attempted.
But what if the heart was so badly damaged, it couldn't be repaired? Surgeons now began to contemplate the unthinkable replacing one human heart with another.
This was an era when boundaries were being smashed all over the place.
MUSIC: "Dancing In The Street" by Martha and the Vandellas And heart surgery moved into overdrive.
The whole of cardiac surgery was terribly exciting.
It was all new, it was all advancing rapidly.
People had the attitude that anything was possible.
All around the world, teams were rushing to be the first to transplant a human heart.
But the fears and superstition which surround the heart fuelled opposition to transplant research.
People thought that if you transplanted a heart, you were taking the soul out of somebody and putting it into somebody else and preventing them going to heaven.
One received almost daily death threats, and so on.
I had to have police escorts to take my children to school.
And we had policemen at the gate to protect us.
It really was a very difficult time.
Then, in December 1967, news came from South Africa that Christiaan Barnard had succeeded.
It was now possible to be given someone else's heart.
But in time, this would create a further problem.
There were simply not enough donors.
I'm on my way to meet a 40-year-old Parisian with a remarkable kind of transplanted heart.
Hello.
Bonjour, Olivier.
How are you feeling this morning? I'm OK this morning.
'There's something very special about Olivier Grosset's heart.
Ah! Ah 'To show just how different it is, we both take an ECG, which measures the pattern of our heartbeat.
'Mine is a pretty normal heart trace.
'But Olivier's' Wow.
Completely flat.
Yes, they're very different.
I've never seen anything like this in somebody who is still alive.
I've only ever seen it in patients when they are dead.
Or dying.
'Olivier's heart has been replaced with a totally artificial one'.
This is the heart that is inside you at the moment.
Is that right? Yes.
And what's striking to me is how incredibly simple they are.
'Air is pumped in and out through this pipe, 'which moves a diaphragm, which pumps the blood.
' Can I feel? WHOOSHING How strange.
I can feel the vibrations.
I've felt plenty of hearts, but nothing like this.
'The noise you can hear is the air pump that has kept Olivier alive 'for the past three months.
' I think this is the first time I've been for a walk with a man with no heart.
'Last year, Olivier discovered he had a defective heart that could not be repaired.
'And there was no suitable donor.
'So they implanted an artificial heart to keep him alive until one could be found.
'But relying on an electrical pump for your every pulse has its drawbacks.
' Is it raining? Yes, it's raining.
I think perhaps we'd better stay inside, then.
I really wish you the best of luck.
Thank you very much.
I look forward to hearing when you get a transplant.
OK.
Thank you very much.
Thank you.
Very, very nice.
You'd better take that inside while it's still dry.
Yes.
How incredibly interesting, and what a lovely man.
And it is just mind-boggling that he's continuing to exist with this sort of mechanical machine in him.
Remarkably, the first temporary artificial heart was used in 1969, just one year after Barnard's transplant.
But back then, the machines that drove artificial hearts were huge and unwieldy.
Faced with patients who had no other hope, surgeons were forced to try ever more unusual techniques.
In London in the late '60s, they began to consider pigs.
The animal's heart and lungs would be connected to the patient's heart and lungs, as a temporary device to keep them alive.
The attempt was particularly infamous, and became known in medical circles as "The Night Of The Pig".
One of my colleagues had a patient on the operating table who clearly was never going to get off.
And we had discussed what we called the piggyback operation.
And I asked for a couple of big pigs, 35 stone-ish, as quick as poss.
The surgical team are waiting in the operating theatre.
They are incredibly anxious, because this is a voyage into the unknown.
They really have no idea what is going to happen.
It is a desperate last-ditch effort.
The head porter came in and said, "Mr L, "is that pig in a Land Rover in the other mews anything to do with you?" I said, "Yes, Thompson, it is, why?" And he said, "Well, it's just climbed out".
The pig has escaped from the Land Rover, and is apparently running down Wimpole Street.
Immediately, the entire surgical team, in their gowns, rush out of the hospital, and they go chasing off down the street.
They've got to catch the pig.
I caught it and started driving it back, comment-free from all the passers-by except one fellow, who raised his bowler hat, people wore them in those days, and said, "Excuse me, sir, you're going the wrong way along a one-way street.
" They managed to trap the pig and take him squealing back into the hospital.
So I found myself in a lift with all the visitors going to meet the patients, and a pig making quite a lot of noise.
And it was a very embarrassing situation.
But their problems are only just beginning.
I looked at the patient's name and it was, I think, Levy or Cohen, and on the form it said, "Religion - Jewish.
" Now Longmore is really worried.
Is it right to take a pig heart out and put it into a Jewish man? He doesn't know.
So he contacts his friend who is a rabbi.
And I telephoned him, and I said, "This is the story, Rabbi, what am I to do?" There was a long and appalling silence, then a terrible sort of gasping noise, and Longmore wonders whether the rabbi has had some sort of heart attack.
But eventually he says, "Sorry, sorry.
I was wetting myself with laughter.
"That is the most absurd story I have ever heard!" I said, "But this is serious!" And he said, "I know it is.
"If this is a serious attempt to save life, I will clear it with the Jewish community, "and you'll have no more problems.
" Longmore managed to attach the pig heart and lungs.
But he could not get the heart to start.
And the patient's last chance slipped away.
You don't plan to have failures.
But unfortunately, they happen.
Research on pigs continued, with little success at first.
Today, nearly 3,000 heart transplants are done every year.
And the big problem is shortage of organs.
Scientists are once more, ironically enough, looking at pig hearts, to see if they could be made more acceptable to the human body.
The long-term goal is to find something, animal or mechanical, that can permanently replace the human heart.
For the moment, however, the ideal option for patients with heart defects is to keep their own hearts.
Even if that does involve drastic surgery.
In an attempt to repair Sophie Clarke's defective heart, surgeons are about to drain the blood out of her body.
In any normal situation, this would kill her.
But it's the only real chance Sophie has.
You're going to feel very weak and very sleepy.
This is the culmination of everything that has been learned since Dwight Harken's pioneering cardiac operation 64 years ago.
The first thing surgeon Stephen Westaby does is to connect Sophie to a heart-lung bypass machine .
.
an invention which owes its success not only to John Gibbon, but also to the anti-coagulant, heparin.
You give a dose of heparin, it stops the blood from clotting.
And heparin comes from cows' guts.
But at the end of the operation, you don't want the patient to bleed to death, so you have to reverse the heparin with a substance called protamine, which neutralises the heparin's effect.
And that comes from salmon sperm.
So we've got the cows' guts going in and the salmon sperm coming out, and both are very important.
'Next, Sophie's heart is injected with potassium chloride, 'and it stops.
' When you look at the heart rate monitor up there, instead of a number, all you see is a great big question mark, and a completely flat line.
'Westaby replaces a faulty valve, 'solving the first of Sophie's problems.
' We just slide it down into the hole.
'Meanwhile, the heart-lung machine has not only been oxygenating her blood, but also cooling it.
'An hour into the operation, instead of a normal body temperature 'of 37 degrees, Sophie's core is now just 16 degrees.
' If you feel her face, she feels like a body in the morgue.
It's very, very strange.
'And the effects of the cooling on her brain are dramatic.
'Asleep and anaesthetised, Sophie's brain activity used to look like this.
'Now she's been cooled, her brain activity has all but ceased.
' The fact that you don't have brainwaves doesn't that mean you're dead.
No.
It just means you're not thinking very much.
She's certainly not thinking very much at the moment.
'Taking Bill Bigelow's original idea to the extreme, Sophie is now so cold 'that her entire body is using very little oxygen '.
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which means they can drain almost all the blood out of her body.
' OK, Richard.
Stop and drain.
'The heart-lung machine stops pumping the blood 'back into Sophie, and instead slowly fills up with her blood.
' Sophie has no heartbeat.
Her brain trace is almost completely flat.
She has virtually no blood in her body, and she is now as cold as a corpse.
Under normal circumstances, any one of those things would be completely incompatible with life.
'But in these circumstances, 'it means surgeons can tackle Sophie's main problem.
'Her artery, the aorta, has ballooned, 'and will burst if not replaced with this synthetic artery.
'It is fiddly work, 'and involves also reconnecting the blood vessels that go to the brain.
' This is her for the rest of her life now.
And it's a lot better than what she was born with.
Doing a good job.
'Sophie has a new aorta, 'after an hour-and-a-half on the heart-lung machine, 'and 45 minutes without blood in her system.
'They have now reached the final part of the operation, 're-filling her with blood.
'This is dangerous.
'Any air bubbles left in her system will cause blockages 'or even brain damage.
' I have her tipped head down, so that any air in the system won't go to the brain.
Air always rises, so air will move away from the blood vessels going into the brain.
They've started pouring blood back into her.
They're warming her body back up.
Her heart has started once more, and her brainwaves have begun to appear.
It's really, really, really satisfying.
'After the operation, she developed a chest infection 'and her lungs filled with fluid.
' So they've taken the fluid off, I've been pumped full of lots of antibiotics, and hopefully, almost ready to go home.
Her doctors are convinced that she will make a full recovery, and she can look forward to a life untroubled by a defective heart.
Do your funny eyes.
It's amazing to think that 70 years ago, effective heart surgery didn't exist.
What held cardiac surgeons back for so long wasn't just lack of knowledge or technology, it was fear and superstition.
But when the taboo was finally broken, cardiac surgery raced ahead.
From being the messiest, bloodiest and most dangerous of all the specialities, cardiac surgery has now become one of the most effective, and certainly life-saving.
It seems that cardiac surgeons can now repair almost anything.
It's a fitting, if belated, tribute to those brave souls on either side of the knife who had the courage to see just how far they could go.
Next time, I'll be tracing the history of one of surgery's most controversial ideas, transplants.
It's tale of sinister surgeons, dark and desperate experiments, and a constant battle with a mysterious biological force.
I'll be learning surgical techniques, meeting patients who have benefited from transplants' progress, as well as those who paid the price for being first.
This is a real human body, beautifully dissected to show the arteries and veins.
In fact, each one of us has nearly 75,000 miles of blood vessels in our bodies.
That's enough to go round the world three times.
And at the centre, the pump, the force that is driving it all.
The heart.
The heart possesses a mystique, a romance that sets it apart from every other organ.
This deference helped make heart surgery an extremely dangerous procedure.
Not just for the patient Suddenly, catastrophe struck.
And we could see the blood beginning to froth, bubbles forming and starting to go towards the top of the lung.
.
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but also for any surgeon prepared to operate on it.
One received almost daily death threats.
I had to have police escorts to take my children to school.
I've traced the cardiac surgery's journey, from the daring but deadly early operations to today.
Cardiac surgery at the extreme.
Sophie has no heartbeat.
Her brain trace is almost completely flat.
She has virtually no blood in her body, and she is now as cold as a corpse.
How are you feeling this morning? I've met a man whose heart flatlines.
And I'm going to repeat some classic experiments on myself.
Jeez! Jeez! What I need to know, Jin, is where do the vessels to the head come off? Cardiac surgeon Stephen Westaby is about to perform one of the most astonishing operations I have ever seen.
What you're gonna see is a patient who is put on a bypass machine, cooled down to 18 degrees, the circulation is stopped and all the blood emptied out of the body, so we can do a careful and very structured operation on the heart.
How extraordinary.
You're actually going to empty all the blood out of her system? Yes.
That opens all the blood vessels up, so that I can see from the inside and work on them and be very precise.
So you're a bit like a plumber? Yeah, I think certainly heart surgeons are plumbers.
You have to get the blood out of the way in the same way as you have to switch the water off before you change the pipes.
Right.
While attempting to mend his patient's heart, Stephen Westaby will effectively be operating on a bloodless, lifeless body.
Who's that? His patient is 34-year-old Sophie Clarke.
She was born with multiple life-threatening heart defects.
She's gonna be having an operation soon.
Sophie looks so well, it's hard to believe her life hangs in the balance.
Do you want to take that with Daddy? Hello.
Hello.
How are you feeling? Very, very nervous.
I haven't slept very much at all last night.
I'm not at all surprised.
No.
These electrodes will monitor Sophie's brain activity while she lies chilled and bloodless on the operating table.
Do you get sort of periods of blankness? I get dizziness.
I've had lots of the heart symptoms.
Palpitations, sweating, pain on exertion.
After that, I've also had neurological symptoms.
I've had slurring of speech and co-ordination problems and muscle control problems.
I mean, you look extraordinarily well on it, is all I can say, you know.
It's the make-up.
So what does your son think about all this? I don't know how much of it he really understands.
My husband's been trying to explain to him that Mummy will be away for a little while.
They've said it could be a week.
So I've just been trying to make the most of this last bit of time this morning.
Getting lots of cuddles.
The walls of Sophie's main artery, her aorta, are weak and could burst at any time.
The operation to replace it is complex and risky.
Bye-bye, Mummy.
Give Mummy a kiss.
See you in a few hours.
Love you, babe.
See you in a few hours, all right? Soon they will chill her, stop her heart, drain her blood.
They will be taking Sophie to the edge of what the human body can survive.
So how did cardiac surgeons master the elements that make up this drastic and dramatic procedure? This is the Royal College of Surgeons.
If these books could talk, they would tell of the glorious history of surgery.
Of heroic surgeons who performed delicate, life-saving operations on the heart.
Or not.
They tried but they failed.
And some of them took it extremely badly.
One man, in 1881, having killed a patient on the operating table, shot himself in the head two days later.
No-one else dared touch the heart.
Then along came Stephen Paget.
In 1896, Paget wrote an acclaimed textbook on surgery of the chest.
But some of his statements were, well, less than accurate.
He firmly declared that heart surgery had "reached the limits set by nature".
It's a case of famous last words, because just one year later, a German surgeon called Ludwig Rehn did actually successfully operate on a young man who had been stabbed in the heart.
It is the first case we know of of somebody whose heart is operated on who actually survives.
But Rehn didn't dare try it again.
And others who did often wished they hadn't.
Whether they were trying to repair hearts damaged by the sword or the bullet, their patients almost always died.
Surgeons became dispirited, almost paralysed with the fear of failure.
For decades they made fantastically little progress.
Why? How hard can operating on the heart really be? Hello there, Jonathan.
Hello, Michael.
Yes, how do you do? 'Jonathan Hyde trains cardiac surgeons.
'Today he has created a bullet wound for me to repair.
' I've lodged a foreign object deep within the ventricle.
And you're going to try to get it out.
OK.
'After I've done that, I'll have to sew up the hole.
'I'm operating on a pig heart, which is almost identical in structure to a human one.
'To make it more realistic, this pig heart is rigged up to a pressurised container of blood.
' The urgency of the situation is all related to how fast the blood loss is.
OK.
We'll give it a go.
I'm not wildly confident about this, I have to say.
OK.
Any other questions? Um, millions, but I don't imagine any of them I must admit I'm quite nervous.
Well, I have a stopwatch here.
On your marks, get set, go! OK, pig.
I'm just going to try and unlodge it.
Oh, nice it's beginning to bleed.
That is a catastrophic haemorrhage now.
They're dead, are they? That size jet would be enough to kill the patient within minutes.
'The heart pumps over five litres of blood a minute, 'which makes cardiac surgery a particularly messy business.
' I've managed to get it out, there we go.
Quite a big bit.
I've got an enormous hole.
You should have your finger on the hole.
So I'm trying to stitch while .
.
While blood's coming out of the heart.
'In a lifetime, the human heart pumps enough blood to fill a football stadium.
' Can you put your finger in the hole? I can.
And at that end.
That would be even better, thank you.
Marvellous.
With that amount of bleeding, there's no way of keeping up with that.
No, that would cause death.
Oh, my heart's going, I have to say This is one hell of a hole.
Anyway, your time is running down, you've had two-and-a-half minutes.
Ah, God, I just stabbed myself! You can use forceps if you wish.
I don't really have time for forceps at the moment.
OK, now I just need to relax.
I can feel my hand shaking, as the adrenaline goes shooting through.
So you're in a bad situation.
The amount of blood and that size of a hole, the heart has almost certainly stopped.
That was a real buzz, and I can still feel the adrenaline going through me.
I also understand now just why it was that surgeons found the heart so difficult to operate on.
I think it's probably time to go and get cleaned up.
For many years, heart surgery remained more fatal than useful.
And the heart remained feared and sacrosanct.
An organ of mystery and reverence.
As the 20th century unfolded, Einstein came up with the theory of relativity.
The television was invented.
And the world went to war.
Again.
MUSIC: "In The Mood" by Glenn Miller and his Orchestra By the early 1940s, surgeons were routinely operating on almost every organ in the body, from the bowels to the brain.
But the heart remained feared and untouchable.
In 1944, a young, tempestuous American was about to make surgical history in a field, near here, in southwest England.
Dwight Harken was dynamic, ambitious.
He thrived in the upheaval of war.
All sorts of horrific casualties came back from the front.
Army surgeons did what they could in often primitive settings.
But there was one group of men they would not operate on.
Those with shrapnel in their hearts.
The conventional wisdom was that you left shrapnel in place because the risks of operating were far too great.
But Harken didn't believe in conventional wisdom.
35-year-old Harken really couldn't see what the fuss was about.
Shrapnel was plainly a surgical problem so he would attack it surgically.
What I find interesting is that Harken wasn't driven to do this by any great new surgical innovation or any great insight he had.
He simply did it because he couldn't see a reason not to do it.
He had what many great surgeons have, the courage to fail.
I'm meeting Dwight Harken's son, Alden, a cardiac surgeon from California.
Hello there.
Hello, good morning.
Nice to see you.
Hop in.
I hope you've dressed up warm.
There may be a horrible clashing of gears.
GEARBOX CRUNCHES There it is! 'I'm taking him to the site of a Second World War field hospital.
' So this is where your dad was operating way back in 1944.
It is remarkable.
It's a thrill for me to see this.
And you still can see some old remnants of foundations.
'After more than 60 years, only one of the huts remains standing.
' I think just through the trees here you can see Oh, there it is.
Isn't that amazing? That is remarkable.
Dwight Harken spent months experimenting on animals.
The night before his first attempt to do heart surgery on a soldier, he wrote nervously to his wife.
He said, "If I succeed, we will have developed the future of cardiac surgery.
"If I fail, my career and our lives are over.
" So it had to be a terrifying experience.
Harken had the foresight to film one of his operations.
This footage is a remarkable record of a ground-breaking chapter in cardiac surgery.
Here we make incisions through the pericardium and the myocardium.
When you make an incision in a high pressure chamber, blood shoots out.
It's just like puncturing a water balloon.
A huge amount of blood or water just comes shooting out.
While the patient's blood was gushing out, Harken tried to find the metal fragment.
He knew the bullet was inside the heart, but of course he couldn't see it.
He then takes a clamp, blind, and fishes around inside this ventricle with blood shooting out, and grabs the bullet.
We grasped over and over.
The missile entwined and entangled in the chordae tendineae.
The first time he pulled it out, he dislodged it at the edge of the heart.
Darn! Second time, third time, fourth time.
Again it escapes.
Finally, Harken got a firm hold of the fragment, and it popped out like a champagne cork.
There it is, and the missile goes out in the left upper corner.
By now, the patient had lost copious amounts of blood and needed a massive transfusion.
But if you just drip the blood in, it doesn't go in fast enough.
So they had big blood bags and these glass bottles.
So they put little tubes up in the top of these glass bottles, pump high pressure into the top of the bottles.
Then they'd clamp the tubes, and as soon as they needed the blood, they'd take the clamps off.
The problem is, every once in a while they'd get too much pressure in the top of the blood and the glass bottle would explode with bloody glass all over the operating room.
The first 14 I operated on all died.
The second, seven of the 14 died.
The third, two of the 14 died.
I was getting better.
But the fourth 14 all survived.
And the only difference between these first three groups and the fourth group was that these were all animals and the 14 in the final group were all American soldiers, and they all survived.
Harken had broken the taboo.
He had proved that the heart could in fact be operated on.
He went on to perform this operation on more than 130 soldiers, and every one survived.
Were you proud of your dad? Tremendously proud, tremendously proud.
And actually I was more proud when I saw him do some of the operations and saw the gratitude of the patients.
They couldn't breathe before the operation because their lungs filled up with fluid, and after the operation, he would, with great ceremony, he had a lot of PT Barnum in him, march them out to the bottom of a set of stairs.
And he'd say, "Walk up those stairs," and they'd say "I can't.
" And he'd say, "No, go ahead.
" And they would walk up the stairs, and at the top, they just routinely burst into tears.
It was gratifying.
As a little kid, to watch that, I thought that all fathers did that.
I didn't know that he was unique.
What Dwight Harken achieved in these buildings was the first consistently successful heart operation.
Cardiac surgery had finally begun.
Now surgeons all over the world began to attack the heart.
As well as simple wounds, they attempted to repair congenital heart defects.
But this was no golden era.
In fact, it must have been very depressing to be a cardiac surgeon, because the body count remained distressingly high.
By now, surgeons were no longer having to race against the clock to get the operation done before the patients bled to death.
They had solved that particular problem by clamping off the major vessels around the heart.
But this in turn created another problem.
Clamping the blood supply also stopped oxygen in the blood from reaching the brain.
And certain brain cells are extremely sensitive to lack of oxygen.
Without oxygen, the brain will die in as little as four minutes.
Hardly enough time to mend any sort of heart defect.
Cardiac surgeons found themselves constantly up against a four-minute deadline.
They had to find a way to slow the fatal stopwatch, to buy themselves more precious time.
But how could this be done? They were facing a massive biological challenge.
Finding a way to cut the body's oxygen demands.
If you could drop the oxygen consumption of the tissues, not just the heart but the brain and kidneys, et cetera, then the heart could be stopped for a longer period than the traditional three to four minutes.
In Canada, a surgeon called Bill Bigelow had an interesting idea.
He wondered if hypothermia, an extreme and often fatal loss of body temperature, might be the way to advance heart surgery.
None of his colleagues thought it would work.
I'm on my way to test out Bigelow's theory.
Superficially at least, it all seems incredibly plausible.
Cooling does slow down metabolic processes.
But does it really work that way in humans? I'm about to find out.
The quickest way to cool a human body down is to immerse it in cold water.
Now, it's a very brisk winter's morning, and the water temperature is, I'm told, just a few degrees above freezing.
When I was a medical student, I did research into hypothermia, but I never thought I would be the subject.
Bigelow's hypothesis was that, if you cool somebody down, then everything sort of slows down and their consumption of oxygen will also drop.
But does it work in reality? And I've got Ben, who's going to measure my oxygen consumption when I go into the icy-cold water.
'My oxygen consumption while sitting on the side is less than half a litre a minute.
' OK.
Bloody hell! Bloody hell.
Bloody hell! Jeez! Jeez! Ow! Guh! Guh! Guh! Bloody hell.
Right.
Ow, thathurts.
Thatreallyhurts! One of the things, apparently, that happens when you get hypothermia is you're no longer able to do that.
There's also a thing called paradoxical undressing, which means when people get really cold they get really confused and they take all their clothes off.
So if I start to do that, Ben, can you get me out of the water? I've been in now for five minutes and I've begun to shiver quite uncontrollably.
And I'm beginning to lose the ability to do that.
My oxygen consumption has more than doubled, to well over a litre a minute.
Ooh, God! I'm not sure how much more of this I can actually tolerate.
So what's actually happened is that my consumption of oxygen has shot up rather than dropped down, as Bigelow had predicted.
In fact, the exact opposite.
And in a way it was sort of obvious, because what's happening is, I'm shivering because my body is trying to keep my core temperature up.
And when I shiver I really burn up oxygen because all my muscles are just going.
So, not the result that Bigelow was hoping for at all.
I'm going to go and get changed now.
'It seemed that cold was not the answer to the heart surgeon's time problem.
'But Bigelow refused to give up.
' Bigelow realised if he was ever going to make hypothermia work in humans, then he was going to have to abolish the shivering.
And he came up with an elegant solution.
Ether.
It's a general anaesthetic, but it also relaxes the muscles.
So he detryded He decided to try it out in his dogs.
This time, success.
Cold did work, so long as he also stopped the shivering.
Bigelow and his colleagues found that by surface cooling and decreasing the dogs' temperature by 7 degrees centigrade, that they could decrease the oxygen need, or oxygen consumption, by 50%.
In 1952, Bigelow decided he was finally ready to use hypothermia on his first cardiac patient.
He'd been working on this problem now for over ten years.
All he needed was the right patient.
What he didn't know is his moment of glory was about to be stolen from him by an ambitious American team.
Unfortunately for Bigelow, the Americans did have a suitable patient ready and waiting.
On September 2 1952, five-year-old Jacqueline Johnson was wrapped in a cooling blanket.
It took them over two hours to get her core temperature down to 28 degrees.
This was as low as Bigelow's dog experiments had suggested it was safe to go.
At this temperature, her heart rate was half what it had been before they started cooling her.
The two surgeons, John Lewis and Walt Lillehei, clamped the vessels around Jacqueline's heart.
Her blood could no longer circulate.
Even with Jacqueline's body cooled right down, they calculated they had at most six minutes.
Lillehei started the stopwatch.
The lead surgeon, John Lewis, cut into the right atrium.
He became the first person we know of ever to look inside a beating human heart.
He looked inside and he realised that the thing that was causing Jacqueline all her problems was a hole between two chambers of the heart.
He started to sew.
Lillehei was anxiously watching the clock.
They were four minutes in.
This is the point at which normally a human brain would start to die from lack of oxygen.
Lewis continued to calmly stitch away, closing the defects in the heart.
Lewis, under intense pressure, finishes his stitching.
But he's got to test it.
He injects in some saline.
It leaks.
Five minutes.
He's running out of time.
Lewis puts in another couple of stitches.
But he's got less than one minute to go.
He stitches the atrium wall.
The big question is, will it hold? Has his repair actually worked? They have no time left.
They released the clamps.
The blood flows back into the heart, and thankfully there is no leak.
'But Jacqueline was not safe yet.
' They pick the young girl up and put her into a warm bath and slowly warm her up.
This is a really critical moment because, will her heart restore to its normal beat rate? Will she die? Will she leak? What would happen? Nobody knows because nobody has ever done an operation like this before.
Slowly, her temperature rises.
And slowly, her heart becomes stronger.
Jacqueline will live.
Amazingly, just 11 days later, Jackie was well enough to go home.
Bigelow had been absolutely right.
Hypothermia could slow the fatal stopwatch.
And hypothermia had also achieved another breakthrough.
Previously restricted to blindly poking around inside the heart, surgeons now had the time to open the heart, look right inside and actually see what they were doing.
This, in 1952, was the first genuine open-heart surgery.
As the technique was improved, the stopwatch was extended further, up to ten minutes.
Hypothermia allowed the surgeon access inside the heart, for eight to ten minutes.
Safely.
Hypothermia would go on to save thousands of lives and is widely used in cardiac surgery today.
Hypothermia was a real achievement, but ten minutes was not long enough, not nearly long enough, if you wanted to do complex surgery.
They had to find something more dramatic, something which would really slow the stopwatch and extend time.
To mend major defects, what surgeons really needed was a way of keeping the body alive while the heart was operated on.
Walt Lillehei, who had assisted in the first hypothermia operation, thought he had the perfect solution.
Lillehei's idea was one of the most inspired and frankly demented I have come across in my researches.
It was also brilliantly simple.
Imagine it.
This is the patient.
He's got a dodgy heart.
I am brave volunteer.
What Lillehei proposed was connecting the femoral artery and vein from the patient to my artery and vein.
Then my heart and lungs would drive fresh oxygenated blood round not only my own body but also the patient's body.
While that's going on, Lillehei would be able to isolate and operate on the patient's heart.
Brilliant! The idea utterly appalled Lillehei's colleagues.
Taking risks with a healthy person violates the Hippocratic oath, where doctors swear, above all, to do no harm.
But Lillehei was a born risk-taker and he went ahead anyway.
10-year-old Michael Shaw had a huge hole in his heart.
It was an operation ideally suited to Lillehei's new technique.
But Michael also had a very rare blood type.
His parents' blood didn't match.
None of his siblings or relatives matched either.
They had to look outside the family.
I got a call from the American Legion commander and he says that they've checked the records and found out that I've got AB negative blood, and there's a young boy that needs an operation, and that's the type of blood that he's got.
Howard Holtz decided to help.
I mean, they were desperate.
And they just had to go out and see if they could find somebody that would have this type of blood and would go along with it to save his life.
Lillehei discussed with Howard the risks he would face.
"I hope that it all pans out OK.
" I said, "You know, I got a wife and three little boys at home and one on the way.
"I wanna be around!" Howard put his faith in Walt Lillehei.
In a crowded operating theatre, these tubes connected Howard's blood vessels to the young boy's.
Howard's heart pumped AB negative blood around both their bodies.
Howard's heart was keeping Michael alive.
Well, hello there, Mike! How are you? It's good to see you! It's been a while, that's for sure.
How are you doing? After the operation, they both made a full recovery.
A connection made between strangers in the operating room has lasted a lifetime.
Knowing the risks involved, I cannot imagine volunteering for such a procedure, but Howard is humble about his contribution.
I'm just thinking, if I can help this young fella out, I sure would do it, you know.
I had three children.
And if something was wrong with my boys, I'd sure appreciate if someone did something like that for me.
Amazing.
Well, here's to you, Mike.
Here's to you, Howard.
Thank you very much for what you've done.
I was happy I could do it.
Things went pretty good.
Saved his life.
Very happy for him.
Mike and Howard survived.
Others were not so lucky.
One in three of the patients died.
But then again, they might have died anyway.
Lillehei repeated this procedure more than 40 times.
But it was when one of the healthy volunteers suffered severe brain damage that intense pressure was put on Lillehei to stop this procedure.
But there was also still intense pressure to find an alternative way to keep oxygenated blood circulating around the patient's body.
Some surgeons tried using animals.
This contraption involves monkey lungs in jars being pumped full of oxygen.
More than 15 children died connected to it.
These were desperate times.
If they couldn't find an answer, cardiac surgery would be limited to operations that could be done in less than ten minutes.
The problem they faced was that the human body is extremely good at extracting oxygen from the air and into our blood.
I want to show you just how good it is, and therefore how difficult it is to replicate.
I've got in my pocket here something called a pulse oximeter.
And I can just put it on my finger.
'It indicates the amount of oxygen in my blood.
'It's shown as a percentage of how saturated with oxygen my blood cells are.
' So currently my saturation levels are around 98-99%, which is normal.
Let's see what happens when I cut off the supply.
To do that I need one of these, which is a nose-peg.
Elegant.
And I think probably this as well, to give me an incentive.
The stopwatch.
OK, so all I'm going to simply do is try and hold my breath, and hold it for as long as possible, and see what happens to my oxygen saturation levels.
OK.
HE STARTS STOPWATCH 'Blood is flowing round my body but oxygen is not getting into my blood.
'I start to get dizzy as my brain is starved of oxygen.
'My lungs are burning.
'My body is crying out, "Breathe! Breathe!" 'After a minute-and-a-quarter, the urge to breathe becomes overwhelming.
' God that hurt.
That really hurt.
'There is a time lag as the unoxygenated blood travels from my lungs, down my arm to the sensor.
' That really, really hurt.
78%.
77%.
Phew.
It's actually taking a little while to catch up as the blood reaches my finger.
So I took it down to 77%, which is pretty damn low.
Any more than that and I think I would have passed out.
'But what is remarkable is how quickly 'my oxygen levels returned to normal as soon as I started breathing again.
' It's now quickly coming back.
You can see the numbers rising again.
It's back up to 98% and I'm feeling better.
My oxygen levels took a minute and a quarter to drop and only 20 seconds to return to normal.
Human lungs are fantastically efficient at oxygenating blood.
This is partly because the surface area of the lungs is vast, about the size of a tennis court.
If cardiac surgeons were to progress, they'd have to find a way to cram a tennis court into an operating theatre.
As a young surgeon, John Gibbon watched a patient die from a blood clot in the lungs.
This event seems to have triggered his quest to replace the human heart and lungs with a machine.
For over a decade, Gibbon and his wife Maly worked on various designs.
His wife may have shared his vision, but his colleagues did not.
They called him fanciful, mad.
In the end, his quest would nearly destroy him.
He tinkered, tested, adjusted, until, after 18 long obsessive years, he finally had a machine that could keep a cat alive for 100 minutes.
But Gibbon soon discovered that, to scale it up for a human, he'd need a machine three storeys high.
No matter.
Try again.
Fail again.
Until finally he got there.
This is a Gibbon heart-lung machine, one of the few that is still in existence, and it's rather elegant, don't you think? The blood comes in here, into this pump, which is the heart.
From there, it goes into the mechanical lungs, if you like.
The blood runs down parallel mesh screens which give the maximum surface area in the smallest space.
Gibbon's version of a tennis court in a box.
Looks very simple, but there are lots and lots of things that can go wrong.
In the pump you can get the blood cells getting mashed up.
You might get clotting, bubbles in the blood, which, if they get into the patient, will cause brain damage, even death.
The first human use of a heart-lung machine took place in 1953.
But a misdiagnosis meant that Gibbon was searching for a hole in the heart which wasn't there.
The patient died.
But Gibbon's machine had performed as planned.
Shaken, but undeterred, Gibbon decided to try again.
He assembled the best team he could.
My role for the operation was I was in charge of the machine, along with Jo-Anne Corothers.
And we had to be sure everything worked well with the machine.
That was my primary concern.
And I remember very vividly wheeling this huge machine, which was about the size of a baby grand piano, through the hallways, from the research laboratory into the operating room.
On May 6th 1953, 18-year-old Cecelia Bavolek was brought into theatre.
When Gibbon opened her chest, he discovered her heart was massively enlarged, clear signs of a serious problem.
The vessels to her heart were clamped shut, and her blood diverted to the machine.
Cecelia was now being kept alive by Gibbon's invention.
He was then able to see this hole in her heart, in the upper chambers, the size of a silver dollar.
As the surgery proceeded, it was going along fairly well.
Suddenly, catastrophe struck.
Suddenly, the blood began to build up, and we could see the blood beginning to froth, bubbles forming and starting to go towards the top of the lung.
It was getting ready to spill out.
I remember jumping up on the stool, trying to hold the lid down on top.
The blood inside the artificial lung was clotting and blocking the exit tubes.
I was afraid the pressure might grow up so much, it'd blow the whole top of the artificial lung off.
And you'd have blood all over the operating room, and the patient losing all their blood.
Dr Gibbon turned around to Dr Miller and said "BJ, get out there and do something!", and, of course, he was really the mechanical brains behind this artificial heart and lung.
And so he dropped out of the operation, came over, cut off the circulating machine, therefore giving the amount of blood back she needed and getting her the oxygen needed.
As quickly as he could, Gibbon closed the massive hole inside her heart, and finished the operation.
Incredibly, Cecelia survived.
But Gibbon's next two operations ended in the patients dying.
Gibbon felt he had opened some terrible Pandora's Box.
He declared a moratorium on the use of his machine.
Utterly disheartened, Gibbon never returned to cardiac surgery.
He later died, ironically enough, from a heart attack, on a tennis court.
CONTINUOUS BEEP Gibbon died never knowing what a massive breakthrough he had actually achieved.
He had proven it was possible to artificially oxygenate blood.
And over the years, many other people would refine and improve the heart-lung machine.
With these machines, the time pressure on cardiac surgeons eased.
We were able to open a heart and operate in a relaxed atmosphere.
You didn't have the pressure, gotta get in and out.
Thanks to Gibbon and the heart-lung pioneers, the tyranny of the stopwatch was finally over.
In fact, the heart-lung machine allowed surgeons to stop the clock entirely.
The human heart normally beats 100,000 times every single day.
And the constant movement makes delicate heart surgery tricky.
On bypass.
OK.
But with the patient being kept alive by a heart-lung machine, surgeons can inject potassium chloride into the heart, which will slow it until it stops completely.
This heart is now just an inert piece of muscle.
It was the final piece of the jigsaw.
Most heart repairs could now be attempted.
But what if the heart was so badly damaged, it couldn't be repaired? Surgeons now began to contemplate the unthinkable replacing one human heart with another.
This was an era when boundaries were being smashed all over the place.
MUSIC: "Dancing In The Street" by Martha and the Vandellas And heart surgery moved into overdrive.
The whole of cardiac surgery was terribly exciting.
It was all new, it was all advancing rapidly.
People had the attitude that anything was possible.
All around the world, teams were rushing to be the first to transplant a human heart.
But the fears and superstition which surround the heart fuelled opposition to transplant research.
People thought that if you transplanted a heart, you were taking the soul out of somebody and putting it into somebody else and preventing them going to heaven.
One received almost daily death threats, and so on.
I had to have police escorts to take my children to school.
And we had policemen at the gate to protect us.
It really was a very difficult time.
Then, in December 1967, news came from South Africa that Christiaan Barnard had succeeded.
It was now possible to be given someone else's heart.
But in time, this would create a further problem.
There were simply not enough donors.
I'm on my way to meet a 40-year-old Parisian with a remarkable kind of transplanted heart.
Hello.
Bonjour, Olivier.
How are you feeling this morning? I'm OK this morning.
'There's something very special about Olivier Grosset's heart.
Ah! Ah 'To show just how different it is, we both take an ECG, which measures the pattern of our heartbeat.
'Mine is a pretty normal heart trace.
'But Olivier's' Wow.
Completely flat.
Yes, they're very different.
I've never seen anything like this in somebody who is still alive.
I've only ever seen it in patients when they are dead.
Or dying.
'Olivier's heart has been replaced with a totally artificial one'.
This is the heart that is inside you at the moment.
Is that right? Yes.
And what's striking to me is how incredibly simple they are.
'Air is pumped in and out through this pipe, 'which moves a diaphragm, which pumps the blood.
' Can I feel? WHOOSHING How strange.
I can feel the vibrations.
I've felt plenty of hearts, but nothing like this.
'The noise you can hear is the air pump that has kept Olivier alive 'for the past three months.
' I think this is the first time I've been for a walk with a man with no heart.
'Last year, Olivier discovered he had a defective heart that could not be repaired.
'And there was no suitable donor.
'So they implanted an artificial heart to keep him alive until one could be found.
'But relying on an electrical pump for your every pulse has its drawbacks.
' Is it raining? Yes, it's raining.
I think perhaps we'd better stay inside, then.
I really wish you the best of luck.
Thank you very much.
I look forward to hearing when you get a transplant.
OK.
Thank you very much.
Thank you.
Very, very nice.
You'd better take that inside while it's still dry.
Yes.
How incredibly interesting, and what a lovely man.
And it is just mind-boggling that he's continuing to exist with this sort of mechanical machine in him.
Remarkably, the first temporary artificial heart was used in 1969, just one year after Barnard's transplant.
But back then, the machines that drove artificial hearts were huge and unwieldy.
Faced with patients who had no other hope, surgeons were forced to try ever more unusual techniques.
In London in the late '60s, they began to consider pigs.
The animal's heart and lungs would be connected to the patient's heart and lungs, as a temporary device to keep them alive.
The attempt was particularly infamous, and became known in medical circles as "The Night Of The Pig".
One of my colleagues had a patient on the operating table who clearly was never going to get off.
And we had discussed what we called the piggyback operation.
And I asked for a couple of big pigs, 35 stone-ish, as quick as poss.
The surgical team are waiting in the operating theatre.
They are incredibly anxious, because this is a voyage into the unknown.
They really have no idea what is going to happen.
It is a desperate last-ditch effort.
The head porter came in and said, "Mr L, "is that pig in a Land Rover in the other mews anything to do with you?" I said, "Yes, Thompson, it is, why?" And he said, "Well, it's just climbed out".
The pig has escaped from the Land Rover, and is apparently running down Wimpole Street.
Immediately, the entire surgical team, in their gowns, rush out of the hospital, and they go chasing off down the street.
They've got to catch the pig.
I caught it and started driving it back, comment-free from all the passers-by except one fellow, who raised his bowler hat, people wore them in those days, and said, "Excuse me, sir, you're going the wrong way along a one-way street.
" They managed to trap the pig and take him squealing back into the hospital.
So I found myself in a lift with all the visitors going to meet the patients, and a pig making quite a lot of noise.
And it was a very embarrassing situation.
But their problems are only just beginning.
I looked at the patient's name and it was, I think, Levy or Cohen, and on the form it said, "Religion - Jewish.
" Now Longmore is really worried.
Is it right to take a pig heart out and put it into a Jewish man? He doesn't know.
So he contacts his friend who is a rabbi.
And I telephoned him, and I said, "This is the story, Rabbi, what am I to do?" There was a long and appalling silence, then a terrible sort of gasping noise, and Longmore wonders whether the rabbi has had some sort of heart attack.
But eventually he says, "Sorry, sorry.
I was wetting myself with laughter.
"That is the most absurd story I have ever heard!" I said, "But this is serious!" And he said, "I know it is.
"If this is a serious attempt to save life, I will clear it with the Jewish community, "and you'll have no more problems.
" Longmore managed to attach the pig heart and lungs.
But he could not get the heart to start.
And the patient's last chance slipped away.
You don't plan to have failures.
But unfortunately, they happen.
Research on pigs continued, with little success at first.
Today, nearly 3,000 heart transplants are done every year.
And the big problem is shortage of organs.
Scientists are once more, ironically enough, looking at pig hearts, to see if they could be made more acceptable to the human body.
The long-term goal is to find something, animal or mechanical, that can permanently replace the human heart.
For the moment, however, the ideal option for patients with heart defects is to keep their own hearts.
Even if that does involve drastic surgery.
In an attempt to repair Sophie Clarke's defective heart, surgeons are about to drain the blood out of her body.
In any normal situation, this would kill her.
But it's the only real chance Sophie has.
You're going to feel very weak and very sleepy.
This is the culmination of everything that has been learned since Dwight Harken's pioneering cardiac operation 64 years ago.
The first thing surgeon Stephen Westaby does is to connect Sophie to a heart-lung bypass machine .
.
an invention which owes its success not only to John Gibbon, but also to the anti-coagulant, heparin.
You give a dose of heparin, it stops the blood from clotting.
And heparin comes from cows' guts.
But at the end of the operation, you don't want the patient to bleed to death, so you have to reverse the heparin with a substance called protamine, which neutralises the heparin's effect.
And that comes from salmon sperm.
So we've got the cows' guts going in and the salmon sperm coming out, and both are very important.
'Next, Sophie's heart is injected with potassium chloride, 'and it stops.
' When you look at the heart rate monitor up there, instead of a number, all you see is a great big question mark, and a completely flat line.
'Westaby replaces a faulty valve, 'solving the first of Sophie's problems.
' We just slide it down into the hole.
'Meanwhile, the heart-lung machine has not only been oxygenating her blood, but also cooling it.
'An hour into the operation, instead of a normal body temperature 'of 37 degrees, Sophie's core is now just 16 degrees.
' If you feel her face, she feels like a body in the morgue.
It's very, very strange.
'And the effects of the cooling on her brain are dramatic.
'Asleep and anaesthetised, Sophie's brain activity used to look like this.
'Now she's been cooled, her brain activity has all but ceased.
' The fact that you don't have brainwaves doesn't that mean you're dead.
No.
It just means you're not thinking very much.
She's certainly not thinking very much at the moment.
'Taking Bill Bigelow's original idea to the extreme, Sophie is now so cold 'that her entire body is using very little oxygen '.
.
which means they can drain almost all the blood out of her body.
' OK, Richard.
Stop and drain.
'The heart-lung machine stops pumping the blood 'back into Sophie, and instead slowly fills up with her blood.
' Sophie has no heartbeat.
Her brain trace is almost completely flat.
She has virtually no blood in her body, and she is now as cold as a corpse.
Under normal circumstances, any one of those things would be completely incompatible with life.
'But in these circumstances, 'it means surgeons can tackle Sophie's main problem.
'Her artery, the aorta, has ballooned, 'and will burst if not replaced with this synthetic artery.
'It is fiddly work, 'and involves also reconnecting the blood vessels that go to the brain.
' This is her for the rest of her life now.
And it's a lot better than what she was born with.
Doing a good job.
'Sophie has a new aorta, 'after an hour-and-a-half on the heart-lung machine, 'and 45 minutes without blood in her system.
'They have now reached the final part of the operation, 're-filling her with blood.
'This is dangerous.
'Any air bubbles left in her system will cause blockages 'or even brain damage.
' I have her tipped head down, so that any air in the system won't go to the brain.
Air always rises, so air will move away from the blood vessels going into the brain.
They've started pouring blood back into her.
They're warming her body back up.
Her heart has started once more, and her brainwaves have begun to appear.
It's really, really, really satisfying.
'After the operation, she developed a chest infection 'and her lungs filled with fluid.
' So they've taken the fluid off, I've been pumped full of lots of antibiotics, and hopefully, almost ready to go home.
Her doctors are convinced that she will make a full recovery, and she can look forward to a life untroubled by a defective heart.
Do your funny eyes.
It's amazing to think that 70 years ago, effective heart surgery didn't exist.
What held cardiac surgeons back for so long wasn't just lack of knowledge or technology, it was fear and superstition.
But when the taboo was finally broken, cardiac surgery raced ahead.
From being the messiest, bloodiest and most dangerous of all the specialities, cardiac surgery has now become one of the most effective, and certainly life-saving.
It seems that cardiac surgeons can now repair almost anything.
It's a fitting, if belated, tribute to those brave souls on either side of the knife who had the courage to see just how far they could go.
Next time, I'll be tracing the history of one of surgery's most controversial ideas, transplants.
It's tale of sinister surgeons, dark and desperate experiments, and a constant battle with a mysterious biological force.
I'll be learning surgical techniques, meeting patients who have benefited from transplants' progress, as well as those who paid the price for being first.