Cardiac Surgery

Cardiac Surgery before Jim Baird's appointment

There has always been a strong and interdependent relationship between the two services, Cardiology and Cardiothoracic Surgery.

Before the arrival in Wellington of specifically trained surgeons, a small number of cardiac surgical procedures were undertaken.

This was one of the first operations in NZ for PDA;  Five months later, Douglas Robb in Auckland would perform a similar operation for an infected duct, though that patient did not survive.

The next ductal ligation in Wellington occurred nearly 3 years after the first.   On 21/2/1947, Richard Orgias, who had in 1946 succeeded Bert McNickle as Resident Surgeon, successfully operated on a young serviceman with an infected ductus. Dick Orgias was assisted in this operation by Eric Luke. 

There were four more ductal ligations performed before Jim Baird's arrival, all performed by Dick Orgias.

The other type of cardiac surgery undertaken early related to the pericardium.

Two other pericardiectomies were undertaken in 1947.

One of these attracted some publicity - in the Dominion newspaper on 13/5/1947

Appointment of first Cardiothoracic Surgeon

From the time of Jim Baird's appointment in 1952 as the hospital's first cardiothoracic surgeon, a close working relationship developed with the cardiology service.  Given the personalities involved, the relationship was sometimes a little fraught in the early years but things settled down in time.

Tim Savage joined Jim as the second cardiothoracic surgeon in 1955.

A weekly meeting in the cardiology department between the cardiologists and cardiothoracic surgeons was held, at which cardiologists presented potential cardiac surgery candidates to the surgeons.  If a referral was accepted the patient was wait-listed for surgery.
For the most part, these presentations were of patient histories and results of investigations, but in the early years, patients were often brought to the department on the day of the presentation.  This allowed the surgeons to make a first-hand assessment of the surgical candidate.   By 1963, seventyseven patients had been presented to the surgeons.  The weekly meetings were referred to as the "Combined Cardiac Clinic".

Some historical detail of particular forms of cardiac surgery follows.  Surgery for congenital heart disease is mentioned elsewhere.

VALVE SURGERY

Within three months of Jim Baird's appointment to the staff, he had performed the first closed mitral valvotomy.  Jim had trained at the Brompton Hospital under Sir Russell Brock and O S Tubbs.
By the time Tim Savage arrived in 1955, Jim had undertaken twentythree such procedures.
The peak annual number of closed mitral valvotomies (21) was reached in 1969, but over the next ten years the frequency declined, and the last such operations were undertaken in 1979.  Open mitral valvotomies were first carried out in Wellington in 1971 and became the norm after 1979.

However, operative treatment of mitral stenosis gave way to percutaneous balloon valvuloplasty from 1998 (Phil Matsis).

In 1960, Jim Baird spent six months in the UK and USA studying cardiac surgery.   In the States in particular, his focus was on open heart surgery.
In 1963 Jim proposed that Wellington Hospital should become the second open heart surgery facility in NZ, and despite a late challenge from Dunedin (who wanted the facility to be there), the Minister of Health announced on 4 July, 1963 that Wellington Hospital's bid was approved.   Detailed planning for the unit followed, including regular animal surgery to familiarise and test out the new techniques.  The first cardiopulmonary bypass procedure (closure of an ASD) was undertaken in December, 1964.

By the time of the first valve replacement operation, 48 cardiopulmonary bypass procedures had been undertaken.

The choice of a homograft valve was no doubt influenced by the successful use of such valves at Green Lane Hospital.  Homograft valves were used in only three subsequent aortic valve replacements, in 1967, 1968 and 1969.

The second aortic valve replacement was carried out in March 1967.

This was clearly a disappointing start to the valve replacement programme, but the surgeons were committed to continuing and a further 28 patients were operated on in 1967.

Most of the early valve replacements were aortic but the first mitral valve replacement took place in June 1967.

He remained reasonably well until 1988 when he developed prosthetic endocarditis.  He underwent an urgent MVR (Alan Hilless) on 23/8/88, had a protracted post-op course, and died on 28/10/88.

The second MVR was carried out one month after the first.

Here is a cardiac surgical procedure underway in the Seddon Theatre, with surgeons Jim Baird, Tim Savage and Bede Squire all scrubbed.

In time, valve replacement surgery results improved, in part as a result of better patient selection.

Numbers of aortic valve replacements have steadily increased, whereas mitral valve replacement numbers reached a plateau.  Mitral valve repair has played a part here.

CORONARY DISEASE SURGERY

It will come as a surprise to some that we need to go back to 1938 to learn about the first surgery undertaken for coronary disease at Wellington Hospital.

This operation had been pioneered by a brilliant young British surgeon, Lawrence O'Shaughnessy.   In a letter written to me in October 2002, Verney Cable mentioned:
"I saw the first English heart operation - a pushing, eager young surgeon who knew that angina was a consequence of defective myocardial blood supply, so he opened the abdomen of an anginal patient, took the delicate peritoneal apron which hangs from the outer curvature of the stomach and which has small arteries and veins in it, incised the diaphragm and sewed this on to the heart."
At the time, Verney was HP at the City of London Hospital for Diseases of the Heart and Lungs, Victoria Park.

Fred Bowerbank was in London in late 1937 on study leave.  Whilst there, he made two visits to the Lambeth Hospital to watch O'Shaughnessy carry out cardio-omentopexy operations, and he also attended an evening meeting at which O'Shaughnessy described the operation.  Bowerbank returned to Wellington in 1938, and so it comes as no surprise that he suggested such an operation for the patient just described.
Ten months after that first operation, another patient with angina presented.

No further such procedures were carried out at Wellington Hospital.

To find the next instances of surgery for coronary disease we need to jump forward nearly thirty years.