John Gibbon and the heart-lung machine: a personal encounter and his import for cardiovascular surgery.

I am privileged to have been invited to participate in this Golden Anniversary of the development and first successful clinical use of the heart-lung machine, and I am especially touched to be able to honor Dr Gibbon’s memory. He was not only a friend but also an inspiration to me. I had the pleasure of meeting Dr Gibbon for the first time in the 1930s at a medical meeting, and he later invited me to his laboratory to discuss the experimental work he was then doing on the heart-lung machine using cats. He noted that one of the mechanical problems he encountered was the pump; he was dissatisfied with the one he was using. He had devised a pump himself and had used the Dale Schuster pump for perfusion, but these were simply not adequate for his purposes. When I was a medical student at Tulane University School of Medicine, I had the privilege of working as a technician in a research laboratory. The faculty member under whom I was working was interested in a pump that he could use to study the pulse wave, and he asked me to find such a pump. As a medical student, I had no knowledge of pumps, but I felt a responsibility to fulfill my assignment. I went to the medical library in search of existing knowledge about pumps, but I felt I needed more information. Then I remembered that one of my freshman classmates in the Tulane College of Arts and Sciences decided to study engineering. We had become good friends during college, and when he went into engineering and I went to medical school, we continued to see each other at lunch or dinner about once every week or two. Shortly after my assignment to find a pump, I met him and mentioned my frustration. He pointed out that I had gone to the wrong library and directed me to the one in the engineering school, where, he said, I would find a great deal about pumps. I immediately went to that library and found that people had been working on pumps for more than 2,000 years, dating back to Archimedes, who developed a pump for irrigation purposes (similar in principle to an axial flow pump, to which I will refer later). As a consequence of my library experience, I developed the roller pump. When I became a resident at the Charity Hospital in New Orleans, we used direct blood transfusions (there were no blood banks at the time), and I used this pump quite successfully for that purpose [1]. And so when I met Dr Gibbon, I suggested that he might try this pump. I then sent him a model of my roller pump, which he subsequently incorporated into his heart-lung machine. In some of his articles, he graciously referred to obtaining the roller pump from me [2]. And that is how it became an integral component of the heart-lung machine. I would like to comment on some other aspects of Dr Gibbon’s contribution because it had a much more profound effect than the mere construction of a mechanical pump for temporary replacement of the function of the heart and lungs. Once he showed successfully that it could be used for that purpose, that success had a profound impact on the medical community, particularly on researchers who were interested in the cardiovascular field. In a way, he blasted open the door that had been locked for centuries against any medical therapeutic intrusion into the cardiovascular field, and he thus helped greatly to stimulate the developments in the past half century that have provided us the satisfying experience we have today in dealing with cardiovascular problems. Not that we have completed that process by any measure. After all, we still do not know the real cause of arteriosclerosis, although we do know a great deal more about how to deal with it and with other forms of cardiovascular disease because of the door he opened. That, I think, is the most important aspect of his contribution. The mechanical part was, of course, also important, but he stimulated the imagination of other researchers, and his contribution certainly had a great impact on me. In this connection, it is of interest that Dr Gibbon, in his Presidential Address before the Society for Vascular Surgery in 1965, recognized some aspects of this impact by choosing with admirable insightfulness to discuss the artificial intracorporeal heart [3], a device that has since received increasingly intensive investigation. I have selected a series of illustrations to show Dr Gibbon’s impact from my standpoint, because it also illustrates the impact on many others. Figure 1 is an autographed photograph he kindly gave me. This quotation from one of his early articles projects a vision that led to the event of half a century ago that we are celebrating today—one of the truly great sagas of medical research in Presented at the symposium, “Gibbon & His Heart-Lung Machine: 50 Years & Beyond,” Philadelphia, PA, May 2, 2003.