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50th Anniversary Landmark Commentary on Bove EL, Behrendt DM. Open-heart surgery in the first week of life. Ann Thorac Surg 1980;29:130–4

2015; Elsevier BV; Volume: 100; Issue: 2 Linguagem: Inglês

10.1016/j.athoracsur.2015.06.052

1552-6259

Pirooz Eghtesady,

Pulmonary Hypertension Research and Treatments

Many Star Wars fans are looking forward to the upcoming December release of Episode VII: The Force Awakens. It was 25 years ago, in 1980, when the Empire Strikes Back was released, the largest grossing movie in the history of film at the time. It was perhaps a sign of the times. President Reagan had transitioned from movies to Governor and finally President of the United States. Miniaturization of electronics introduced the “camcorder” and fax machines. The United States boycott of the Moscow Olympics and the war breaking out between Iraq and Iran had affected the international political scene, and perhaps changed it forever. A quiet revolution was also taking place in the world of cardiac surgery. In this commemorative issue of The Annals, we highlight the landmark article by Drs Bove and Behrendt [1Bove E.L. Behrendt D.M. Open-heart surgery in the first week of life.Ann Thorac Surg. 1980; 29: 130-134Abstract Full Text PDF PubMed Scopus (18) Google Scholar], which marks a new era—that of complete cardiac repair in the newborn. Although the report summarizes the experience with only 11 patients, it is a major achievement and a hallmark of what was to come in the field of pediatric cardiology and cardiac surgery. Figure 1 illustrates this point, as published literature on the topic of neonatal cardiac surgery increased greatly after 1980. During this era, Drs Castaneda in Boston, Barratt-Boyes in New Zealand, Ebert in San Francisco, and Behrendt in Ann Arbor (and Dr Herbert Sloan before him), among others, were slowly and methodically pushing the envelope regarding the repair of many defects, such as transposition of great arteries, truncus arteriosus, and tetralogy of Fallot, among others, in newborns rather than doing palliative procedures or waiting for the child to get older (and often sicker!). As the authors emphasized in their report, this achievement relied on important collaboration requiring the efforts and support of many, especially pediatric cardiology, critical care, and anesthesia colleagues. I suspect there were those who did not agree, who thought the approach was “out there,” and perhaps even others who tried to place obstacles in the way of this undertaking. It is remarkable to note that 7 of the 11 infants in this report survived the operation, many with severe and premorbid conditions, and some with rather complex anatomies. This was achieved during a time when dedicated cardiac intensive care units did not exist, preoperative maintenance of ductal patency with prostaglandins was just being introduced, surface hypothermia was still a key part of intraoperative management, and much had yet to be learned in caring for the average neonate. It is remarkable that nearly all of these infants were extubated within 72 hours; if we could only go back in time! Despite circulatory arrest times as long as 90 minutes, only 1 infant sustained neurologic injury. The same infant, however, was in shock before going to the operating theater. An accurate diagnosis of many of these infants required cardiac catheterization, which in many ways was also in its infancy. Uncertainty about diagnosis and what was to be found in the operating room likely lurked in the back of the minds of many of these brave pioneers. At the time, Dr Bove—now one of the giants in the field—was a cardiothoracic surgery fellow. No doubt this experience had a profound effect on his career. When he finished his training and returned to Ann Arbor, he championed early primary repair when possible and, along with others, set the standards for neonatal heart surgery that are now widely practiced. It gives me pause, having read this article, to reflect on what we are doing now, what we consider “out there” (eg, ventricular assist device support in the single-ventricle neonate?) that is currently not routine but will someday become part and parcel of our specialty. Each one of the Star Wars films starts with these lines “A long time ago, in a galaxy far, far away….” Indeed, we have come a long way, thanks to real-life heroes like Dr Edward Bove. May the force also be with all others who dare to keep pushing the frontier!