The artificial heart valve

Albert Starr is at Providence St. Vincent Medical Center, 9155 Southwest Barnes Road, Suite 240, Portland, Oregon 97225, USA. e-mail: astarr@starrwood.com Published online 17 September 2007; doi:10.1038/ nm1644 So much in life is determined by being in the right place at the right time, and by being prepared and bold enough to seize opportunities as they present themselves. I was prepared in large part by Columbia University—as an undergraduate at Columbia College, then as a medical student at Columbia College of Physicians and Surgeons, and finally as a resident training in both general surgery and cardiothoracic surgery. A surgical internship at Johns Hopkins with the great Alfred Blalock provided a southern flavor to my Northeast background. For the boldness, I owed my parents and my great teachers. At Columbia College, it was Lionel Trilling; at Physicians and Surgeons, it was George H. Humphreys III, Frank Berry and the master of surgical technique J. Maxwell Chamberlain. With this background, I arrived at the right place—the University of Oregon Medical School, with its brand new University Hospital and frontier mentality—in August 1957 to start their program in open-heart surgery with the confidence, not unusual in a surgeon, that I could do anything. The timing was also right; cardiac surgery was just getting started. The major focus was on the treatment of congenital heart disease. Surgeries for patent ductus arteriosus, coarctation of the aorta, and tetralogy with the Blalock Taussig shunt—all performed outside the heart—were in place. The first open-heart surgery using the heart lung machine had been performed by Gibbon1 in 1953. In Minnesota, Lillehei and Varco in Minneapolis and Kirklin in Rochester were making steady progress in the same direction2,3. My job was to introduce their techniques to Oregon and achieve results similar to our great Midwestern centers as soon as possible. In the fall of 1957 we opened an animal laboratory to perform studies on oxygen consumption during cardiopulmonary bypass, and to address surgical issues of atrial septal defect and pulmonary hypertension. When we treated our first patient in the spring of 1958, the operating room was our laboratory, and I became fully engaged in clinical work. At that time I had a visitor, a retired engineer named M. Lowell Edwards (Fig. 1), who asked if I would collaborate with him in the development of an artificial heart. He was serious. I told him it was too soon, that we did not even have satisfactory artificial valves, and that simple vascular grafts were not yet fully satisfactory. The quality of valve surgery itself was still relatively crude for both closedand open-heart techniques. But we made a deal. We would start the project by developing one valve at a time, taking the mitral first and later doing the heart. We shook hands. In the West that was it. I watched him walk to his car through my office window. He was fragile with early Parkinson’s disease and wore crumbled slacks, a sports shirt without a tie and a tan golfing jacket. I did not realize then that I was taking on an additional full-time job. Edwards would set a grueling pace. His background was in hydraulic engineering, and he designed many hydraulic debarking systems for the lumber industry. He had many patents, the most important of which was his fuel-injection system for rapidly climbing aircraft during World War II. His royalty income financed the Edwards Development Laboratory, a private engineering and research company in Portland, where his interests in fluid dynamics was now directed to the human circulation.