John Callaghan performing open-heart surgery. Photo credit: Medical Photography, University of Alberta Hospital
This September marks the 61st anniversary of Canada's first successful open-heart surgery, performed at the University of Alberta by John Callaghan. One of the earliest trainees in cardiac surgery in the country, Callaghan went on to perform several other national firsts, including the first successful "blue baby" operation-a surgical innovation that would later be used to save the life of his great-granddaughter a decade after he had passed away.
Callaghan was "one of the great pioneers worldwide in cardiac surgery," said former colleague Elliot Gelfand. Gelfand recalls that Callaghan "was never stuck in his ways, and was open to trying new ideas and new technology," so long as it was done responsibly. "In 1968, the very first heart transplant was done in South Africa. It disturbed most authorities, and John was a leading critic of transplant during this period. He recognized that the issue was not the transplant itself, but rather the immunology and controlling rejection of organs. He believed that we should not be doing transplants until we sorted immunology out. He later was an advocate for a heart transplant program at the U of A."
Gelfand graduated from UAlberta's MD program in 1965. He then interned at the University of Alberta Hospital (UAH) where he was first introduced to Callaghan. "I spent a month in his service and became enchanted," reflected Gelfand. "He had a great sense of humor, was a great raconteur, and a wonderful guy. I owe my career to him. He was so supportive and so encouraging."
Prior to coming to Edmonton, Callaghan worked with William Bigelow in Toronto on groundbreaking hypothermic research that demonstrated the benefits of cooling the heart prior to surgery. Collaborating with electrical engineer J. A. Hopps, National Research Council of Canada, the two also co-developed the first intravenous pacemaker.
In 1955, Callaghan joined the Department of Surgery at the U of A. He was recruited by department head and future dean Walter C. Mackenzie, who tasked Callaghan with starting an open-heart surgery program. Under Callaghan's leadership, the U of A program was soon at the forefront of cardiac surgery in Canada.
First successful open-heart surgery in Canada
Canada's first successful open-heart surgery took place in September 1956 at the UAH. Callaghan recounts the first successful open-heart surgery in his book 30 years open heart surgery at the University of Alberta Hospitals, a copy of which is available in the Rawlinson Collection at the John W. Scott Health Sciences library.
Remembering the preparation that went into the first surgery, Callaghan writes, "The year prior to our first case found many of us heavily involved in the Surgical Medical Research Institute, setting up the fundamentals for extracorporeal circulation. We had already chosen the Lillehei-DeWall pump oxygenator, and the checking and double-checking of performance under experimental conditions and meticulous attention to sterility were constantly being undertaken."
The operation itself took 10 hours and the heart lung pump that the team used looked like it came from a hardware store. In an article recapping Callaghan's accomplishments, journalist Richard Cairney wrote, "The pump, which ran on a gravity-feed system, had almost as many parts as a car: nearly 40 tubes of different diameters and lengths had to be sterilized and connected before an operation could begin."
Callaghan's team included Eric Elliott, Morris Friedman and nurse Anita Wilde who helped set up and monitor the heart-lung pump, as well as Ted Gain, who coordinated the anaesthetic component of the operation. Les Willox, a more senior surgeon, who according to Callaghan "provided surgical maturity," was also present along with Lois Eiffert, a scrub nurse, resident William "Bill" Lakey, and cardiologists Joe Dvorkin and Robert Fraser. The latter two also led the postoperative care.
Callaghan's groundbreaking and internationally recognized clinical work, of which the first open heart surgery is just an example, led the way for the first successful heart transplantation in western Canada-performed by Dennis Modry in 1986-and set the foundation for U of A's current world-renown heart program.
Here is a timeline of some of the 'firsts' Callaghan was responsible for over the course of his career, as well as some notable milestones:
1949: While a research fellow at the Banting and Best Institute in Toronto, Callaghan and Wilfred "Bill" Bigelow collaborate with electrical engineer J. A. Hopps of the National Research Council of Canada to develop the first intravenous pacemaker.
1955: Callaghan joins the UAlberta surgical department.
1956: Callaghan performs the first successful open-heart surgery in Canada at the UAH.
October 24, 1956: Callaghan performs his first operation on an atrial septal defect. The patient, 10-year-old Suzanne Beattie, is the fourth patient to undergo open-heart surgery. Callaghan remembers, "with the first few open hearts behind us, we began to develop a little more confidence and began to attack more complex forms of abnormalities."
December 1956: Callaghan leads the first successful "blue baby" operation in Canada. The operation repairs cross-circulation problems in the heart of an 18-month-old.
January 1957: Callaghan performs the first open-heart surgery to correct a complex form of tetralogy of Fallot in Canada. The patient, Dolly Ann, was four years old.
1960: The division of thoracic and cardiovascular surgery is established with John Callaghan as the divisional director.
1962: Callaghan performs the first successful Starr-Edwards mitral prosthesis implant in Canada to replace patient Irene Dahl's diseased mitral heart valve. This is the first successful heart valve replacement in Canada.
1963: Callaghan performs the first double valve replacement in Canada.
1965: 24-year-old Louise Visser agrees to have her aortic valve replacement performed on nationwide television. The video is produced by CBC, narrated by Callaghan and shown in North America and Europe.
June 7, 1967: Monica McAllister is the 1,000th patient to undergo open-heart surgery at the UAH.
1967: Nick Zubko of Cine Audio produces the short film New Hearts For Old, funded by the Alberta Heart Foundation. The film includes footage from Callaghan's heart surgeries, animation by Meredith Evans, script and performance by Jerry Forbes (CHED radio), and musical direction by Keith James of CHED radio assisted by Bob McCord. Joining Forbes in his role of the father is Gracy Anness as the mother (Callaghan's then-future wife) and Bret Couves (son of U of A surgeon Cecil Couves) as the nine-year-old patient.
June 1977: Callaghan's open-heart surgery on patient Richard Folstad is filmed live and transmitted to the annual meeting of the Canadian Medical Association at the Fairmont Hotel MacDonald.
March 1986: Domenico Marano is the 7,000th patient to undergo open-heart surgery at the UAH.