What happened next

Stanford’s heart transplant breakthrough precipitated years of protocol advances

The first successful adult heart transplant in the United States, performed 50 years ago at Stanford Hospital by Norman Shumway, MD, PhD, ultimately led to the success of the procedure around the world today.

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Surgeon Norman Shumway and cardiologist Ed Harrison speak to the media, below, after the historic surgery. (Photo: Stanford Medical History Center)

The operation, which took place Jan. 6, 1968, sparked a flurry of heart transplantations worldwide, but most institutions and cardiac surgeons quickly stopped because of the high rate of post-surgical deaths.

However, Shumway and his team at Stanford persisted.

“Norman Shumway not only introduced a lifesaving procedure but also made sure that the operation became widespread practice,” says Lloyd Minor, MD, dean of the School of Medicine. “We are honored to celebrate the anniversary of this unforgettable moment in Stanford Medicine’s history, and to recognize Dr. Shumway’s radical innovation and perseverance.”

Dream finally realized

The operation was the culmination of a decade of research during which Shumway and colleagues perfected the surgical technique still in use around the world today. Through studies in dogs, they worked out the surgery, developed the method of preserving the donor heart in cold saltwater, and gained insights for overcoming the key stumbling block to survival after heart transplantation — donor heart rejection.

In the years following that first transplant, Stanford’s program — working under the auspices of the National Institutes of Health Program Project Grant for Cardiac Transplantation — made further advances that greatly improved patient survival rates, writes Joseph Woo, MD, current chair of cardiothoracic surgery, in a 2015 article for the journal Seminars in Thoracic and Cardiovascular Surgery.

“These included refinements in immunosuppression, management of complications such as infection and lymphoma, distant heart procurement, patient and donor selection criteria, and the diagnosis of rejection by biopsy,” Woo writes.

In 1972, assistant professor of cardiovascular surgery Edward Stinson, MD, who assisted in the first transplant, and visiting scientist Philip Caves, MD, performed the first cardiac biopsy on a transplant patient, which provided a noninvasive method of measuring the potential for rejection of a donor heart. By 1980, Stanford had also advanced the use of the immunosuppressive drug cyclosporine, an essential breakthrough for preventing donor heart rejection.

Using these improvements, in 1981, Bruce Reitz, MD, who succeeded Shumway as chair of the department and is now a professor emeritus of cardiothoracic surgery, performed the world’s first heart-lung transplant at Stanford.

Mechanical heart advances

During the 1980s, Stanford went on to advance the field of mechanical heart support. Stanford researchers developed a left ventricular assist device, or LVAD, which made history in 1984 when Phil Oyer, MD, PhD, Stanford professor of cardiothoracic surgery, implanted the device for the first time to keep a gravely ill heart patient alive mechanically for eight days until a heart was available for transplantation — a procedure called “bridge to transplant.”

“Although a few other types of LVADs had been implanted elsewhere by that time, this was the first patient in the world who survived both the LVAD implant and heart transplant operation to be discharged from the hospital and, in fact, lived an active life for more than 23 years,” Oyer says.

Surgery improved

In 1995, Reitz performed the first Heartport procedure, using a device that allows for heart surgery via small incisions between the patient’s ribs, eliminating the need for cutting the breastbone. And in 2004, Lucile Packard Children’s Hospital Stanford became one of the first U.S. hospitals to use the Berlin Heart, an external heart pump, keeping a 3-month-old child alive for 55 days until a transplant could be done.

Since that first heart transplant in 1968, the total number of heart transplants performed at Stanford had reached 1,933 as of December 2017. More than 60,000 successful heart transplants have been performed around the world.

Today, 80 percent of patients who receive a heart transplant survive the first year. 

Tracie White is a science writer for the medical school’s Office of Communication & Public Affairs. Email her at tracie.white@stanford.edu.

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