Yesterday, Today, and Tomorrow

摘要

Good morning. It is my pleasure to welcome you all to the 49th meeting of the American Society for Artificial Internal Organs. I am especially pleased as your President to welcome the International Society of Artificial Organs to Washington, DC, for the first joint meeting of our two societies. I have two passions in life—one is my family, as depicted here during a recent family gathering (Figure 1), and the other is medicine. The first ASAIO meeting I attended was in 1967 in Atlantic City. I was a first year surgical resident and was overwhelmed and awed to be in the company of the pioneers of this society. Little did I know that nearly 30 years later I would be standing here as your president. I am truly honored and humbled by this experience. Figure 1: Family picture during a recent vacation cruise.Yesterday, my early years were spent in surgical training with Dr. Adrian Kantrowitz, who is shown in Figure 2 with Dr. Joseph Krakauer, with one of the early intra-aortic balloon pump patients. 1 These were very exciting times for me as a young physician. These were the days of the initial implants of the mechanical auxiliary ventricle, the intra-aortic balloon pump (IABP), and the first cardiac transplants done in the United States. I want to tell you the story of the first patient to receive an IABP. Dr. Kantrowitz involved his clinical house staff in many of his research projects. Figure 2: Dr. Joseph Krakauer and Dr. Adrian Kantrowitz, at the bedside of one of the initial balloon pump patients.My assignment was the IABP. One afternoon Dr. Kantrowitz called me and said, “Steve, we’re ready for a clinical patient. Find me one.” As a first year surgery resident, I was responsible for covering the emergency room at night. In the break room next to the emergency room was a 24/7 poker game. The room was filled with cigarette smoke, empty pizza boxes, and people sitting in for a few hands of poker. That evening on my way home I stopped to check the ER and sat in for a few hands of poker. Sitting next to me was Dr. Menachem Shapiro, the Chief Medical Resident. I explained the function of the IABP to him and said, “Menachem, if you have a patient with cardiogenic shock, give me a call, and we will implant the IABP.” At 4 A.M. my phone rang, and it was Menachem. He said, “Steve, we have a 48 year old woman who is dying in cardiogenic shock. Come on over with your pump.” I mobilized the team, and we met at the patient’s bedside. As it was 5 A.M., I did not want to awaken Dr. Kantrowitz, nor did Dr. Shapiro want to awaken the Chief of Cardiology. Drs. Tjonneland, Butner, and I inserted the first IABP. It functioned quite well and allowed the patient to survive. At 7 A.M. we called our respective chiefs who came running to the patient’s bedside with great trepidation. The reason was that in those days the department of medicine and the department of surgery were not on the most collegiate terms. In retrospect, I am sure that the IABP would never have been inserted if it were left up to the chiefs to decide. Shortly after Christian Barnard performed his historic heart transplant in Cape Town, South Africa, Dr. Kantrowitz performed a second transplant in the United States. It was done on a 3 week old baby utilizing deep hypothermia and circulatory arrest. The transplant was carried out in the middle of the night. The bathinette that we used for the transplant belonged to my first son, because the only bathinettes available were unacceptable for clinical use, as they were from the animal lab. As all the stores were closed and I had a newborn son, I ran to the house staff quarters and literally took my son’s bathinette out from under him (Figure 3). Figure 3: Preparing a 3 week old infant for the first US cardiac transplant using my oldest son’s bathinette. The procedure was performed utilizing deep hypothermia and circulatory arrest.This next picture (Figure 4) is of a young Dr. Phillips explaining the IABP to Dr. Christian Barnard and Dr.