John W. Kirklin

John Webster Kirklin (April 5, 1917 – April 21, 2004) was an American cardiothoracic surgeon, general surgeon, prolific author and medical educator who is best remembered for refining John Gibbon's heart–lung bypass machine via a pump-oxygenator to make feasible under direct vision, routine open-heart surgery and repairs of some congenital heart defects. The success of these operations was combined with his other advances, including teamwork and developments in establishing the correct diagnosis before surgery and progress in computerized intensive care unit monitoring after open heart surgery.

After completing his undergraduate education at the University of Minnesota, Kirklin gained admission to Harvard Medical School from where he graduated in 1942. He was a neurosurgeon during the Second World War, but later, after being appointed to the Mayo Clinic in 1950, specialised in the surgical treatment of congenital heart disease. From 1964 he led the surgical departments at the Mayo Clinic and from 1966 until retirement, held the same position at the University of Alabama School of Medicine (UAB). He performed the world's first successful series of open heart operations using the heart-lung machine. The Board of Governors at the Mayo Clinic approved the first eight operations, of whom four (50%) survived.

Kirklin had the idea of training surgeon assistants as a new type of physician's assistant and started the UAB's Surgeon Assistant (SA) Training Programme in 1967. He was also the editor of The Journal of Thoracic and Cardiovascular Surgery and received a number of honorary degrees from universities around the world. He was president of the American Association for Thoracic Surgery in 1978.

Early life and education John Kirklin was born in Muncie, Indiana, in the United States, on April 5, 1917. His parents were Byrl Raymond Kirklin, a radiologist, and Gladys Marie Webster Kirklin. He had one sister, Mary W. Kirklin. At the age of eight, he moved with his family to Minnesota, where his father became the first director of radiology at the Mayo Clinic. Subsequently, he completed his undergraduate education at the University of Minnesota in 1938 He then carried out his internship at the University Hospital of Pennsylvania and finished his residency at the Mayo Clinic.

In 1952, F. John Lewis, at the University of Minnesota, used deep hypothermic circulatory arrest to visualize and directly close an atrial septal defect (ASD) in a five-year-old girl. In 1954, Kirklin's rival, C. Walton Lillehei used the technique of cross-circulation to operate on an 11-month-old baby who died on the 11th day after surgery. Usually using the parent for cross-circulation, he performed 45 operations of ventricular septal defects (VSDs), ASDs and tetralogy of Fallot. 30 survived and 20 were still alive 50 years later.

Following the experimental trial in dogs, which by 1955 had demonstrated a 90% survival following heart-lung bypass, Kirklin's team were granted permission by the governance of the Mayo Clinic to go ahead with a clinical trial in eight children, using the machine. In March 1955, the first child survived a repair of a VSD. One such surgeon was Donald Ross.

Initially, unsuccessful open heart surgery was frequently the result of errors in diagnosis and limited understanding of the anatomy and pathophysiology of the congenital heart defects that the surgeons were attempting to correct. Under Kirklin's leadership, other innovations contributing to better success at surgery included developments in establishing the correct diagnosis before surgery and in the progress of computerized intensive care unit monitoring after open heart surgery.

University of Alabama

After years as the chair of the Department of Surgery at the Mayo Clinic, Kirklin accepted the same position at the University of Alabama at Birmingham School of Medicine in 1966,

In addition, Kirklin developed the use of technology for continuous monitoring of vital functions in the intensive care unit.

He started the UAB's Surgeon Assistant (SA) Training Programme in 1967, with four students and enrolling his wife, Margaret Kirklin, as the programme's first Academic Director. This was America's first formal educational programme to train surgeon assistants. They had three children, He died, aged 87, on April 21, 2004, following a head injury. During Kirklin's lifetime, almost one million heart operations had been performed around the world using the heart-lung bypass machine.

Awards and honours Among the awards and honours that Kirklin received are: Elected honorary FRCS England in 1970 The Lister Medal 1972, for his contributions to surgical science. The corresponding Lister Oration, given at the Royal College of Surgeons of England, was delivered on 11 April 1973, and was titled 'An Academic Surgeon's Work'. The American Heart Association Research Achievement Award, 1976 The Ray C. Fish Award (the medal of the Texas Heart Institute) 1977 The Rudolph Matas Award in Vascular Surgery The Rene Leriche Prize of the International Society of Surgery and the American Surgical Association Medallion for Scientific Achievement

Between 1978 and 1979, he was president of the American Association for Thoracic Surgery.

In addition, he received honorary degrees from a number of universities including LMU Munich, the University of Alabama at Birmingham School of Medicine (UAB), Indiana University, the University of Bordeaux, and the University of Marseille.

Selected publications Kirklin had more than 700 publications to his name and with his colleague, Brian Barratt-Boyes, he authored the textbook Cardiac Surgery.

Books The Tetralogy of Fallot from a surgical viewpoint, with Robert B. Karp, Philadelphia: Saunders (1970), Cardiac Surgery, Wiley, 1986. (With Brian Barratt-Boyes) "The Surgical Treatment of Acute Myocardial Infarction", co-authored with James K. Kirklin, International Practice in Cardiothoracic Surgery, Springer Dordrecht (1986), pp. 1069–1079 ,

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