Fifty years of the Slovenian Open Heart Surgery (1958–2008)

Abstract

Background: The beginnings of the Slovenian open-heart surgery reach back to 1958, when the first heart surgery using ECC was performed. The fiftieth anniversary of this event was the impetus for reviewing its developmental path. Methods: Using history-of-medicine methodology, including analyzing primary archival sources and documents, various secondary sources, and interviews from the relevant field connected with the Department of Cardiovascular Surgery of the Ljubljana and Maribor University Medical Centers, we collected, processed, and analyzed the data, and summed up the fifty years of development. Results: The first open-heart surgery in Ljubljana was performed in September 1958 using a Slovenian-made cardiopulmonary bypass machine. This was followed by the first heart-valve implantation and the first pacemaker implantation in 1965. The first coronary artery bypass was performed in 1971 using a vein graft, and in 1973 the same procedure was performed using the mammary artery. Pediatric cardiac treatment began in 1958 and significantly expanded in 1974. Longer cardiac procedures were made possible by the introduction of cardioplegia in 1975 and hypothermia in 1979. In 1986, Miro Košak performed the world’s first successful cardiac autotransplantation. The first cardiac transplantation in Slovenia was performed in 1990. The late 1990s saw the introduction of beating-heart surgery, which is now being used to perform the majority of revascularization procedures. This was followed by minimally invasive approaches and the introduction of endoscopic cardiac surgery in 2000. In 2003, Borut Geršak and his team introduced the first endoscopic aortic valve surgeries on a beating heart. In 2006, the surgical treatment of atrial fibrillation using radiofrequency ablation was introduced, and since 2007 an external centrifugal heart pump has also been used with patients suffering from heart failure. Since 2001, the Maribor cardiac surgery department has been performing all cardiac procedures independently, with the exception of pediatric surgical treatment. A third Slovenian cardiac surgery center, the Medicor Medical Center, was established in 2003 at the hospital in Izola. Together, these three cardiac surgery units meet all the Slovenian needs for cardiac procedures and have minimal waiting times, results comparable to other European centers, and short hospitalization periods. In Slovenia, cardiovascular surgeons perform all the cardiac procedures by themselves, totaling approximately 2,600 procedures a year. They train at international cardiovascular surgery centers, teach at the Ljubljana and Maribor medical faculties, take part in research, and establish international connections.