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The gears of life

The first machines in Brazil to replace heart and lung systems appeared in the 1950's

Revista Brasileira de Cirurgia CardiovascularThe first machine dates back to 1956Revista Brasileira de Cirurgia Cardiovascular

Brazilian heart surgery, normally linked to the field’s traditional names, such as Hugo Felipozzi, Euryclides Zerbini and Adib Jatene, as well as to the quality of scientific production, has a less well known aspect, but one that is no less important. It was largely as a result of the domestic production of the equipment used in operating theaters that this field of medicine developed [in Brazil] and became internationally acknowledged. Conducting open heart surgery only became possible thanks to the development of Brazil’s first extracorporeal circulation machine, in 1955.

“Open heart” is the expression used by physicians to designate surgery in which the heart undergoes internal surgery. To do this, one must make it stop beating while keeping the patient alive. How to solve this problem? The solution arose in 1953, when US surgeon John Gibbon invented an artificial heart-lungs pump, or extracorporeal circulation (ECC) machine, which replaced the function of the two organs while defects in the heart’s structure were repaired.

It was also in 1953 that Hugo Felipozzi, a physician from São Paulo, became acquainted with the ECC machine while in the US, where he was specializing in thoracic surgery. “Upon returning to São Paulo, he brought photographs and drawings of the equipment, already thinking about creating something similar here,” tells us Walter José Gomes, a researcher, surgeon and professor of Cardiovascular Surgery, the chair that belonged to Felipozzi at the Paulista Medical School of the Federal University of São Paulo.

With financial aid from the Anita Pastore D’Angelo Foundation, Felipozzi set up a multidisciplinary team of full-time researchers and started working at the Sabbado D’Angelo Cardiology Institute. “There were professionals from all  areas, from engineers to biochemists, who, together, built the national ECC machine,” says Gomes. On October 15, 1955, a 3-year old boy was the first to have a pulmonary valve operation with partial extracorporeal circulation. And in November 1956, the first operation was conducted in Brazil with full ECC, to be followed by many others. This was just the first product of Felipozzi’s team. Others were built, such as valve prostheses, plastic tubes to replace the aorta and disposable plastic oxygenators, for instance. When the institute was closed down a few years after these operations, the physician moved to the Paulista Medical School, but he did not have enough support to set up a bioengineering center of the same magnitude.

Euryclides Zerbini had better luck. His team, which included Adib Jatene, built an ECC machine, first used in 1958, which made open heart surgery routine at the Clinicas Hospital of the University of São Paulo (HC/USP). Zerbini put together a caravan and traveled around the country with the equipment, operating in several cities. In 1968 he performed Brazil’s first heart transplant and put his fame to good use by raising funds to build Incor, the Heart Institute, which is part of HC/USP.

“Like Felipozzi,  Zerbini realized the importance of learning,  becoming proficient and  producing here  the technology used in surgery and, to this end, he established the Heart-Lung Workshop in the late 1950’s. This subsequently became the Bioengineering Division,” says researcher Idágene Cestari, R&D Director of the InCor Bioengineering Division. Jatene did the same at the Dante Pazzanese Cardiology Institute, where he set up, back in the 1960s, an advanced bioengineering center.