The Early History of the Congenital Heart Surgeons’ Society

Introduction

The 50th anniversary of the Congenital Heart Surgeons’ Society (CHSS) is chronicled and commemorated in this special edition of the World Journal for Pediatric and Congenital Heart Surgery. Previous manuscripts^1,2 have recorded some of the important achievements leading up to this celebration. However, this edition highlights the in-depth accomplishments regarding specific advances by numerous CHSS members in individual manuscripts that are steeped in rich prose, interesting vignettes, and accurate historical accounts.

The pathway leading up to the 1973 creation of the CHSS started in the early twentieth century with intrepid closed heart attempts to cure mitral valve stenosis. ³ This was followed by the successful introduction of closed heart surgery led by Crafoord and Nylin, ⁴ Gross and Hubbard, ⁵ and Blalock and Taussig. ⁶ The era of open-heart surgery using a reliable heart-lung machine was shared by Gibbon et al ⁷ and Kirklin et al, ⁸ in 1954 and 1956, respectively. By the early 1970s, perfusion equipment had evolved from creative on-site development to limited commercial availability. ⁹ Intensive care units were created, ¹⁰ and the knowledge base in pediatric cardiology was improving. ¹¹ Echocardiography first used by Edler and Hertz in 1954 ¹² consisted only of M-mode with 2D and Doppler not yet widely available until the mid-1970s. In publications from that era, Venugopal and associates ¹³ reported a 21% mortality rate for surface cooling, circulatory arrest with limited cardiopulmonary bypass; Moodie and associates ¹⁴ wrote a case report to add to the 172 reports that they found in the literature; Lev et al ¹⁵ suggested a classification to make sense of double outlet right ventricle; Murphy and colleagues ¹⁶ reported the first successful repair of type B aortic arch interruption in a three-day old neonate using a venous homograft from the father; and Trusler and associates ¹⁷ reported experience with the first 58 “Glenn” shunts with seven early deaths. These are only a few of the courageous efforts by surgeons, cardiologists, and anatomists to correct congenital heart disease en route to the introduction and development of the CHSS in 1973.

The Idea of a New Organization to Discuss Challenging Clinical Outcomes

The concept of a new organization for congenital heart surgeons in North America to discuss their difficult cases and offer each other potential solutions was the brainchild of Mr Eoin Aberdeen (Figure 1). A short introduction to Eoin Aberdeen and his vision was published by us in 2015 ¹ and is quoted herein.

“In November 1970, Mr Eoin Aberdeen left his position as Chief of Congenital Heart Surgery at Great Ormond Street Hospital for Children, London, United Kingdom, and accepted a new role as Chief of Congenital Heart Surgery at Children's Hospital of Philadelphia. Aberdeen, a native of Australia, was a recognized expert in surgical management of transposition of the great arteries (TGAs) and reported stellar results with the Mustard operation. Aberdeen's recruitment to Philadelphia occurred after Dr John Waldhausen, the presiding chair and founder of the congenital heart surgery program at Children's Hospital of Philadelphia, departed to head the new Department of Surgery at Pennsylvania State University Medical School in Hershey, Pennsylvania. Aberdeen arrived in Philadelphia with great promise and immediately started to organize his brainchild, a closely knit group of North American congenital heart surgeons, which was destined to become the Congenital Heart Surgeons’ Society (CHSS). At the outset, the group was to be based on the European Pediatric Cardiac Surgery Club of which Aberdeen was an active member.” ¹

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Figure 1.

Dr Eoin Aberdeen.

These are the foundational origins of the CHSS, which was to become the premier organization for congenital heart surgery in North America through the indefatigable efforts of many committed surgeons who steered the CHSS through many groundbreaking eras resulting in clinical improvement, academic excellence, and political presence. The following is a historical account of these developments as they relate to certain eras that shifted the focus of the CHSS toward the present structure. The authors recognize that despite honorable intentions to be accurate and inclusive, all details may not have been considered or mentioned for lack of knowledge or space. We hope that this account will establish the CHSS origins, the nuances of development, and the notable gains that have been achieved for future generations of congenital heart surgeons.

It remained for Eoin Aberdeen to organize and implement the structure that would benefit members and their patients. For this piece of history, we have the recollections, musings, and letters of Dr Albert Pacifico who served as the de facto Secretary of this fledgling association. There were no bylaws, no officers, and no committees. In a letter to CM (Figure 2), Pacifico noted,

“The Society was an idea of Eoin Aberdeen's in 1973. He wanted a small group of experienced congenital heart surgeons with a limited membership of 16 (Table 1). His idea was that the individuals would be friendly with each other and that they would meet for one solid workday each year. In order to maintain the small size of the group, membership needed to be selective, and it was important to Eoin that the members were compatible. The Society was basically organized by Eoin together with Dr John W. Kirklin.”

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Figure 2.

Letter from Dr Al Pacifico to Dr Mavroudis.

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Table 1.

Congenital Heart Surgeons’ Society Founders.

Founders	Affiliation
Eoin Aberdeen, MB, BS	Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
P.G. Ashmore, MD	Vancouver, British Columbia, Canada
Douglas M. Behrendt, MD	University of Michigan, Ann Arbor, Michigan
Aldo R. Castañeda, MD	Boston Children's Hospital, Harvard University, Boston, Massachusetts
George R. Daicoff, MD	University of Florida, Gainesville, Florida Hospital
Anthony R.C. Dobell, MD	The Montreal Children's Hospital, Montreal, Quebec, Canada
L. Henry Edmunds, MD	University of Pennsylvania, Philadelphia, Pennsylvania
Gerard A. Kaiser, MD	University of Miami, Miami, Florida
John W Kirklin, MD	The University of Alabama-Birmingham, Birmingham, Alabama
George G. Lindesmith, MD	University of Southern California, Los Angeles, California
James Malm, MD	Columbia Presbyterian Hospital, New York, New York
Dwight C. McGoon, MD	Mayo Clinic, Rochester, Minnesota
Albert D. Pacifico, MD	The University of Alabama-Birmingham, Birmingham, Alabama
Robert L. Replogle, MD	The University of Chicago, Chicago, Illinois
Albert Starr, MD	University of Oregon Medical School, Portland, Oregon
George A. Trusler, MD	Hospital for Sick Children, Toronto, Ontario, Canada

Al Pacifico, an enormously talented congenital heart surgeon at such a young age, was the appropriate person to take up the organizational structure and plan the meetings. Pacifico was well aware of the accomplishments of nonmembers and invited surgeons to report on their groundbreaking advances. Such an example was Paul Ebert who was invited to report on his results with repair of truncus arteriosus. Paul eventually became a member of the CHSS. The organized structure of the CHSS that included bylaws, officers, committees, and administrative structure would come later. Truly, the first three de facto Presidents of the CHSS were Eoin Aberdeen (Figure 1), John Kirklin (Figure 3), and Albert Pacifico (Figure 4).

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Figure 3.

John Kirklin, MD.

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Figure 4.

Picture of a young Albert Pacifico, MD.

The First Meeting

Owing to the foundational efforts of Eoin Aberdeen, the CHSS was established in Spring 1973. It was determined that the first meeting was to be held on September 7, 1973, at the Sonesta Beach Hotel in Key Biscayne, Florida. Of some historical interest, a list of major news events in 1973 were:

The United States ends its involvement in the Vietnam War

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Figure 5.

Meeting agenda of the first Congenital Heart Surgeons’ Society (CHSS) meeting.

Interestingly, the discussion period was 20 min, twice as long as the case presentation, which was highlighted by an honest give-and-take, dialectic symposium characterized by personal interest, scientific inquiry, and intellectual curiosity. The result was a scientific and clinical exchange of ideas that the membership could implement in their respective practices. It was 1973 and the notable subjects were repair of truncus arteriosus, perioperative hemodynamics, repair for right ventricular to pulmonary discontinuity, and the effect of ischemic arrest on myocardial performance, among others. Although the myocardial ischemic arrest was mentioned, no individual topics relating to myocardial preservation and cardioplegic arrest were presented. This makes sense due to the abandonment of Melrose Solution ¹⁸ and the nascent inquiries regarding cold potassium cardioplegic solution that was reintroduced in the United States by Gay and Ebert in 1973. ¹⁹ It was an interesting time in the evolution of congenital heart surgery—a process that continues today.

The original meeting was attended by pioneering surgeons who were pushing back the frontiers of clinical and scientific inquiry that were necessary for the evolving specialty of congenital heart surgery. This first meeting was attended by 11 of the original 16 members, five could not attend owing to clinical responsibilities (Figure 5). The scientific program for the inaugural meeting is noted in Figure 6. Aside from the program, we have only memories, photographs, and retrospective interviews from that meeting that allow reflection, amazement, and a unique perspective into the mirror of history. Dr Robert Replogle photographed a young Dr Dwight McGoon (Figure 7) who was the Chief of Cardiac Surgery at the Mayo Clinic. Also noted in the photograph (Figure 7) are Drs John W. Kirklin from Birmingham, Alabama, and Doug Behrendt, from the University of Michigan. By his own memory in a conversation with CM (Robert Replogle, MD, Personal communication, July 29, 2014), ¹ Replogle did not know McGoon very well before this meeting. It was a time for making friends and the beginning of the camaraderie that the CHSS was to foster among its members. Their mutual Iowa roots and engaging personalities kindled a lasting close friendship for the rest of their professional and personal careers. Replogle mentioned that McGoon had a quiet but effective style that instilled confidence and respect from his colleagues. There are other reflections of that meeting as well. On March 22, 2023, CM had the precious and singular honor to interview a now 96-year-old Dr George Trusler (Mavroudis C Personal telephone communication with Dr George Trusler on March 22, 2023) who was one of the original CHSS founding members (Figure 8). As a background to our telephone conversation, Dr Trusler noted that he engaged in a Traveling Fellowship (January through June 1957) during which time he visited John Kirklin and Dwight McGoon at the Mayo Clinic in Minneapolis. He remarked, “Everyone knew John Kirklin; at meetings, I saved up my inquiries until the end of the meeting and I turned lose my questions on John.” A chuckle followed. He also noted that “Dwight McGoon was an amazing individual with intuitive thoughts and ambitious plans.” Most of the founding members knew each other and formed the camaraderie that allowed the CHSS to grow roots and eventually become the face of congenital heart surgery in North America. Dr Trusler was very much impressed with the first CHSS meeting and noted that “the discussion was frank and interactive; you don’t get that kind of interaction at a formal meeting.” On a personal note, George has retained his brilliant memory and pleasing personality, which was obvious during the interview.

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Figure 6.

Program agenda of the first meeting of the Congenital Heart Surgeons’ Society (CHSS).

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Figure 7.

Dr Robert Replogle’s photograph of Dr Dwight McGoon. Also in the picture is Dr John Kirklin in the foreground and Doug Behrendt from The University of Michigan sitting in the background.

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Figure 8.

Photograph of Dr George Trusler at the University of Toronto.

Moving forward, in 1975, the meeting was moved to the Hyatt Regency Hotel, O’Hare in Chicago owing to geographic centrality and the ease of accessibility. Except for hotel choice, this location did not change with the exception of the 50th Anniversary Meeting (October 2023), which is to be held in Boston, Massachusetts. The meeting program underwent changes from the September, Thursday to Saturday format to the September/October Sunday to Monday schedule that is largely in effect at the present time. During the maturation of the CHSS, membership slowly increased as interest in the format encouraged members to invite others and ensure that the CHSS would have a future intake of younger members. This unwritten tenet was noted in our earlier CHSS history manuscript ¹ ; namely, “Another important decision of the founders was that invited guests were required to make a presentation to the group, thereby ensuring they would be active participants rather than observers.” An example of this outreach program was recanted by Pacifico who in 1976 invited Dr Paul Ebert to the meeting to give a talk on his excellent results with repair of truncus arteriosus. Pacifico suggested the title for Ebert, “Why My Results with Truncus Arteriosus Type I Were Better than Everyone Else's.” Ebert was a humble man and would never name a lecture in this manner. But Pacifico recognized Ebert's contributions and phrased the request in this manner so that Ebert would emphasize the technical aspects of the operation to the membership for their benefit. It is unclear what title Ebert used for his opening slide. However, he did give the talk, and this marked the beginning of his membership, future attendance, and further contributions. This was just an example of some “beautiful presentations” that were made by the membership (Albert Pacifico, Personal communication, August 14, 2014).” ¹

In 1978, Eoin Aberdeen retired from his practice of congenital heart surgery and ceded his position at the Children's Hospital of Philadelphia. Pacifico then became the informal Secretary of the CHSS and “assumed the responsibilities of organizing the meetings, collecting dues, and carrying on the business of the CHSS.”^1,2 These activities amounted to the duties of a de facto President which was to take form in the years ahead when the CHSS was incorporated in 2002.

This edition of the World Journal for Pediatric and Congenital Heart Surgery commemorates the historical accounts and achievements of the CHSS over the last 50 years. Further historical advances are noted in the subsequent manuscripts within this edition that highlight,

The establishment of the Data Center in 1984