Dr Dwight E. Harken
Dwight Emary Harken, chirurgien renommé, est né aux États-Unis en 1910. Diplômé de la faculté de médecine de l’Université Harvard, il a poursuivi une formation postdocto-rale à Londres.
Pendant la Seconde Guerre mondiale, il a servi dans le Corps médical des Forces armées américaines, où il a marqué l’histoire par ses contributions révolutionnaires à la chirur-gie cardiaque.
Advances During World War II
During the war, a fearsome projectile named after its 18th-century inventor, Major General Henry Shrapnel, caused countless fatal injuries. This device, filled with small lead pellets, exploded to scatter metal fragments in all directions, creating a deadly shower.
Heart injuries, in particular, were considered a death sentence. If the victim did not quickly succumb to massive hemorrhage, widespread infection would often prove fatal.
Dr. Rehn and the Legacy of "Don't Touch the Heart"
Dr. Dwight Harken was well-acquainted with the technique for repairing heart wounds developed by Dr. Ludwig Rehn, a pioneer in cardiac surgery.
However, gaining acceptance for this procedure from his superiors in the U.S. Army Corps of Surgeons proved to be a significant challenge. It was with the support of the British Royal College of Surgeons that he was ultimately able to put this bold technique into practice.
D-Day
On June 6, 1944, a date already etched in history as D-Day, another remarkable achievement took place. On that day, Dr. Dwight Harken performed an unprecedented procedure: he successfully removed a metallic fragment from the right ventricle of a wounded soldier.
His method involved immediately sealing the heart wound with his finger after extracting the projectile. He would then carefully suture the wound, inserting the needle only during the heart’s relaxation phase. This innovative approach made Harken the first surgeon to systematically succeed in this type of cardiac surgery.
During the war, he saved nearly 130 soldiers by removing shrapnel fragments from their hearts
The Heart Is No Longer Untouchable
In July 1946, Dr. Harken published his groundbreaking results in the American Heart Journal. In his article, he quoted the Greek philosopher Aristotle, who had written:
“Of all the organs, only the heart cannot tolerate a serious wound.”
Armed with photographic evidence documenting his successes, Harken decisively disproved this centuries-old belief. He declared that the longstanding medical taboo against “touching the heart,” which had persisted for two millennia, should now be abandoned.
This moment marked a turning point in the history of cardiac surgery, paving the way for interventions once deemed impossible.
The Next Challenge: Mitral Valve Stenosis
Returning to Boston after the war, Dr. Dwight Harken faced a new medical challenge: treating mitral valve stenosis, a severe condition that restricts bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow between the left atrium and the left ventricle of the heart.
A Bold but Risky Attempt
Harken’s approach was groundbreaking for its time. He would make an incision in the atrium, granting direct access to the mitral valve. Using a blade affixed to his finger, he manually widened the valve opening to improve bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow. Once the procedure was complete, he closed the atrium using a technique similar to the one he had perfected during his wartime shrapnel removal surgeries.
However, the outcomes were tragic. After six consecutive fatalities, Harken made the difficult yet ethical decision to abandon this approach.
Lessons in Humility
In an extraordinary display of candor and humility, he stated:
“Primum non nocere” — “First, do no harm.”
He added:
“No responsible man would continue after such a disaster.”
Harken also highlighted the importance of adaptability in medicine, asserting:
“Only the stubborn refuse to change their minds!”
A Model of Courage and Medical Ethics
This painful experience underscored the necessity for safer and more thoroughly researched methods for cardiac interventions.
It also revealed the greatness of a physician willing to acknowledge his mistakes for the sake of his patients.
Harken continued to play a pivotal role in advancing cardiac surgery, always guided by the fundamental ethical principles of medicine.
Learning from Failure: A Crucial Step Toward Success
Faced with the failure of his initial procedures, Dr. Dwight Harken found inspiration during a visit from cardiologist Dr. Lawrence Brewster Ellis.
Ellis encouraged Harken to learn from the previous fatalities and persevere, using those experiences to refine his technique.
A Turning Point
On his seventh attempt, Harken successfully performed his first surgery to treat mitral valve stenosis. This milestone occurred less than a week after Dr. Charles Bailey achieved a similar feat.
Recognizing the importance of swiftly documenting this medical breakthrough, Harken authored a detailed description of his surgery, which was published the same year in the New England Journal of Medicine, a cornerstone of medical literature.
Connections That Matter
The rapid publication of Harken’s article was made possible through his friendship with Dr. Joe Garland, editor-in-chief of the journal, who expedited the process.
In contrast, Dr. Charles Bailey’s first successful mitral valve surgery, often cited as a landmark event, was only published the following year.
Innovation and Perspective
In a spirit of humility and innovation, Harken remarked on this situation:
“Whether priority is given to the first operation or the first publication is a matter of personal opinion.”
Continuous Learning
Dr. Harken’s journey underscores the importance of learning from mistakes, being open to advice, and valuing innovation over ego or recognition.
His ability to adapt and share his discoveries remains a cornerstone of medical progress.
A Different Outcome for Aortic Stenosis
With his relentless scientific curiosity, Dr. Dwight E. Harken attempted to adapt his mitral valve repair technique to address aortic stenosis. However, he quickly discovered significant differences between the two surgical contexts.
Accessing the left ventricle proved far more challenging than the left atrium due to the significantly higher bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressures in the ventricle. These technical hurdles underscored the limitations of this approach for treating aortic stenosis, paving the way for innovative solutions in cardiac surgery.
A Lasting Medical Legacy
Dr. Dwight E. Harken passed away in 1993 from pneumonia, but his legacy remains indelible in modern medicine.
In 1951, he established the first intensive care unit, a groundbreaking innovation that transformed the management of critically ill patients.
Dr. Harken not only pushed the boundaries of cardiac surgery but also redefined standards of care, saving millions of lives and laying the foundation for modern cardiovascular medicine.
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