John W. Kirklin

John Kirklin was born in Muncie, Indiana, in the United States, on April 5, 1917.{{Cite journal|last1=Hurst|first1=J. Willis|last2=Fye|first2=W. Bruce|last3=Weisse|first3=Allen B.|date=December 2005|title=John W. Kirklin (1917–2004)|journal=Clinical Cardiology|language=en|volume=28|issue=12|pages=585–586|doi=10.1002/clc.4960281210|pmid=16405204|pmc=6654028}}{{Cite journal|last=Fontan|first=Francis|date=July 2000|title=John Webster Kirklin: consummate cardiac surgeon and scientist|journal=Cardiology in the Young|language=en|volume=10|issue=4|pages=332–339|doi=10.1017/S1047951100009628|pmid=10950329|s2cid=28637994|issn=1467-1107}} His parents were Byrl Raymond Kirklin, a radiologist, and Gladys Marie Webster Kirklin. He had one sister, Mary W. Kirklin.{{Cite journal|last=Hodgson|first=John R.|date=1959-05-01|title=Byrl Raymond Kirklin 1888–1957|url=https://www.gastrojournal.org/article/S0016-5085(59)80043-3/pdf|journal=Gastroenterology|language=en|volume=36|issue=5|pages=714–715|doi=10.1016/S0016-5085(59)80043-3|issn=0016-5085|doi-access=free}} 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.{{Cite web|url=http://www.encyclopediaofalabama.org/article/h-3980|title=John Webster Kirklin|last=Wright|first=A.J.|website=Encyclopedia of Alabama|language=en|access-date=9 February 2019}}{{Cite journal|last1=Patel|first1=Toral R.|last2=Tubbs|first2=R. Shane|last3=Pennycuff|first3=Tim L.|last4=Shoja|first4=Mohammadali M.|date=2015|title=John Webster Kirklin (1917–2004)|url=https://ijhpm.org/index.php/IJHPM/article/view/110|journal=International Journal of History and Philosophy of Medicine|pages=1–3|doi=10.18550/ijhpm.011515.0508|doi-broken-date=1 November 2024 |archive-url=https://web.archive.org/web/20190212012801/https://ijhpm.org/index.php/IJHPM/article/view/110 |archive-date=2019-02-12 |url-status=dead }} Subsequently, he completed his undergraduate education at the University of Minnesota in 1938 after which, in 1942, he graduated from Harvard Medical School.{{Cite journal|last=Cooley|first=Denton A.|date=2004|title=In Memoriam John W. Kirklin 1917–2004|journal=Texas Heart Institute Journal|volume=31|issue=2|pages=113|issn=0730-2347|pmc=427366}}{{Cite journal|last=Cooley Denton A.|date=22 June 2004|title=John W. Kirklin, MD|journal=Circulation|volume=109|issue=24|pages=2928–2929|doi=10.1161/01.CIR.0000133601.16718.0F|doi-access=free}} He then carried out his internship at the University Hospital of Pennsylvania and finished his residency at the Mayo Clinic.

In 1944, Kirklin began service with the United States Army with the rank of captain and undertook neurosurgical training at O'Reilly General Hospital in Missouri. He served as an army neurosurgeon until he was discharged in 1946.

File:1955 heart lung machine.jpg

Kirklin's interest in neurosurgery changed to heart surgery and congenital heart disease under Robert Gross at the Boston Children's Hospital. In 1950, he was appointed to the Mayo Clinic in Rochester, Minnesota. He later recalled writing notes "about how we would fix the inside of a heart if we could get there. We couldn't, of course, but being young, you dream!".{{Cite web|url=https://core.ac.uk/download/pdf/82431342.pdf|title=The Journal of Thoracic and Cardiovascular Surgery|last=Stephenson|first=Larry W.|date=July 2007|website=www.jtcvs.org|access-date=11 February 2019}}

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 the same year, Kirklin formed a team of specialists including a cardiologist, a physiologist and an engineer to advance a cardiac surgical programme for the clinical application of a mechanical pump-oxygenator. Kirklin acquired John Gibbon's pump-oxygenator blueprint after evaluating other devices. Gibbon had successfully closed an ASD in an 18-year-old woman on 6 May 1953, with use of his machine, the only successful procedure using the pump-oxygenator machine before Kirklin's work.

Kirklin refined the heart-lung machine (screen type) originally developed by Gibbon, to the point that it allowed the person to receive oxygenated blood, temporarily providing a blood free environment to work on the heart.{{Cite journal|last=Melrose|first=D. G.|date=1961|title=Types Of Heart-Lung Machines Used In Extra-Corporeal Circulation|url= |journal=Postgraduate Medical Journal|volume=37|issue=433|pages=639–645|doi=10.1136/pgmj.37.433.639|pmid=14472465|pmc=2482473}} 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.{{Cite book|url=https://books.google.com/books?id=BAnjCQAAQBAJ&q=john+w.+kirklin+cardiac+catheterization&pg=PT21|title=Congenital Heart Disease: Molecular Genetics, Principles of Diagnosis and Treatment|last1=Muenke|first1=Maximilian|last2=Kruszka|first2=Paul S.|last3=Sable|first3=Craig A.|last4=Belmont|first4=John W.|date=2015|publisher=Karger Medical and Scientific Publishers|isbn=978-3-318-03004-4|pages=6–7|language=en}}

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. In this planned series of clinical cases, a 50% survival was reported. This was the first clinical series of open heart surgeries performed with a mechanical pump-oxygenator. Prior to this, the conditions were predominantly fatal. He therefore 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.

As a result, open heart surgeries and repairs of some heart defects could be performed under direct vision routinely and with a high degree of success. Kirklin's modifications and team work also allowed repairs of tetralogy of Fallot.

Varying in style and character, Lillehei and Kirklin worked only 90 miles away from each other. During the 1950s and 1960s, the trend for ambitious trainee cardiac surgeons was to fly to Minneapolis to observe Lillehei and subsequently travel to the Mayo Clinic to then watch Kirklin.{{Cite journal|last1=Daly|first1=Richard C.|last2=Dearani|first2=Joseph A.|last3=Mcgregor|first3=Christopher G. A.|last4=Mullany|first4=Charles J.|last5=Orszulak|first5=Thomas A.|last6=Puga|first6=Francisco J.|last7=Schaff|first7=Hartzell V.|last8=Sundt III|first8=Thoralf M.|last9=Zehr|first9=Kenton J.|date=May 2005|title=Fifty Years of Open Heart Surgery at the Mayo Clinic|url=https://www.mayoclinicproceedings.org/article/S0025-6196(11)63095-4/pdf|journal=Mayo Clinic Proceedings|volume=80|issue=5|pages=636–640|doi=10.4065/80.5.636|pmid=15887431|doi-access=free}}{{Cite book|url=https://books.google.com/books?id=kfYeQSgWSwEC&q=john+kirklin+surgeon+assistant&pg=PP49|title=The Rise And Fall Of Modern Medicine|last=Le Fanu|first=James|date=1999|publisher=Little, Brown Book Group|isbn=978-0-748-13143-3|language=en}} One such surgeon was Donald Ross.{{Cite journal|last=Stoney|first=William S.|date=2009|title=Evolution of Cardiopulmonary Bypass|url=http://pdfs.semanticscholar.org/321c/b7669a5ad67038d9d6d2ddf7f8cdabdb160c.pdf|archive-url=https://web.archive.org/web/20190222021539/http://pdfs.semanticscholar.org/321c/b7669a5ad67038d9d6d2ddf7f8cdabdb160c.pdf|url-status=dead|archive-date=2019-02-22|journal=Circulation|publisher=American Heart Association|volume=119|issue=21|pages=2844–2853|doi=10.1161/CIRCULATIONAHA.108.830174|pmid=19487602|s2cid=12730025}}

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.

In 1960, he became Professor of Surgery and in 1964 he was appointed Chairman of the Department of Surgery at the Mayo Clinic.

In 1961, Italian surgical trainee Giancarlo Rastelli received a North Atlantic Treaty Organization (NATO) scholarship and entered into a fellowship under Kirklin's guidance.{{Cite book|chapter-url=https://books.google.com/books?id=AVbeCwAAQBAJ&q=john+w.+kirklin+cardiac+catheterization&pg=PA303|title=Surgery of Conotruncal Anomalies|last1=Kreutzer|first1=Christian|last2=Bove|first2=Edward|last3=Hraška|first3=Viktor|last4=Morell|first4=Victor|last5=Spray|first5=Thomas L.|date=2016|publisher=Springer|isbn=978-3-319-23056-6|editor-last=Lacour-Gayet|editor-first=Francois|pages=303|language=en|chapter=17. TGA-VSD and LVOT: Rastelli Procedure|editor-last2=Bove|editor-first2=Edward|editor-last3=Hraška|editor-first3=Viktor|editor-last4=Morell|editor-first4=Victor Morell|editor-last5=Spray|editor-first5=Thomas L.}}

File:Kirklin Clinic.png

After years as the chair of the Department of Surgery at the Mayo Clinic, Kirklin accepted the same position at the University of Alabama School of Medicine in 1966, succeeding Champ Lyons. He later recounted that he felt he would be better able to develop a department of surgery and the training of surgeons in Birmingham. He built the school and UAB Hospital system into one of the leaders in the health care industry, and UAB named its Kirklin Clinic in his honour. He was also the editor for The Journal of Thoracic and Cardiovascular Surgery and established a training programme for surgical assistants at UAB.{{Cite book|url=https://books.google.com/books?id=CWIHtDDlbdQC&q=john+w.+kirklin&pg=PA6|title=Architecture & Medicine: I.M. Pei Designs the Kirklin Clinic|last=Betsky|first=Aaron|date=1992|publisher=University Press of America|isbn=9780819188786|language=en}}

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

Kirklin had the idea of training surgeon assistants as a new type of physician assistant in the late 1960s.{{Cite web|url=https://pahx.org/assistants/kirklin-john-w/|title=Kirklin, John W.|last=Gleysteen|first=John J.|website=Physician Assistant History Society|language=en-US|access-date=5 February 2019}}

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.

Kirklin married physician Margaret Katherine Hair.{{Cite web|url=https://livesonline.rcseng.ac.uk/client/en_GB/lives/search/detailnonmodal/ent:$002f$002fSD_ASSET$002f0$002f372277/one?qu=%22rcs%3A+E000090%22&rt=false%7C%7C%7CIDENTIFIER%7C%7C%7CResource+Identifier|title=Kirklin, John Webster (1917–2004)|website=livesonline.rcseng.ac.uk|access-date=7 February 2019}} They had three children, of whom one son, James K. Kirklin is a cardiothoracic surgeon who became the Director of Cardiothoracic Transplantation at UAB and Director of the Division of Cardiothoracic Surgery.

Kirklin retired in 1989.{{Cite web|url=https://www.uab.edu/newsarchive/42933-john-kirklin-cardiac-surgery-pioneer-dead-at-age-86|title=UAB – News Archive – John Kirklin Cardiac Surgery Pioneer Dead at Age 86|last=Vaughan|first=Maryanne|date=23 April 2004|website=UAB|language=en-US|access-date=9 February 2019}} He died, aged 87, on April 21, 2004, following a head injury.{{Cite news|url=https://www.nytimes.com/2004/04/30/us/john-w-kirklin-is-dead-at-86-innovator-in-cardiac-surgery.html|title=John W. Kirklin Is Dead at 86; Innovator in Cardiac Surgery|last=Pearce|first=Jeremy|date=30 April 2004|work=The New York Times|access-date=7 February 2019|language=en-US|issn=0362-4331}} During Kirklin's lifetime, almost one million heart operations had been performed around the world using the heart-lung bypass machine.

The John W. Kirklin Award for Professional Excellence is awarded by the American Association of Surgical Physician Assistants.{{Cite web|url=https://www.aaspa.com/about/john-w-kirklin-md-award-history|title=John W. Kirklin, MD Award History {{!}} AASPA|website=www.aaspa.com|access-date=10 February 2019|archive-date=12 February 2019|archive-url=https://web.archive.org/web/20190212011946/https://www.aaspa.com/about/john-w-kirklin-md-award-history|url-status=dead}}

Among the awards and honours that Kirklin received are:

• Elected honorary FRCS England in 1970{{Cite journal|date=1970|title=Proceedings of the Council in January 1970|url=https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2387716&blobtype=pdf|journal=Royal College of Surgeons (Eng)|pages=114}}
• The Lister Medal 1972, for his contributions to surgical science.{{Cite journal |pmc = 2387974|year = 1972|title = Lister Medal|journal = Annals of the Royal College of Surgeons of England|volume = 50|issue = 6|pages = 382}} 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'.{{cite journal | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2388198/pdf/annrcse00839-0051.pdf | title= College News| journal= Annals of the Royal College of Surgeons of England| date= March 1973 | volume= 52|issue=3|page= 206 | pmc=2388198 }}
• 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 the University of Munich, UAB, Indiana University, University of Bordeaux and the University of Marseille.

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

• [https://trove.nla.gov.au/work/21166080?q&versionId=25235628 The Tetralogy of Fallot from a surgical viewpoint], with Robert B. Karp, Philadelphia: Saunders (1970), {{ISBN|978-0721654744}}
• [https://books.google.com/books?id=VVxpQgAACAAJ&q=Cardiac+Surgery.+(With+Brian+Barratt-Boyes) Cardiac Surgery], Wiley, 1986. (With Brian Barratt-Boyes) {{ISBN|9780471014164}}
• [https://link.springer.com/chapter/10.1007/978-94-009-4259-2_92 "The Surgical Treatment of Acute Myocardial Infarction"], co-authored with James K. Kirklin, International Practice in Cardiothoracic Surgery, Springer Dordrecht (1986), pp. 1069–1079 {{doi|10.1007/978-94-009-4259-2_92}}, {{ISBN|978-94-010-8391-1}}

• {{cite journal | pmid = 14371757 | volume=30 | title=Intracardiac surgery with the aid of a mechanical pump-oxygenator system (gibbon type): report of eight cases | year=1955 | journal=Proc Staff Meet Mayo Clin | pages=201–6 | author=Kirklin JW, Dushane JW, Patrick RT, Donald DE, Hetzel PS, Harshbarger HG, Wood EH | issue=10 }}
• {{cite journal | pmid = 491719 | volume=78 | title=A letter to Helen (presidential address) | year=1979 | author=Kirklin JW | journal=J Thorac Cardiovasc Surg | issue=5 | pages=643–54 | doi=10.1016/S0022-5223(19)38051-1 | doi-access=free }}
• {{cite journal | pmid = 2682017 | volume=98 | title=The middle 1950s and C. Walton Lillehei | year=1989 | author=Kirklin JW | journal=J Thorac Cardiovasc Surg | issue=5 | pages=822–4 | doi=10.1016/s0022-5223(19)34259-x | doi-access=free }},
• {{cite journal | pmid = 14371743 | volume=30 | title=Apparatus of the Gibbon type for mechanical bypass of the heart and lungs; preliminary report | year=1955 | author=Jones RE, Donald DE, Swan HJ, Harshbarger HG, Kirklin JW, Wood EH | journal=Proc Staff Meet Mayo Clin | issue=6 | pages=105–13 | doi=10.1016/S0025-6196(24)00528-7 }}
• {{cite journal | doi = 10.1001/jama.1956.02960460028007 | volume=160 | year=1956 | journal=Journal of the American Medical Association | author=DuShane James W| title=Ventricular Septal Defects with Pulmonary Hypertension | issue=11 | pages=950–3 | pmid=13295049 }}

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{{Portal|Biography}}

• [https://web.archive.org/web/20100613084722/http://main.uab.edu/Sites/MediaRelations/articles/42933/ UAB Press Release about Kirklin]

{{University of Alabama at Birmingham}}

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Category:1917 births

Category:2004 deaths

Category:Harvard Medical School alumni

Category:University of Alabama at Birmingham people

Category:United States Army officers

Category:People from Muncie, Indiana

Category:People from Rochester, Minnesota

Category:Military personnel from Indiana

Category:Physicians from Indiana

Category:Physicians of the Mayo Clinic

Category:History of heart surgery

Category:20th-century American surgeons

Category:Military personnel from Minnesota

Category:Members of the National Academy of Medicine

Category:Presidents of the American Association for Thoracic Surgery