In his early career, he wrote on xenografthyperacute rejection and in December 1980 was part of the team that performed the first successful human heart transplant using the then newly discovered immunosuppressantcyclosporine. In 1981, he was part of Bruce Reitz's team that performed the world's first successful combined heart-lung transplant procedure at Stanford University. Following that, he continued to make significant contributions to heart-lung transplant procedures, and led programmes in cardiothoracic surgery in both adults and children.
Stuart Jamieson was born in 1947[1] and brought up in Rhodesia (now Zimbabwe), where he was educated at Falcon College.[2][3] His childhood was spent on a 2.5 million acre ranch with pets that included a zebra, an ostrich[4] and a giraffe.[5] At the age of 18, Jamieson was sent to St Mary's Hospital, affiliated with the University of London, to study medicine.[5] He financed his studies by working as a waiter.[4][6]
Background
The first combined heart-lung transplant was accomplished by Denton Cooley in 1968, in Houston, in a two-year-old girl with severe pulmonary hypertension. Despite surviving less than a day, her case showed that this kind of procedure could be effective.[7] The second such transplant was performed in 1969,[8] by C. Walton Lillehei at Cornell University Medical Center in New York City, in a 43-year-old man with emphysema. He lived for eight days.[7] In 1971, South African Christiaan Barnard, also performed a combined heart-lung transplant in a 49-year-old man with emphysema, surviving for 23 days.[7] The poor survival rates of these early transplantations, primarily resulted from inadequate immunosuppression and difficulties with joining the airways. In addition, Joel D. Cooper had found corticosteroids to weaken the bronchial anastomosis.[9] It was on this background of tragic deaths that Jamieson later acknowledged and shared his research on xenograft hyperacute rejection.[5]
Early surgical career
Following 1971's Life Magazine's media coverage of failed early heart transplantations, Jamieson published his first papers on xenograft hyperacute rejection in 1974 and 1975.[5][10]
In 1978, the American Heart Association awarded him a fellowship to study at Stanford University under the pioneering heart surgeon Norman Shumway, who had performed the first human heart transplant in America in 1967.[4][11] Jamieson completed his residency in 1980[12] and stayed on as chief resident at Shumway's request.[5] Later, he was listed in Clinical Cardiology (2000), as one of Norman Shumway's distinguished trainees.[12]
Before 1980, just under 40 lung transplantation procedures had been attempted, all of which resulted in the patient's death within a few months and just one resulted in the patient's discharge from hospital.[5] In 1979 at Stanford, Jamieson performed 25 heart transplants, comprising more than 50 percent of the total performed globally at that time.[1]
In 1979, he described a series of successful transplantations in primates using cyclosporine, a fungal derivative whose immunosuppressive properties were reported by Jean-Francois Borel.[5] Observing Roy Calne's reports on how cyclosporine led to a reduction in acute rejection and consequent longer survival rates following liver and kidney transplantation,[9] Jamieson then demonstrated the possibility of using cyclosporine in human heart-lung transplantations.[13] Subsequently, with Edward Stinson and Norman Shumway, he published Stanford's achievements in a report in the British Medical Journal (BMJ) on "Cardiac transplantation in 150 patients at Stanford University".[14] This report was one of the developments that supported the recommencement of heart surgery in the UK under Sir Terence English in 1979.[15]
In December 1980, he participated in the first successful human heart transplant using cyclosporine.[5][16] The recipient was then age 20 and still living in 2017 at the age of 58.[5]
Stanford group
On 9 March 1981, Jamieson was part of the team that achieved the first long-term survival following a combined heart-lung transplant procedure, led by Bruce Reitz[17] and accompanied by John Wallwork and Norman Shumway. The recipient, a 45-year-old woman with Eisenmenger's syndrome, lived for 5 years.[5][7] A series of combined heart-lung transplant procedures followed in which alternative blood vessels provided blood to the main airways, reducing bronchial restricted blood supply since the coronary blood vessels remained intact after the bronchial artery had been ligated. Use of cyclosporine reduced acute rejection.[7][18][19]
Simultaneous work in Toronto, under Joel D. Cooper and the Toronto transplant group also reported success with single-lung transplants and then with en bloc bilateral lung transplants.[7] Over the next two decades, the state of lung transplantation grew and multiple lung transplant centers became global. Bilateral and single-lung transplants continued to account for most procedures performed. Heart-lung transplants became reserved primarily for those patients with the Eisenmenger anomaly or severe primary pulmonary hypertension.[18] Jamieson was responsible for numerous descriptions of early heart-lung and double lung transplant techniques.[20]
He co-founded the International Society for Heart and Lung Transplantation (ISHLT) in 1981 and later became its president in 1986.[20]
In 1982, Jamieson became the director of heart and lung transplantation at Stanford and retained this position until 1986.[2]
Minnesota
University of Minnesota East Bank campus in the winter
In 1986, Jamieson replaced Walton Lillehei at University of Minnesota as director of the Minnesota Heart and Lung Institute,[4] performing Minnesota's first heart-lung transplant in the same year. In 1988, he performed the Midwest's first double-lung transplant.[21]
San Diego
UC San Diego Medical Center in HillcrestThe Sulpizio Family Cardiovascular Center houses the Departments of Cardiology and Emergency Medicine in La Jolla
By 1989, Jamieson had transferred his entire surgical team, including Michael Peter Kaye,[22] to the University of California, San Diego.[4][6] to which he introduced heart-lung, lung, double lung and living-related transplant, and established the first lung transplantation programme to be Medicare certified and co-founded the Sulpizio Cardiovascular Center[5]
The International Registry for Heart Transplantation, which possesses global heart and heart-lung transplants records, and the editorial offices of the Journal of Heart Transplantation also moved to UCSD Medical Center.[3][23]
Heart-lung surgery
pulmonary endarterectomy
By 1989, he had performed around 500 heart transplants and more than 50 heart-lung transplants.[3] However, due to the shortage of donor supplies, an attempt was made to reduce heart-lung transplants. The heart was increasingly repaired where possible and pulmonary thromboendarterectomy (PTE) performed for Chronic thromboembolic pulmonary hypertension (CTEPH).[5]
PTE is an operation that removes organized clottedblood (thrombus) from the pulmonary arteries of people with chronic thromboembolic pulmonary hypertension (CTEPH).[24] Many physicians have been unaware of the existence of CTEPH and as a consequence it has been underdiagnosed. Jamieson was the first to report that CTEPH can be corrected with PTE.[25]
Jamieson's 2003 publication, describing the first 1,500 cases of PTE, confirmed the benefits of surgery and dismissed the myth that poor right ventricular function disqualified a patient as fit for surgery.[26] He argued that whatever the degree of right ventricular failure, PTA improved patients lives.[26] While medical management may provide some temporary relief of symptoms, PTE is considered curative for CTEPH.[27][28]
By 2011 there were approximately 30 centers worldwide that offered pulmonary endarterectomy and half of the 4,000 procedures performed were being done by Jamieson's programme directorship at University of California, San Diego (UCSD).[26]
Jamieson pioneered the procedure of pulmonary thromboendarterectomy (PTE).[29][30] During his four decades at UCSD, he made modifications to the procedure of PTE, adapted surgical instruments and proposed a classification of CTEPH.[5]
Karen (orangutan)
In 1994, Jamieson led the team that performed the first open heart surgery on an orangutan, Karen, at the San Diego Zoo. He repaired her penny-size hole in the heart when she was two years old. She recovered and made headlines.[31][32]
Personal life
Jamieson is a cattle rancher and commercial helicopter pilot.[29] He has three children.[4]
Pulmonary hypertension is a condition of increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, fainting, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual. According to the definition at the 6th World Symposium of Pulmonary Hypertension in 2018, a patient is deemed to have pulmonary hypertension if the pulmonary mean arterial pressure is greater than 20mmHg at rest, revised down from a purely arbitrary 25mmHg, and pulmonary vascular resistance (PVR) greater than 3 Wood units.
A heart–lung transplant is a procedure carried out to replace both failing heart and lungs in a single operation. Due to a shortage of suitable donors and because both heart and lung have to be transplanted together, it is a rare procedure; only about a hundred such transplants are performed each year in the United States.
Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall.
Pulmonary angiography is a medical fluoroscopic procedure used to visualize the pulmonary arteries and much less frequently, the pulmonary veins. It is a minimally invasive procedure performed most frequently by an interventional radiologist or interventional cardiologist to visualise the arteries of the lungs.
Lung transplantation, or pulmonary transplantation, is a surgical procedure in which one or both lungs are replaced by lungs from a donor. Donor lungs can be retrieved from a living or deceased donor. A living donor can only donate one lung lobe. With some lung diseases, a recipient may only need to receive a single lung. With other lung diseases such as cystic fibrosis, it is imperative that a recipient receive two lungs. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for those with end stage pulmonary disease.
In thoracic surgery, a pulmonary thromboendarterectomy (PTE), also referred to as pulmonary endarterectomy (PEA), is an operation that removes organized clotted blood (thrombus) from the pulmonary arteries, which supply blood to the lungs.
Bruce A. Reitz is an American cardiothoracic surgeon, best known for leading the first combined heart-lung transplantation in 1981 with pioneer heart transplant surgeon Norman Shumway. He obtained an undergraduate degree at Stanford University a medical degree at Yale Medical School and completed an internship at Johns Hopkins Hospital (1971) and residencies and fellowships at Stanford University Hospital the National Institutes of Health (1974). He joined the surgical faculty at Stanford University (1978) then became chief of cardiac surgery at Johns Hopkins University (1982–92) and Chairman of the Department of Cardiothoracic Surgery at Stanford (1992–2005). In 1995 he conducted another pioneering operation: the first Heartport procedure, using a device that allows minimally invasive coronary bypass and valve operations. Reitz also played a major role in the resident education program at Stanford, which he reorganized and maintained.
Royal Papworth Hospital is a specialist heart and lung hospital, located on the Cambridge Biomedical Campus in Cambridgeshire, England. The Hospital is run by Royal Papworth Hospital NHS Foundation Trust.
Atrial septostomy is a surgical procedure in which a small hole is created between the upper two chambers of the heart, the atria. This procedure is primarily used to palliate dextro-Transposition of the great arteries or d-TGA, a life-threatening cyanotic congenital heart defect seen in infants. It is performed prior to an arterial switch operation. Atrial septostomy has also seen limited use as a surgical treatment for pulmonary hypertension. The first atrial septostomy was developed by Vivien Thomas in a canine model and performed in humans by Alfred Blalock. The Rashkind balloon procedure, a common atrial septostomy technique, was developed in 1966 by American cardiologist William Rashkind at the Children's Hospital of Philadelphia.
Norman Edward Shumway was a pioneer of heart surgery at Stanford University. He was the 67th president of the American Association for Thoracic Surgery and the first to perform an adult human to human heart transplantation in the United States.
Sharon Ann Hunt is a cardiology professor and Director of the Post Heart Transplant Programme in Palo Alto, California and is affiliated with Stanford University Medical Center, professionally known for her work in the care of patients after heart transplantation.
Hans-Joachim Schäfers is a German surgeon, as well as cardiac, thoracic, and vascular surgeon and university professor. He is director of the department of Thoracic and Cardiovascular Surgery at the Saarland University Medical Center in Homburg/Saar, Germany. He is known for his activities in aortic valve repair, aortic surgery, and pulmonary endarterectomy.
Christian Emile Cabrol was a French cardiac surgeon best known for performing Europe's first heart transplant at Pitié-Salpêtrière Hospital in 1968.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term disease caused by a blockage in the blood vessels that deliver blood from the heart to the lungs. These blockages cause increased resistance to flow in the pulmonary arterial tree which in turn leads to rise in pressure in these arteries. The blockages either result from organised blood clots that usually originate from the deep veins of the lower limbs of the body (thromboembolism) and lodge in the pulmonary arterial tree after passing through the right side of the heart. The blockages may also result from scar tissue that forms at the site where the clot has damaged the endothelial lining of the pulmonary arteries, causing permanent fibrous obstruction. Most patients have a combination of microvascular and macrovascular obstruction. Some patients may present with normal or near-normal pulmonary pressures at rest despite symptomatic disease. These patients are labelled as having chronic thromboembolic disease (CTED).
Philip Caves (1940–1978) was a Northern Irish cardiothoracic surgeon. In 1972, while at Stanford University, he pioneered the use of the bioptome and transvenous endomyocardial biopsy in the early diagnosis of heart transplant rejection. It was considered the most significant advance in antirejection therapy of the time. Awarded the British American Research Fellowship in 1971, Caves worked with pioneering cardiothoracic surgeon Norman Shumway at Stanford and became staff surgeon leading the transplant programme by 1973. A year later he went to Edinburgh as a senior lecturer in cardiac surgery, where he became particularly interested in pediatric cardiac surgery.
The International Society for Heart and Lung Transplantation (ISHLT), established in 1981, is a professional organization committed to research and education in heart and lung disease and transplantation. It holds annual scientific meetings and publishes The Journal of Heart and Lung Transplantation. It also holds the worlds largest registry of heart and lung transplant data.
Jack Greene Copeland is an American cardiothoracic surgeon, who has established procedures in heart transplantation including repeat heart transplantation, the implantation of total artificial hearts (TAH) to bridge the time to heart transplant, innovations in left ventricular assist devices (LVAD) and the technique of "piggybacking" a second heart in a person, while leaving them the original.
Michael Peter Kaye was an American surgeon and researcher who co-founded the International Society for Heart and Lung Transplantation (ISHLT) in 1981. He developed the society's registry and edited the Journal of Heart and Lung Transplantation.
Edward B. Stinson is an American retired cardiothoracic surgeon living in Los Altos, United States, who assisted Norman Shumway in America's first adult human-to-human heart transplantation on 6 January 1968 at Stanford University.
Balloon pulmonary angioplasty (BPA) is an emerging minimally invasive procedure to treat chronic thromboembolic pulmonary hypertension (CTEPH) in people who are not suitable for pulmonary thromboendarterectomy (PTE) or still have residual pulmonary hypertension and areas of narrowing in the pulmonary arterial tree following previous PTE.
↑ Hamilton, David (2012). "Notes". A History of Organ Transplantation: Ancient Legends to Modern Practice. Pittsburgh: University of Pittsburgh Pre. p.509. ISBN978-0-8229-4413-3.
↑ New Scientist. Reed Business Information. 18 January 1979. p.155.
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