Atrial Well Technique

Posted by dcacbtcfmc @dcacbtcfmc, Sun, Apr 21 7:07pm

I am a survivor of Atrial Septal Defect closure by the Gross Atrial Well Technique, a method that was refined by the renowned Mayo surgeon, John W. Kirklin. Would anyone out there happen to know for certain in what year the Mayo moved from this procedure to exclusive use of cardiopulmonary bypass for the repair of these lesions? It must be somewhere between 1959 and 1961. If 2019 is not the sixtieth anniversary of the transition then we are certainly getting close to it. Perhaps a fellow survivor from the early period, a physician or a specialist in the history of medicine would have the answer for me. Here's hoping – and thanks in advance if you can help.

Hi @dcacbtcfmc and welcome to Connect! Thank you for sharing your story.

I wanted to share this article on the history of open heart surgery at Mayo Clinic as it may contain some answers for you: https://www.mayoclinicproceedings.org/article/S0025-6196(11)63095-4/pdf

I also wanted to share the Congenital Heart Disease page as it contains more information on Mayo's Congenital Heart Disease Clinic: https://connect.mayoclinic.org/page/congenital-heart-disease/

Back to you @dcacbtcfmc how have you been doing over the years since your procedure? Have you had to have any other procedures since then?

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Your response is most appreciated, Ethan. I am already familiar with this article but the exact year of the move away from the atrial well technique remains unclear to me. One Mayo trainee from the 1950s who subsequently rose to fame as an accomplished cardiac surgeon elsewhere has given me 1961. But he was no longer at the clinic when the decision to employ bypass for closing all varieties of ASD was taken. Without being precise, McGoon and others have implied a little earlier than '61. It might take a Mayo person from that long-ago period, whether older doctor or patient, to recall the year with certainty for me. I am not even sure that this group forum would have that sort of reach; my fingers are crossed none the less.

You'll no doubt have heard it said that "once a heart patient, always a heart patient." My paediatric surgery accorded me 43 years of very good cardiac health. However, in advancing age issues both old and new have manifested themselves. I have had a late percutaneous procedure and cannot say whether that has influenced my general condition for better or for worse. Fortunately, an experiment with nocturnal oxygen seems very recently to have improved an arrhythmia burden that had a negative impact on my physical and psychological wellbeing over the preceding six years.

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Hello @dcacbtcfmc,

I know it’s been a while since you posted your message on Connect – nonetheless I thought you might be interested to hear know that I just met with Dr. Richard Daly, cardiovascular surgeon at Mayo Clinic, https://mayocl.in/2mdiG4c, and asked him if he knew more about the Atrial Well Technique. I didn’t realize he was the author of the paper that @ethanmcconkey mentioned, above!
– Fifty Years of Open Heart Surgery at the Mayo Clinic https://www.mayoclinicproceedings.org/article/S0025-6196(11)63095-4/pdf

According to Dr. Daly, Mayo Clinic stopped doing the Gross Atrial Well Technique, (named after Robert Gross), in 1955, with the development of the cardiopulmonary bypass machine ( heart-lung machine).
I hope that answers your question…how are you doing, @dcacbtcfmc? Do you still experience arrhythmia?

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Thank you so much, Kanaaz. I am most impressed that someone would go to this trouble for me. You certainly have access to the right people. Unfortunately, I have to advise that Dr Daly is mistaken. The year 1955 is indeed correct for the Mayo's sealing of an atrial septal defect under cardiopulmonary bypass. However, such repairs using the Gross Atrial Well and CPB ran side-by-side for several years after that initial CPB intervention. You can read about parallel use of the two surgical approaches in the following article: Dwight C. McGoon, James W. DuShane, John W. Kirklin, "Surgical Treatment for Atrial Septal Defect in Children," Pediatrics, December 1959, Volume 24, Issue 6. It is available online. You will see that as late as December 1958 the Mayo Clinic was still using the well technique. In the above study the great majority of children (under 15 years of age), those deemed preoperatively to have simple ASD lesions, had surgeries under well. So, regarding when the clinic moved to exclusive use of CPB for closing these lesions, I still do not have an answer that I would consider definitive.

Thank you also for your enquiry after my health. Just a few weeks back my EP's opinion was that my episodes of flutter/fib may have become reasonably persistent atrial flutter. Strangely, perhaps, I feel much better in this state than when tachy/brady strikes.

In appreciation.

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