After completing his residency in general surgery, Dr. Callaghan secured a two-year McLaughlin post-doctoral scholarship to study at the TGH and in London and Los Angeles before moving to the University of Alberta to start their open-heart surgery program. After a year of building a bypass machine and practicing surgical techniques in the new Surgical Medical Research lab, he joined cardiologists Drs. Robert Fraser and Joe Dvorkin to carry out the first bypass operation on a pulmonary stenosis patient on September 18, 1956. It was a cautious start since the operation could have been done without bypass. Successful, they operated on a congenital atrial septal defect (ASD) in a 10-year-old on October 24. It was a Canadian first and gave her a normal life. The team completed a repair of a Tetralogy of Fallot in December and a more complex one in January 1957, both Canadian firsts.
Early operations took 10 hours, even though the maximum bypass time was never more than 63 minutes. During the first five years, all the patients had congenital heart disease. The team faced innumerable challenges choosing cases, practising, designing equipment, finding OR time and research space, building their teams, or performing unplanned re-operations. Blood was a critical factor. One case required 60 pints. With better pumps, less red cell damage occurred, and longer pump times became possible.
The U of A team presented their first 35 cases at the Royal College of Physicians and Surgeons of Canada (RCPSC) in October 1957. That month UBC surgeons performed their first ASD repair, three months before the TGH performed any open-heart procedures. Although Dr. Callaghan’s mortality rate in the beginning was low (25%), it appeared better than the later reported TGH rate of 33%.
Dr. Callaghan would attempt the first plastic Starr-Edwards ball valve insertion (1961). Although it failed, he performed a successful mitral valve replacement (1962), aortic valve and aortic arch replacement (1962), double valve replacement (1963) and triple valve replacement (1963), all firsts in Canada.
After the Vineberg coronary artery bypass procedure was introduced (1963), Dr. Callaghan performed his first one ‘outside Montreal’ in 1964. Then in 1965 he successfully performed a ‘bloodless’ ASD repair on a six-year-old patient, using only saline as the perfusion solution, another first. Willing to analyze his failures, he published articles on the first 61 deaths (1961) and the first 50 Starr-Edwards insertions (1964), his mitral valve replacement complications (1974) and endocarditis complications (1982).
In the lab, Dr. Callaghan’s early research team focused on creating an artificial placenta to support respiratory function in lambs born prematurely. The project was successful in supporting one for 5-6 hours. The possibility however did reach the attention of Life magazine, which featured it in 1963. The project inspired investigators attempting to extend periods of extracorporeal oxygenation.
Always focused on decreasing deaths, he reported on 33 aortic replacements with only one loss. One case was shown live on CBC. His overall mortality rate was down to 4%. (1967), the year he produced the film New Hearts for Old. By then OR times were down to four hours and bypass times could be up to four hours. The team finished their 1,000th case on June 7, 1967, six years before Toronto reached that plateau.
Dr. Callaghan’s contribution to the medical literature reached 109 articles. Some were translated into multiple languages. He contributed chapters to two textbooks on cardiovascular surgery, including editing one. His bibliography would be twice that of Dr. Bigelow’s. He was invited to present the first Bigelow lecture in 1984.
A sought-after speaker (400 presentations), one focus was on preventing smoking as a way of decreasing lung cancer and heart disease. He noted that two packs per day increased the cancer rate 1,000 percent, and surgical cases were only 8 percent successful after five years. He would quit himself circa 1966.
In 1965 Dr. Callaghan secured a pledge from Alberta Health Minister Donovan Ross to fund a Western Canadian Heart Institute, as part of a subspecialty hospital expansion (1965). As construction costs soared, the Lougheed government cancelled the project (1971).
Dr. Callaghan’s refusal to advocate for heart transplants after the first Barnard operation in December 1967 garnered widespread attention. He felt the field of immunosuppression was too immature. His friend (renowned surgeon) Denton Cooley agreed, but told Dr. Callaghan, “I’ll nevertheless be dong transplants and have a heart institute before you.” Sadly, that is what happened.
Dr. Callaghan retired from cardiovascular open-heart operations in 1986. With his extra time, he contacted the original open-heart team for their recollections and published them in the personable 30 years of Open-Heart Surgery at the University of Alberta Hospitals (1986). He also introduced a future book on his year in the Northwest Territories in 1995, which his son completed in 2008.
In retirement, he worked as a medical director for the Western Regional Authority and a consultant to Workers’ Compensation Board and the College of Physicians and Surgeons. Reflecting on his career, Dr Callaghan said, “If I hadn’t been able to withstand the stress of my practice, I’d have left it. I doubt I’d have lasted if technology hadn’t improved over the years. My primary goal was always the survival and improvement of the patient.”
Dr. Callaghan passed away on April 6, 2004, the most noteworthy cardiovascular and thoracic surgeon in Canadian history.
Banner image credit: U of A Hospital