Ernest Stanley Crawford (1922-1992) was an internationally renowned cardiovascular surgeon whose greatest technical work involved innovative surgical techniques in the treatment of complex aortic diseases and diseases of the heart. He was a tremendous innovator who became the co-inventor of the Baylor Rapid Autologous Transfusion System, a machine that recycles a patient’s own red blood cells during surgery. The transfusion system reduced the amount of blood and blood products needed during complex aortic and other arterial surgeries, greatly increasing safety and lowering the costs of surgery. One of his specialty areas was the treatment of vascular complications of Marfan syndrome.
Dr. Crawford received his medical degree from Harvard Medical School in 1946, served in the U.S. Navy from 1947 to 1949, and completed his postgraduate surgical training at Massachusetts General Hospital. He joined the faculty at Baylor University, becoming a full professor in 1956, and remained at Baylor until the end of his career.
One of Dr. Crawford’s most important contributions to vascular surgery was the clamp-and-sew method of thoracic aortic aneurysm repair, which he developed in the 1970s. His technique involved the use of intraluminal Dacron tube grafts and the reimplantation of visceral and renal arteries. This treatment was considered to have vastly improved the efficacy of thoracic aortic aneurysm repair, but it required considerable skill on the part of the surgeon in order to avoid complications from extended cross-clamping of the aorta.
“Thousands of patients are living happy, productive lives as the result of Dr. Crawford’s contributions, both directly [he was their personal surgeon] and indirectly through his teachings to other cardiovascular surgeons,” stated Dr. Cavlin B. Ernst in a memorial paper published in the Journal of Vascular Surgery in 1993, several months after Dr. Crawford’s death in October 1992.
Dr. Crawford was also intimately involved in the development of the first artificial heart assist devices, working with Dr. Michael DeBakey and Dr. Domingo Liotta at Baylor University.
“During 1961-62,” Dr. Liotta reminisced, “our lab at Baylor developed a small, intrathoracic, pneumatic-driven pump that partly bypassed the left ventricle from the left atrium to the thoracic aorta….
“On 18 July 1963 one of Dr. E. Stanley Crawford’s patients underwent an aortic valve replacement. The calcified stenotic valve was replaced with a Starr-Edwards prosthetic valve. Early the next morning, the patient had a cardiac arrest and was resuscitated by means of the open-chest technique. After the chest was closed, it was evident that severe brain damage had occurred. The patient remained in a coma, with low cardiac output and anuria. Subsequently, a rather severe pulmonary edema developed and was refractory to standard treatment.
“The first clinical VAD, bypassing the left ventricle from the left atrium to the descending aorta through a left thoracotomy, was implanted in this patient on the evening of 19 July by Dr. Crawford and me. The pump was regulated to bypass with 1,800 to 2,500 mL of blood per minute. Although the anuria that had been present since cardiac arrest persisted, the pulmonary edema cleared, as indicated by plain chest x–ray and auscultation. We discontinued mechanical support after 4 days of continuous use, but the patient remained in a coma and died,” said Dr. Liotta.
Among his accomplishments were 300 peer-reviewed publications and book chapters, and the much-valued textbook “Diseases of the Aorta,” which he co-authored with his son, John Lloyd Crawford II, M.D.. But Dr. Crawford is perhaps most known for his contributions to professional medical associations and education.
For E. Stanley Crawford was a tireless advocate of vascular surgery as a unique and autonomous profession. As part of these efforts, Dr. Crawford made significant contributions to the evolution and development of the nuts and bolts of the Society for Vascular Surgery and the journals that serve as the bedrock of the field. He was treasurer of the Society for Vascular Surgery from 1977 to 1980 and president from 1987 to 1988, and served as a member of the editorial board of the Journal of Vascular Surgery.
Dr. Crawford was also firmly committed to vascular surgery education, and much of what the profession is today was made possible by his years of teaching and mentoring some of the finest practitioners to grace the field. He served as president of the Lifeline Foundation of the SVS, working to implement the foundation’s objective of enhancing the careers of young academic surgeons.
Among these key educational accomplishments was the development of the Society for Vascular Surgery Forum on Critical Issues in Vascular Surgery, which today bears his name. He convened the first Society for Vascular Surgery Forum on Critical Issues in Vascular Surgery at the SVS annual meeting in Chicago on June 11, 1988, and at the 1988 SVS Council Meeting, under his aegis, it was decided that one of the responsibilities of the president-elect would be to organize and orchestrate future Critical Issues meetings.
Sources and Suggested Readings
1) J. Vasc. Surg. 1996;23:1081-7.
2) J. Vasc. Surg. 1993;17:618-19.
3) Tex. Heart Inst. J. 2002;29:229-30.
4) Vascular Surgery Principles and Practice, 3rd ed.; Robert W. Hobson II, Samuel E. Wilson, Frank J. Veith, Eds.; Marcel Dekker: New York, 2003.