Johann 'Hans' Ehrenhaft 1915 – 2009

Johann Leopold Friedrich Ehrenhaft, M.D., called "Hans" by his friends, died in Iowa City, Iowa, on June 17, 2009, at age 93. He had a long and distinguished career as an educator, physician and pioneer in vascular and cardiothoracic surgery at the University of Iowa. At his request, no services were held.

Born in Vienna on October 10, 1915, Hans was raised there in a scientifically and culturally inspiring environment, which by his late teens (1933-34) was already clouded by the rise of Nazism, and later devastated when Germany annexed Austria in March 1938. His parents were married in the Catholic church (1908), but the family had Jewish heritage. Hans' father, Felix Ehrenhaft (doctorate, 1903), a friend and colleague of Albert Einstein, was a renowned Professor and Head of Physics at the University of Vienna until his forced resignation and detention under the Nazi regime. Once released, Ehrenhaft worked in New York (1940-46), and then resumed his positions in Vienna until his death in 1952. Hans' mother, Olga Steindler, the University of Vienna's first woman doctorate in physics (1903), who is best known as a reformer of women's education, founded Austria's first women's business school. For her public service Olga Steindler-Ehrenhaft was granted the title of Hofrat in 1931. She died in December 1933. The Ehrenhafts frequently were hosts to figures from academia and the arts. Einstein preferred to stay with them when in Vienna. Among many others, the Ehrenhafts' guests included the physicists Niels Bohr, Max Planck, Robert Millikan, and Arthur A. Compton; inventor-explorer-physicist Auguste Piccard; Charlotte Buhler, a founder of developmental psychology; and Alma Maria Mahler, the composer Gustav Mahler's widow, who married architect Walter Gropius. Among Hans' closest friends was Manon Gropius, the daughter of Gropius and Maria Mahler. At 17, Hans graduated from Vienna's Schottengymnasium, where the humanistic education by Benedictine priests stressed rigorous study of Latin and Greek, philosophy, history, math and the sciences.

From this richly stimulating background Hans' lifelong intellectual curiosity, and drive for advancement of his chosen field, were formed. His interest in medicine was stimulated by his grandfather, a general practitioner, and his mother's death due to a massive pulmonary embolus. In 1934, after a year of medical school at the University of Vienna, Hans visited his uncle, Arthur Steindler, the Head of Orthopedics in Iowa City, then a very small town. Due to changing European politics it was decided he should continue his studies in Iowa. This was a great change for Hans, having come from a large, cosmopolitan European city. After loss of his mother in 1933, Hans was touched by Manon Gropius' untimely death from polio in April 1935. He missed his home country. In 1936, Hans made a brief trip back to Austria, and had to pass through France, Holland, and Germany. The trains were full of Nazi Youth, and the German-Austrian border was closed. He finally arrived safely in Vienna, but experiencing first hand the rapidly deteriorating political landscape, Hans concluded he could have no future in Austria. He returned to Iowa, received his M.D. degree there in 1938, and became a naturalized U.S. citizen on February 12, 1940.

Hans was a surgical intern (1938-39), and a William Halsted Fellow in surgery (1939-40) at Johns Hopkins, in Baltimore. There, with co-interns Rollins Hanlon and William Longmire, he saw many cardiac and thoracic wounds in the accident room; and in animals he studied lung and vascular surgical techniques. In 1940 Hans returned to Iowa to complete his surgical residency. In World War II, as an Army Air Corps Flight Surgeon (1942-45), Hans served with Byron Blades, Paul Samson, and Tom Burford, all trained at Washington University, St. Louis, by Evarts Graham, a leader in research, surgical techniques and education, who was the first to successfully remove an entire lung to treat cancer (1933). In that wartime unit, chest wounds, lung surgeries, and positive pressure mask ventilation were studied. This further stimulated Hans' interest in thoracic surgery; and postwar, Hans joined Iowa's surgical faculty. Before streptomycin was available, he recognized need for and immersed himself in surgical treatment of tuberculosis, as well as peripheral and thoracic vascular surgery, and closed mitral valve repairs. Hans then took a Fellowship with Dr. Graham (1948-49), whose program at St. Louis was then one of only two in the Midwest offering structured thoracic surgery training. There, in addition to surgical activity, Hans helped Dr. Gauer, an originator of oximetry, develop a prototype ear lobe device for measuring blood oxygen saturation. During this period Hans also traveled to Ann Arbor to observe Cameron Haight's and Herbert Sloan's pediatric esophageal and cardiac surgery, and to Baltimore to observe Alfred Blalock's shunt operations and Rudolph Bing's early cardiac catheterizations.

On his return to Iowa City in 1949, Hans initiated the Iowa thoracic surgery residency program. By 1986, when he stepped down as Chair of the Division of Thoracic and Cardiovascular Surgery, Hans had educated 80 residents in vascular and thoracic surgery, many of whom went on to distinguished academic careers. As a Professor Emeritus, Hans continued to teach. He was succeeded as Chairman by Douglas M. Behrendt, now retired, whose successor, Mark D. Iannettoni, is now Professor and Head of the Department of Cardiothoracic Surgery at Iowa.

Hans' resumé listed many research papers, other publications, and guest lectures. As a recognized leader in surgical education, Hans served on the American Board of Thoracic Surgery (1966-1972) and the Residency Review Committee for two terms. Hans was a member of the American Association for Thoracic Surgery and the American Thoracic Society, and a Fellow in the American College of Surgeons. He was active on the Council on Cardiovascular Surgery of the American Heart Association, and Committees on Medical Education for both the AMA and the ABTS. He also was first president of the Thoracic Surgery Directors Association, and an editorial board member for the Journal of Thoracic and Cardiovascular Surgery, and the Annals of Thoracic Surgery.

In 1949, Hans could not foresee that, under his chairmanship, the Iowa residency program he established would be the longest-running such program under a single director. During the next 50 years Hans and faculty he mentored contributed to the most exciting period in the development of vascular, cardiac and thoracic surgery. Hans helped initiate vascular angiography and cardiac catheterization at Iowa. Vascular grafts were evaluated, a device to measure intraesophageal pressure was built, bronchography was explored, and some of the first surgical removals of metastatic lung cancer were reported. Open cardiac surgery began in 1953 at Iowa, using a deep hypothermia technique initiated at Toronto by Wilfred Bigelow. Using ice baths, these patients' core temperatures were lowered, allowing their hearts to be stopped for short periods. This predated cardiopulmonary bypass (CPB) using heart-lung machines which make longer open heart surgery possible. Before commercial availability of such equipment, a heart-lung machine was built at Iowa in Hans' lab in 1955, in cooperation with Minnesota researchers, and with help of Jack Walters, head of Iowa's Medical Instrument Shop, and Dan Wiltfang, Hans' perfusionist. Hans first used it on June 22, 1956, to close a VSD (ventricular septal defect) in a 5-year-old girl, just months after John Kirklin and James Dushane at Mayo Clinic reported first successes with the operation using CPB. This came 3 years after John Gibbon reported first use of such a device on a human (1953). During her follow-up visits, Hans was gratified to hear that his first bypass patient completed school, became a teacher, married, and raised a family. Throughout his career, Hans frequently commented that few things gave him greater joy than seeing a patient resume a normal, productive life. The pump oxygenator from that first Iowa CPB procedure was used in more than 200 operations until it was replaced in 1960. Twenty-five years later, on June 2, 1985, the first heart transplant at Iowa would be performed; and on January 5, 1987, thoracic surgeons at Iowa performed the program's 10,000th open heart operation.

Hans married Patricia F. Dunn in 1940. In 1949 they had a son. Hans was married again in 1953, to Jean Lees Lovett, Head of Occupational Therapy at the University of Iowa. They lived happily together for 53 years until her death in May 2007. Hans' surviving family includes his son, J. Bruce Ehrenhaft, J.D., his wife Alexis (Jepeway) Ehrenhaft, and their son Christian Anthony Ehrenhaft, all of Coral Gables, Florida; a nephew, Dr. Arthur S. Albert, M.D., of Manhattan, New York, and a niece, Dr. Deborah L. Albert, M.D., of Tampa, Florida, the children of Hans' sister, Anna Marie ("Anny") Ehrenhaft Albert, who preceded him in death; and Jennie L. (Steger) Keepers, the niece of Jean L. Ehrenhaft, and her husband Craig S. Keepers, and their children Kara and Brian, all of Eden Prairie, Minnesota.

Seven decades after his 1934 emigration to the small rural community which then seemed so foreign to him, Hans reflected on how he was completely at home in the culturally-rich university community that developed in Iowa City. He was a Rotarian, and active in other community and University organizations. Hans was a gardener, and loved to cook. He was also a voracious reader, who studied art, and political and social changes, particularly those surrounding the Renaissance. He loved the outdoors, and found America's streams, lakes, mountains, and forests to be not so unlike those in Europe, where he had fished, hiked, and gathered wild mushrooms with his father and grandfather. Here, especially in Iowa, Wisconsin and Colorado, Hans avidly pursued those same activities, sharing his love of them with his wife, son, grandson, and friends. Among his travels were trips for work and pleasure to 5 continents, and a trip to Europe as a "People to People" Ambassador.

Hans was a towering, sometimes intimidating, presence in the hallways of the University of Iowa Hospitals. From the commencement of his program in 1949, he ignored racial, gender, and cultural barriers when selecting his trainees and hiring staff, among whose ranks were some of the first African Americans and women formally trained in cardiovascular surgery. He vigorously championed patient care and surgical education, often bringing himself into conflict with administrators. Hans epitomized the "old fashioned" clinician who believed he could assess a patient's circulation better by feeling the feet than by generating numbers with a Swan-Ganz catheter. He worried about the decline of clinical acumen in favor of fancy instrumentation and a retreat to simply looking at data. He rued the loss of large portions of thoracic surgery to other disciplines, for example endoscopy and pacemaker surgery, and was especially concerned about the split of the specialty into cardiac and thoracic divisions. Hans was among the last of the generation which brought thoracic and cardiac surgery from a branch of general surgery to the mature specialty that it has become, and he will be greatly missed.

J. Bruce Ehrenhaft, J.D.
Coral Gables, FL USA

Mark D. Iannettoni, MD, MBA
Johann L. Ehrenhaft Professor of Cardiothoracic Surgery 
Director, Department of Cardiothoracic Surgery
Surgical Director, UI Heart and Vascular Center
The University of Iowa Hospitals & Clinics
Iowa City, IA USA