the earliest operations on the pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by francisco romero (1801) dominique jean larrey, henry dalton, and daniel hale williams. the first surgery on the heart itself was performed by norwegian surgeon axel cappelen on 4 september 1895 at rikshospitalet in kristiania, now oslo. he ligated a bleeding coronary artery in a 24-year-old man who had been stabbed in the left axilla and was in deep shock upon arrival. access was through a left thoracotomy. the patient awoke and seemed fine for 24 hours, but became ill with increasing temperature and he ultimately died from what the post mortem proved to be mediastinitis on the third postoperative day. the first successful surgery of the heart, performed without any complications, was by ludwig rehn of frankfurt, germany, who repaired a stab wound to the right ventricle on september 7, 1896.