VESSELS OF INNOVATION
Author Thomas Thompson once characterized Houston circa 1945 as a citywhere medicine of the most mediocre sort was practiced, a city with a third-rate medical school, no heritage of scholarly thinking and where extinguishing life by violence was far more common than exploring methods to prolong it.
That all changed in “less time than it takes to age a good bottle of wine,” according to the author of the true-crime classic “Blood and Money.”
“In a swampy area six miles south of the heart of downtown, in fields where racoons and water moccasins lived, there sprang up a collection of medical facilities which, by1970, had become one of the handful of distinguished medical centers in the world,” Thompson wrote in “Hearts: Of Surgeons and Transplants, Miracle sand DisastersAlong the Cardiac Frontier .”
No one was more responsible for the transformation, of course, than Michael DeBakey and Denton Cooley, the pioneering surgeons whose innovations made Houston and the Texas Medical Center the epicenter for cardiovascular care, a place where the most cutting-edge therapies were practiced with the greatest skill, a place that drew patients from around the nation and world, both common man and heads of state.
The advances culminated in Cooley implanting the world’s first artificial heart in a person, a dream since the 1940s, a Kitty Hawk-type of advance. The story made headlines around the world and, though the device was never used again, its legacy can be seen in the mechanical cardiac parts people now take for granted — valves, pacemakers and, most of all, support devices that help diseased hearts better pump blood.
But the achievements started long before that. Inmedical school, DeBakey invented the so-called roller pump, which made it possible to provide a surgical patient with a continuous flow of blood. DeBakey’s invention would become the essential component of the heart-lung machine that maintained the patient’s vital functions during procedures, ushering in the era of open-heart surgery.
In 1952, DeBakey performed the first successful operation on an aneurysm— a ballooning of the arterial wall — by replacing the affecting area with a graft from a cadaver artery. The following year he performed the first successful surgery to remove blood clots and plaque from the inner lining of blood vessels that deliver blood to the brain and head, an advance that would go on to spare countless patients from devastating strokes.
Around that time, DeBakey created the first Dacron grafts— one of the Texas Medical Center’s great stories— which enabled durable repair of artery walls weakened by aneurysms. He invented the techniqueonhis wife’s sewing machine using the then new material, bought at Foley’s in downtown Houstonwhen theywere out of nylon and vinyon, the fabrics he preferred. He soon determined Dacronwas superior because it didn’t degenerate over time.
“The role of Providence in human endeavor is speculative, but I like to think that in a personal case it was purposeful,” DeBakey wrote in the journalAmerican Surgeon in 2008. “Obviously, because of my good fortune, Iwas ahead of everyone else in the field.”
The invention, one of more than 50 he devised to repair hearts and arteries, won DeBakey the 1963 Lasker Award, the top American award in medicine.
The following year, while attempting a surgery that proved too difficult to complete, DeBakey improvised a coronary bypass procedure only previously performed successfully indogs. In so doing, he became the first surgeon to perform a successful coronary bypass on a human patient.
In 1968, DeBakey was credited with the first simultaneous, multiorgan transplant, overseeing a team that removed the heart, lobe of one lung and both kidneys from a 20-year-old victim of a gunshot wound. The organs were transplanted into four patients: A 50year-old man got the heart; a 39year-old man got the partial lung; and two men, 41 and 22, each received a kidney.
Meanwhile, Cooley focused on hearts, performing an estimated 65,000 procedures over four decades, more than any other surgeon. Atonetime, his surgical team was performing one-tenth of all open-heart surgeries in the U.S.
Cooley stood above all others because of his speed and dexterity, a combination that produced what wasdescribed at the time as“Woolworth volume and Tiffany quality.” Hewasquotedas sayinghe“always wanted to be known as the Sam Walton of heart surgery,” in reference to the founder ofWalmart.
But Cooley also pushed the boundaries of heart surgery. Dr. Christian Baarnard in South Africa beat him to the first heart transplant in December1967, butCooley matched the achievement five months later, and his patient went on to live 204 days, compared to 18 for Baarnard’s patient.
In 1969, Cooley stunned the world by implanting a mechanical heart intothechest ofHaskellKarp, a printing estimator in the last stages of heart failure. The device worked long enough to replace it with a donor heart when one became available three days later, although Karp died 32 hours later of pneumonia and kidney failure.
For all the attention it generated, the event didn’t set off awaveof implants across the nation, the technology considered premature, rejection issues not yet well understood. Instead, it focused attention on alternatives known as left ventricular assist devices (LVADs), which assist the chamber that pumps blood throughout the body. The approach was pioneered by DeBakey after he abandoned research into the total artificial heart.
Also pioneered in Houston: a minimally invasive procedure to replace a failing heart valve. The surgery, which entails threading the new valve to the heart through a blood vessel in the patient’s groin rather than open-heart surgery, was approved first for patients too sick and frail for open-heart surgery, then forpatients at intermediate risk. More recently, studies showed it proved better than openheart surgery in young, healthy patients.
Houston doctors are at forefront of the next great hope for cardiovascular care, too: regenerative medicine. The field is based on the idea that stemcells — found in early-stage embryos and adults, prized for their ability to easily divide and develop into various types of cells — may be able to repair injuries and degeneration to heart tissue, an idea first tested at Texas Heart Institute around 2000. Though still awork in progress, the idea is considered the next frontier.
Advances by DeBakey, Cooley madeHouston a leader in heart care By Todd Ackerman STAFF WRITER