Medical & Science:
World’s best-known surgeon pushed boundaries of operations, machinery
Dr. Denton Cooley’s surgical career included notable firsts.
Longtime rival Dr. Michael DeBakey may be the more important medical figure, but at the zenith of Houston’s era as the epicenter of cardiac medicine, the world’s best-known heart surgeon was Dr. Denton Cooley.
DeBakey had set the stage, making the Texas Medical Center the world capital for bypass surgery, the procedure to divert the flow of blood around a blocked artery. But when a new device called a heart-lung oxygenating machine made it possible to stop the heart and repair its defects, it was Cooley who took the spotlight.
“While DeBakey continued his pioneering work on vessels in the body, Cooley plunged into hearts,” Thomas Thompson wrote in the 1971 classic Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier. “Hundreds of cases became thousands, and in the city where to be first was cherished, nothing could compare with the inventory of human hearts that Cooley had repaired.”
Over four decades, Cooley performed an estimated 65,000 open-heart surgeries at the Texas Heart Institute, more than any other surgeon. At one time, his surgical team was performing one-tenth of all open-heart surgeries in the U.S.
Cooley’s surgeries included two particularly noteworthy ones — in 1968, the first transplant of a human heart in which the patient lived more than a few weeks; and in 1969, the first implantation of a mechanical heart, a dream since the 1940s. The latter, a Kitty Hawk type of advance, set in motion one of Houston’s signature stories.
Cooley stood above all others because of his speed and technical dexterity, a combination that produced what was described at the time as “Woolworth volume and Tiffany quality.” He made early heart-lung machines work because he was able to perform heart surgery so quickly.
“He did 15 surgeries a day and most didn’t last more than 20 minutes,” said Dr. O.H. “Bud” Frazier, another pioneer of heart surgery at the Texas Heart Institute. “He was four times as fast as most, twice as fast as the next fastest. There’s not a surgeon alive today who could do what he could do.”
The experience enabled Cooley to “‘streamline’ open heart surgery, simplifying the surgical techniques and making it more feasible to many other surgeons worldwide,” said Dr. David Cooper, a University of Pittsburgh surgery professor and author of “Open Heart: The Radical Surgeons Who Revolutionized Medicine.” “He demonstrated open heart surgery could be carried out on a much larger scale than previously thought.”
Cooley, 95, was born in Houston in 1920, a true child of the city. A grandfather helped found Houston Heights in 1890, and his father was a prominent local dentist.
Cooley attended the University of Texas, where he played basketball, winning a Southwest Conference championship. He said lessons he learned about teamwork later informed his medical practice and acknowledges the sport’s emphasis on hand-eye coordination and quick hands likely served him well in surgery. In 2003, UT opened the Denton A. Cooley Pavilion next to its basketball arena.
After graduating with honors, Cooley began training to become a doctor, first at the UT Medical Branch in Galveston, then at Johns Hopkins University in Baltimore. As a Hopkins intern in 1944, he assisted Dr. Alfred Blalock in the first “blue baby” operation, the dawn of heart surgery. The condition, a congenital heart malformation, robs the blood of oxygen and gives the skin a bluish cast.
After a two-year stint in the U.S. Army Medical Corps — he was stationed in Adolf Hitler’s hometown of Linz, Austria – Cooley returned to Houston in 1951, recruited to join Baylor College of Medicine under DeBakey, its newly appointed chief of surgery. He also brought the techniques he learned at Hopkins to Texas Children’s Hospital.
In the mid-1950s, Cooley became acquainted with the heart-lung machine, which temporarily takes over the functions of the heart and lungs while surgery is performed. The early versions were crude, but they heralded a new open-heart surgery era. Cooley improved on the machine, cobbling together pieces from a coffee pot, then showed he could fix defective hearts in the short time the machine allowed.
“We revealed to the world that open-heart surgery had begun,” Cooley said.
In the early years at Baylor, Cooley and DeBakey were a strong team, collaborating to make aortic aneurysms treatable. But over the years, the relationship became strained, too much ego, competition and personality differences. After breaking away from DeBakey, in 1962, Cooley founded his own practice, the Texas Heart Institute.
There, Cooley pushed the boundaries of heart surgery. Dr. Christian Baarnard in South Africa beat him to the first heart transplant in December 1967, but Cooley matched the achievement five months later and his patient went on to live 204 days. Baarnard’s patient survived 18 days.
In 1969, Cooley stunned the world by implanting a mechanical heart into the chest of patient Haskell Karp, then 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, though Karp died 32 hours later of pneumonia and kidney failure.
The event dealt the final blow to the Cooley-DeBakey relationship. DeBakey claimed the device was identical to one developed in his lab and complained that Cooley had not received – nor sought – approval to use it. He would go on to call the first-ever use of the device a theft, a betrayal and “a childish act” to claim a medical first.
Cooley countered that the device’s inventor, an Argentinian surgeon who’d come to Houston to work in DeBakey’s lab, brought him the mechanical heart after DeBakey rebuffed the project. Cooley said they then redesigned it for use as an emergency bridge to transplantation before putting it in Karp.
The ensuing rift divided the medical center — Frazier jokes that he was safer at the time flying a helicopter in Vietnam – and DeBakey and Cooley didn’t speak for nearly 40 years.
The two finally mended the rift in 2007, when astronaut Eugene Cernan’s memoir “The Last Man on the Moon” provided Cooley a lesson about “the folly of continuing pointless feuds.” He subsequently wrote DeBakey wishing to make things right.
“As time passes, I have a growing desire to meet with you and express my gratitude for the influence you have had on my life and career,” Cooley wrote. “Especially, I am grateful for the opportunity you provided me more than 50 years ago to become established at Baylor and to be inspired by your work ethic and ambition.”