Dr. Michael DeBakey, 99; preeminent cardiac surgeon saved millions with his breakthroughs

By

Thomas H. Maugh II

Times Staff Writer

Dr. Michael E. DeBakey, the medical pioneer who was the driving force in developing the field of cardiac surgery, operating on more than 65,000 patients and developing medical technology that saved millions more, died Friday. He was 99.

DeBakey died of natural causes at the Methodist Hospital in Houston, according to a statement from the Baylor College of Medicine and the Methodist Hospital.

In his highly influential career, DeBakey performed the first coronary artery bypass surgery and the first carotid endarterectomy to prevent strokes. He developed the pump that is the key component of the heart-and-lung machines that is routinely used on patients during heart surgery and an artificial heart that is now used to keep patients alive while they wait for their own heart to improve.

He also developed the concept of the mobile army surgical hospital – immortalized in the film “M*A*S*H” – played a key role in the creation of the National Library of Medicine and transformed the Baylor College of Medicine and its Texas Medical Center from a third-rate hospital into a nationally recognized center of excellence for heart care.

He was the go-to guy for the rich and the famous, caring for Presidents Kennedy, Lyndon B. Johnson and Nixon, Russian President Boris N. Yeltsin, shipping tycoon Aristotle Onassis, comedian Jerry Lewis, actress Marlene Dietrich and singer Wayne Newton, among others. But he was equally solicitous of the non-celebrity patients who passed through his surgical suite, spending time with their families and often staying overnight in his office when he thought a patient might be in danger.

Yeltsin called him “a magician of the heart” and the Journal of the American Medical Assn. said many consider him to be the “the greatest surgeon ever.”

“His contributions have been enormous, and he will leave an amazing legacy,” said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute. Unlike many of his famous contemporaries, DeBakey “has exported his know-how to the world.”

The heart was a virtually untouchable organ when DeBakey received his medical degree, and cardiovascular surgery was little more than a glint in the eyes of a few physicians. He trained as a general surgeon under the mentorship of Dr. Alton Ochsner of Tulane University because that was the best opportunity available.

He first saw a living heart in 1933 while he was a young intern at New Orleans Charity Hospital. Police had brought in a young stabbing victim and his pulsating heart could be clearly seen through the opening in his chest.

“I saw it beating and it was beautiful, a work of art, an awe-inspiring sight,” he later told United Press International. “I still have an almost religious sense when I work on the heart. It is something God makes and we have yet to duplicate.”

His creativity was evident early. While still in medical school, he invented a hand-cranked roller pump to help a researcher study pulse waves in fluids such as blood. That device, in which the pump components never touched the fluid, was quickly adapted for use in blood transfusions and other applications. Eventually, it became the core of the heart-lung machine, invented in 1953 by Dr. John H. Gibbon Jr., which made coronary artery bypass and other types of heart surgery possible.

After DeBakey joined Baylor in 1948, he began developing theories and surgical techniques for repairing and replacing diseased arteries. One of his first interests was repairing aneurysms in the aorta – dangerous bulges in the main artery that carries blood from the heart to the rest of the body.

Such an aneurysm could be surgically removed, but he needed something to replace the tissue or the aorta would become too small. DeBakey had made it a practice to go to a department store in Houston and purchase synthetic cloth made of nylon or Orlon, looking for a replacement.

One day, they were out of those fabrics; all they had left was a new material called Dacron, so he bought a yard of that instead. Working on his wife’s sewing machine, he fashioned the fabric into tubes the same size as blood vessels and implanted them in animals. They proved ideal.

“Unlike other materials, the body did not reject Dacron, and tissue was attracted to it,” he said later. “It would hold onto it.”

He sewed the Dacron graft into the first patient on Sept. 2, 1954; the patient survived 13 years. Others since have survived much longer.

DeBakey subsequently convinced a textile manufacturer to begin knitting the Dacron into tubes in the same way that athletic socks are knitted.

He subsequently considered this one of his most important achievements – much more significant than his later work with an artificial heart. “How many will receive an artificial heart?” he asked. “Not many, relative to the millions with heart disease.

“But look at the literally thousands and thousands of patients who have had [Dacron graft] replacement for aneurysms of the aorta and other major arteries, not just in this country, but elsewhere. Its impact has been enormous.”

Over the next three decades, DeBakey pioneered techniques for opening clogged arteries and supporting failing hearts or replacing them.

He performed the first carotid endarterectomy in 1953 on a bus driver from Arkansas – scraping out built-up plaque from the carotid artery of the neck so it could not break off and cause a stroke.

In 1964, he performed the first coronary artery bypass surgery, removing a section of vein from the patient’s leg and inserting it into the coronary artery to bypass a blocked section.

Two years later, he was the first to implant a left ventricular assist device – a small pump designed to take some of the load off a failing heart – inserting it into the chest of a 37-year-old Mexican beautician whose heart would not start after surgery. The pump operated for 10 days while her heart recovered. The woman lived another six years before being killed in a traffic accident.

Two years after that, he performed the first multi-organ transplant, taking a heart, a lung and two kidneys from one donor and placing them in four recipients.

One of DeBakey’s few failures involved his efforts to develop an artificial heart. He was one of the first to propose the device and persuaded the federal government to fund the creation of an implantable gas-powered device.

One of his early collaborators at Baylor was Dr. Denton Cooley, a technically brilliant surgeon, but they grew apart because of their strong personalities and competitive natures. In the early 1960s, Cooley moved his base to St. Luke’s Episcopal Hospital, across the street from Methodist Hospital, where DeBakey practiced.

On April 4, 1969, Cooley implanted an artificial heart into the chest of Haskell Karp, a 47-year-old printing estimator from Skokie, Ill. The heart remained in place for 65 hours while a national appeal brought in a donor heart for a transplant, but Karp died 38 hours after the second surgery.

Although Cooley said the heart had been developed in his own laboratory with private funds, it ultimately turned out that Dr. Ray Liotta, a heart researcher who had worked in DeBakey’s lab, covertly brought the device to Cooley.

DeBakey had refused to implant the heart in humans because only three of seven calves receiving the heart had survived, and then only for a maximum of 12 hours. Cooley said he was trying to save a patient’s life.

“But you know, you are trying to save a patient’s life all the time,” DeBakey said later. “You also have to follow ethical rules.”

The incident caused DeBakey problems with the government because the heart was developed in his lab and the surgery hadn’t been approved by Baylor’s ethics board. The incident led to a permanent split between him and Cooley. Cooley left Baylor and the pump has not been used since.

DeBakey’s research took a different tack after he and Dr. George Noon performed a heart transplant on a NASA engineer in 1984. Talking about the newly launched space shuttle with the patient after the surgery, they wondered if it might be possible to adapt the massive impeller pumps used in the shuttle for a heart pump.

After much work, they produced an extremely small left ventricular assist device that is now manufactured by MicroMed Technology of Houston – and called the MicroMed DeBakey. The device was first implanted in a patient in Berlin in 1998 and has now been used to assist failing hearts for as long as two years. It is small enough even to be used in young children.

DeBakey’s hope was that it will eventually be refined enough to serve as a permanent implant. “There are 5 million Americans for whom we can do very little,” he said. “If you can implant this permanently in these types of patients with heart failure, they can get up and walk around and lead a reasonably normal life.”

Michael Ellis DeBakey was born Sept. 7, 1908, in Lake Charles, La. His parents, Morris and Raheeja, were of Lebanese descent and immigrated to this country as children.

His father was a successful pharmacist who invested in farms, and theirs was a life of relative wealth. DeBakey, his brother and three sisters lived in a large house with a chauffeur, maids, butlers and gardeners.

DeBakey’s parents encouraged hard work and learning. The children read voraciously and each had devoured the Encyclopedia Britannica from cover to cover before entering college.

Raheeja also taught her children to sew, crochet, knit and tat, all of which may have contributed to DeBakey’s manual dexterity later in life.

DeBakey enrolled at Tulane and, in his first two years, accumulated enough credits to enter medical school at 19. Despite his full load there, he kept working on his bachelor’s and received both degrees in six years.

A European education was a prerequisite for acquiring surgical skills in those days, and, after graduation, he spent two years at the University of Strasbourg in France and at the University of Heidelberg in Germany. That started a lifetime of world travel to promote his cardiovascular techniques, and he could speak French, German and Arabic.

He married Diana Cooper, a nurse he met in New Orleans before going to Europe, and joined the Tulane faculty. They had four sons: three businessmen and an attorney.

Working again with Ochsner, he noticed that all the lung cancer patients in their hospital wards were smokers. At the time, most experts attributed the startling increase in lung cancer cases to the 1918 flu epidemic or exposure to poison gases in World War I. In 1939, DeBakey and Ochsner published the first scientific paper linking it to cigarettes. When World War II broke out, Tulane wanted to declare him an essential faculty member so he would not be drafted. Instead, he enlisted and joined the U.S. surgeon general’s staff in Europe, where he lived for a time in the same castle as General George S. Patton.

DeBakey observed that many soldiers died because their wounds could not be treated until they reached a hospital well behind the front lines.

“I proposed to the surgeon general that we make mobile teams out of the personnel at these hospitals and call them auxiliary surgical units – they could be moved where needed,” he told the Journal of the American Medical Assn. “We put them in every army and they were a tremendous success. It was recognized as reducing the mortality of the wounded to the lowest level it had been up to that time.”

He also advocated specialized medical and surgical follow-up systems for military veterans, a program that eventually became the Veterans Affairs health-care system.

He returned to Tulane in 1947, but left a year later to join the Hoover Commission, which was reorganizing the executive branch of the government. While there, he often spent time at the Army’s medical library – then considered the finest medical library in the nation, despite the fact that it featured leaky ceilings and outhouses instead of toilets.

He proposed building a new library, but soon learned that the Army was more interested in tanks and guns. “And that triggered in my mind that it didn’t belong in the Army – it was a natural treasure,” he said.

The American Medical Assn. wanted the library built next to its headquarters in Chicago, however, and the impasse led to prolonged delays. But DeBakey had once operated on the husband of Dorothy Vredenberg, the secretary of the national Democratic Party, and he sought her help. Within a day, congressional leaders agreed to let construction begin in Bethesda, Md.

Later that year, the then-Baylor University School of Medicine tried to get him to join the faculty, but he turned them down twice. “They didn’t have any clinical service. They had no hospital. They had no residents, no training program in surgery,” he told the Houston Chronicle.

He ultimately accepted when the university promised him a 20-bed surgical service at Hermann Hospital and a free hand as chief of surgery. He quickly became unpopular.

One of his first controversies involved a rule he promulgated stating that physicians with no training in surgery could not operate at Baylor-affiliated hospitals. “No one who is unqualified to do good operations should be allowed to operate,” he said.

He was also unpopular with the Harris County Medical Society in Houston because of his new ideas – including the creation of intensive care units at Baylor, establishing new training guidelines for surgeons, and admitting black patients – and his frequent appearances in the local newspapers, which was then against the society’s rules. When the society tried to eject him, he hired attorney Leon Jaworski, who stopped the proceedings with a single letter.

After 20 years as chief of surgery, he became the school’s chief executive officer at a time when it was near bankruptcy. One of his first actions was to sever it from Baylor so that it could accept federal funds for research.

He also spearheaded a campaign that raised $30 million to eliminate the school’s debt. A foundation he created still contributes $2 million per year to the school.

About the same time, he also played a key role in the formation of a new Houston high school designed to lure youth, particularly ethnic and racial minorities, into medical professions. The school is now known as the Michael E. DeBakey High School for Health Professions.

When President Kennedy was trying to move Medicare legislation through Congress, he asked DeBakey to invite some colleagues for a White House Rose Garden ceremony introducing the bill. All refused, probably because the American Medical Assn. opposed the bill.

DeBakey was the only physician who appeared at the ceremony, and he received threatening letters and telegrams from physicians all over the country saying they would never refer patients to him again. Most, however, never followed through.

He installed his wife and family in a modest house five minutes from the university and lived there for the rest of his life.

“If I go home after operating, and I’ve lost a patient that day on the operating table, it’s hard for me to sleep that night,” he said. “I keep thinking about what I could have done or what I might have done to stop it Only time gradually eases the pain.”

His greatest pain came in February 1972 when his wife Diane died of a heart attack at their home while he was in surgery. Three years later, he married a German movie actress, Katrin Fehlhaber, whom he met at a party at Frank Sinatra’s house in California. Their daughter Olga was born in 1977 when he was 68.

A year later, he was hospitalized for smoke inhalation suffered when he rescued Olga after a Christmas tree caught fire in his home. “I just barely made it out,” he told the New York Times.

On New Year’s Eve 2005, when he was 97, DeBakey diagnosed a sharp pain in his upper chest as a torn aorta. Home alone, he did not call for help and, when Katrin returned, told her that he had pulled a muscle. Dubious, she called two of his colleagues and he was hospitalized.

Although he initially resisted it because of his age, the surgeons ultimately performed the operation DeBakey had pioneered, installing a Dacron graft to repair the torn aorta in a seven-hour operation. After a month in intensive care, he ultimately recovered and resumed his busy schedule of writing and travel.

Among his other honors, DeBakey received the Lasker Award for Clinical Research, the Presidential Medal of Freedom with Distinction, the National Medal of Science and, in April 2008, the Congressional Gold Medal.

In addition to his wife Katrin, DeBakey’s survivors include two of his sons, Michael and Dennis; and his daughter Olga.

 thomas.maugh@latimes.com