July 13, 2008
Dr. Michael E. DeBakey, Rebuilder of Hearts, Dies at 99
By LAWRENCE K. ALTMAN
Dr. Michael E. DeBakey, whose innovative heart and blood vessel operations made him one of the most influential doctors in the United States, died Friday night in Houston, where he lived. He was 99.
His death, at the Methodist Hospital, was of natural causes, according to a statement released by the hospital and Baylor College of Medicine, where Dr. DeBakey was chancellor emeritus.
“Many consider Michael E. DeBakey to be the greatest surgeon ever,” the Journal of the American Medical Association said in 2005. By the time Dr. DeBakey stopped a regular surgical schedule, when he was in his 80s, he had performed more than 60,000 operations. He also made Houston a major center for heart surgery and research and turned Baylor into one of the nation’s great medical institutions.
Dr. DeBakey’s surgical innovations have become common practice today and have saved tens of thousands of lives. An early invention, the roller pump, devised while he was in medical school in the 1930s, became the central component of the heart-lung machine, which takes over the functions of the heart and lungs during surgery by supplying oxygenated blood to the brain. It helped inaugurate the era of open-heart surgery.
One of Dr. DeBakey’s innovations helped preserve his own life in 2006, when he underwent surgery to repair a torn aorta. He had devised the operation 50 years earlier. Afterward, he spent months making what he called a miraculous recovery and then returned to his office and an active schedule.
Yet he achieved his fame as much for what he did outside the operating room as what he did in it. His care of ailing world leaders, like President Boris N. Yeltsin of Russia, made headlines. And with organizational and political skills and energy as enormous as his pride, Dr. DeBakey traveled the world well into advanced age, lecturing and helping to build cardio-vascular centers. In 2005 alone he made four international trips.
A number of his surgical innovations and observations were initially ridiculed. While working at Tulane University in New Orleans in 1939, Dr. DeBakey and Dr. Alton Ochsner made one of the first links between cigarette smoking and lung cancer. Many prominent doctors derided the concept. Then, in 1964, the surgeon general documented the link.
Dr. DeBakey went on to discover — again in the face of professional skepticism — that Dacron grafts were excellent substitutes for damaged parts of arteries; the finding allowed surgeons to repair previously inoperable aneurysms of the aorta in the chest and abdomen.
Dr. DeBakey popularized — if he did not originate — operations to bypass blocked arteries in the neck, legs and heart. They have since been performed on millions of patients around the world. He was also a leader in developing mechanical devices to assist failing hearts.
In the cold war, Dr. DeBakey made about 20 visits to Moscow to lecture. The trust he earned helped shape recent history when, in a consultation, he determined that Yeltsin, who had fallen ill during a re-election campaign in 1996, could undergo coronary bypass surgery. Yeltsin’s doctors had contended that the president could not survive an operation, Dr. DeBakey said.
That consultation was credited with saving Yeltsin’s presidency, if not his life. (Yeltsin died last year at 76.)
“Calling in Dr. DeBakey was very important, a signal that he was in very serious condition, and consulting with a world leader in surgery this way was almost unthinkable in the Soviet period,” said Marshall I. Goldman, a Russian expert and senior scholar at Harvard.
Dr. DeBakey was also credited with transforming the Baylor College of Medicine in Houston from a provincial school into a leading educational and research institution. In 1948, when he arrived from Tulane to become chairman of Baylor’s department of surgery, he found the department on academic probation and broke.
In World War II, Dr. DeBakey helped modernize battlefield surgery by urging that doctors be moved from hospitals to the front lines, where only first aid had previously been given. Dr. DeBakey said that he and others created early versions of what became the mobile army surgical hospital, or MASH unit, in the Korean War. For changing the strategy of treating the wounded, the Army awarded him the Legion of Merit.
Dr. DeBakey also helped develop a medical program to care for returning war veterans. The Veterans Affairs hospital in Houston is named for him. And he was a driving force in rejuvenating the National Library of Medicine in Bethesda, Md., and turning it into the world’s leading repository of medical information.
Dr. DeBakey advised a number of presidents about health issues and, he said, consulted in the personal care of two of them: Lyndon B. Johnson and Richard M. Nixon. Even though Dr. DeBakey was on Nixon’s enemies list, the president invited him to the White House for a briefing after one of Dr. DeBakey’s visits to the Soviet Union.
Dr. DeBakey attributed his longevity in part to never having smoked and to genes that helped other members of his family live into their 90s. A relatively short man who looked 20 years younger than his age, he could fit into his Army uniform in his later years despite a lack of regular physical exercise, he said.
Even in his 90s, Dr. DeBakey arose at 5 a.m. every day, wrote in his study for two hours and then drove, often in a sports car, to the hospital, where he stayed until 6 p.m. After dinner, he usually returned to his library for more reading or writing before retiring after midnight.
Skilled Innovator
Michael Ellis DeBakey never lost the Southern drawl he acquired growing up in Lake Charles, La. He was born on Sept. 7, 1908, the oldest of five children of Lebanese-Christian immigrants who moved to the United States to escape religious intolerance in the Middle East. His parents chose Cajun country because French was spoken there, as it had been in Lebanon.
Dr. DeBakey credited much of his surgical success to his mother, Raheeja, for teaching him to sew, crochet and knit.
He was inspired to become a doctor from chats with local physicians while he worked at a pharmacy owned by his father, Shaker Morris DeBakey, who also owned rice farms.
While attending schools in Lake Charles and earning undergraduate and medical degrees from Tulane, he played the saxophone and clarinet in a band.
As a medical student, he showed a gift for innovation when an instructor asked him to find a pump to study pulse waves in arteries. From library research, he fashioned older pumps and rubber tubing into one that served the instructor’s purpose, calling it a roller pump.
This was before the time of blood banks, so Dr. DeBakey used the pump to transfuse blood directly from a donor to a patient. The pump was later adapted for use in the heart-lung machine. .
After finishing his training at Charity Hospital in New Orleans in 1935, Dr. DeBakey started out as a general surgeon. At the time, few doctors specialized in heart and chest surgery. Young American doctors who aspired to academic careers typically sought further training in Europe. Dr. DeBakey enrolled at the University of Strasbourg in France and then the University of Heidelberg in Germany.
In his first weeks at Baylor, in 1948, Dr. DeBakey found that a promised affiliation with a hospital in Houston had fallen through and that the hospital’s doctors would accordingly not let him operate on their patients. With nowhere to teach young doctors, Dr. DeBakey was about to resign from Baylor.
But then the Truman administration asked him to help transfer Houston’s Navy hospital to the Veterans Administration. Seizing on the opportunity, he stayed on at Baylor to help make the veterans hospital Baylor’s first official hospital affiliate and build Houston’s first surgical residency program.
Dr. DeBakey had a knack for recruiting good surgeons who played key roles in many of his successes. One was Dr. Denton A. Cooley, who was Dr. DeBakey’s protégé until a rift left them bitter rivals.
In his public and professional lectures, Dr. DeBakey, an inveterate name-dropper, often showed photographs of his celebrated patients and spoke about their ailments. Among these notables were the deposed shah of Iran, Mohammed Reza Pahlavi; the duke of Windsor, the former King Edward VIII of England; Marlene Dietrich; Joe Louis; Leo Durocher, the baseball manager; and Jerry Lewis. His spacious office in Houston and the long corridors leading to it were lined with framed awards and pictures autographed by many of his patients.
Surgery Pioneer
The main focus of Dr. DeBakey’s surgical innovations was arteriosclerosis, a systemic disease in which fatty deposits can damage arteries feeding the heart and other tissues, leading to heart attacks, strokes and loss of limbs.
When Dr. DeBakey began his career, surgeons could do little for arteriosclerosis. He was a leader among those who demonstrated otherwise.
Dr. Allan D. Callow, a vascular surgeon and emeritus professor of surgery at Tufts University, said Dr. DeBakey had recognized that the damage from arteriosclerosis was often limited to critical areas in arteries and that these areas could be cut out or bypassed surgically.
In 1952, Dr. DeBakey successfully repaired an aortic aneurysm — a ballooning of an artery — by cutting out the damaged segment in the abdomen and replacing it with a graft from a cadaver. In 1953, he successfully repaired a blocked carotid artery in the neck. The blockage threatened to cause a stroke by choking off blood flow to part of the brain.
Luck played a big role in one of Dr. DeBakey’s major innovations.
Seeking to use synthetic instead of cadaver grafts, he went to a department store to buy some nylon. The store had run out of it, so a clerk suggested a new product, Dacron. Dr. DeBakey liked its feel, bought a yard and then used his wife’s sewing machine — he was married to the former Diana Cooper at time — to create his first artificial arterial patches and tubes.
He went on to collaborate with a textile engineer in Philadelphia to produce Dacron arterial grafts in large numbers.
Dacron turned out to last for decades as a surgical graft; nylon, by contrast, broke down after about a year.
Many doctors initially scoffed at Dr. DeBakey’s claim about Dacron, in part because he had a tendency, like a number of other surgeons, not to report failures. But when the critics went to Houston, they found he was operating on many patients and was far ahead of them.
That work won Dr. DeBakey a Lasker Award, the country’s most prestigious biomedical prize, in 1963. He was cited for a number of accomplishments that were “responsible in a large measure for inaugurating a new era in cardiovascular surgery.”
In 1964, President Johnson appointed Dr. DeBakey chairman of the President’s Commission on Heart Disease, Cancer and Stroke, which went on to raise standards of care for these diseases.
Dr. DeBakey was a pioneer in performing coronary bypass operations. In one of his last lectures, at the New York Academy of Medicine in Manhattan in November 2005, Dr. DeBakey said that his team had performed the first successful coronary bypass operation, in 1964, but that it did not report it until 1974.
Critics say Dr. DeBakey was eager to claim credit for innovations or exaggerate his role in making them, but since no biography of Dr. DeBakey or thorough analysis of his hundreds of scientific papers has been published, it will be left to medical historians to resolve such controversies.
Shortly after Dr. Christiaan N. Barnard performed the first human heart transplant in 1967, in Cape Town, South Africa, Dr. DeBakey followed, somewhat warily. His team was the first to transplant four organs (a heart, two kidneys and a lung) from one donor to different recipients.
Realizing that the demand for human heart transplants would outstrip the supply, Dr. DeBakey pursued the development of a total artificial heart as well as a partial one, known as a ventricular assist device, or VAD.
Dr. DeBakey is believed to have been the first to use a VAD successfully. Over 10 days in 1966, he weaned a woman from a heart-lung machine after heart surgery and then removed the device when her heart function improved. She died in an automobile accident several years later.
A number of such assisting devices, including a small one bearing Dr. DeBakey’s name, are now marketed or are being tested among patients with severe heart failure. The use of the total artificial heart that Dr. DeBakey was developing with Dr. Domingo S. Liotta led to a widely publicized scandal in 1969. On walking into a meeting at the National Institutes of Health, which was paying for the research, Dr. DeBakey was shocked to learn that hours earlier Dr. Cooley, his former colleague, had implanted an artificial heart in a patient for the first time. The device was the one the DeBakey team had been testing on calves.
The government ordered Baylor to investigate the unauthorized use of the experimental device. Using the artificial heart on the patient, Haskell Karp, was premature, Dr. DeBakey said, because of “discouraging results” in calves. He later called Dr. Cooley’s action a “childish” effort to claim a medical first.
Dr. Cooley, who had moved to another nearby Baylor institution, St. Luke’s Hospital, had never tested the device on animals and said he had implanted it as a desperate measure to keep Mr. Karp alive until he could do a transplant. But others contended that Dr. Cooley had secretly been planning to use the device for several months.
The American College of Surgeons censured Dr. Cooley, who resigned from Baylor, and for almost 40 years the two master surgeons rarely spoke, maintaining perhaps the most famous feud in medicine. But it ended last year, in a surprise reconciliation, when the two men warmly shook hands at a ceremony at St. Luke’s in which Dr. DeBakey received a lifetime achievement award from the Denton A. Cooley Cardiovascular Surgical Society.
Medical Politician
Dr. DeBakey said his ties to the former Soviet Union began after he befriended a small group of Soviet doctors who sat by themselves at a surgical meeting in Mexico in the 1950s. Dr. DeBakey took them to lunch and invited them to watch him operate in Houston on their way home. Later, they invited Dr. DeBakey to speak in the Soviet Union.
In 1973, Dr. DeBakey went to Moscow to operate on Mstislav Keldysh, a nuclear scientist and president of the Soviet Academy of Science. A year later, the Academy of Medical Sciences of the U.S.S.R. elected Dr. DeBakey a foreign member.
For 30 years, from 1964 to 1994, Dr. DeBakey served as chairman of the Albert and Mary Lasker Foundation’s medical research awards jury. Contacts Dr. DeBakey made through the foundation led to referrals from around the world.
As a shrewd medical politician, Dr. DeBakey called on grateful patients and their families to influence national legislation creating the National Library of Medicine and then ensuring that it would be part of the National Institutes of Health in Bethesda, Md.
Dr. DeBakey never shied from controversy.
In the early 1960s, he attended a press conference at the White House with President John F. Kennedy to support the creation of the federal Medicare health insurance plan, bucking the American Medical Association, which had given him its Distinguished Service award in 1959. The Medicare legislation passed in 1965 under President Johnson.
Dr. DeBakey said his greatest professional disappointment was in not solving the mystery of atherosclerosis; he never accepted cholesterol as the dominant factor in producing the disease. In the 1980s, Dr. DeBakey was among the first to explore whether a virus or other infectious agent might lead to arteriosclerosis, a link scientists continue to explore.
In 1969, Johnson awarded Dr. DeBakey the Presidential Medal of Freedom, the highest honor given a United States citizen. In 1987, President Ronald Reagan awarded him the National Medal of Science. In April, he received the Congressional Gold Medal, Congress’s highest civilian honor, in a ceremony attended by President Bush.
Dr. DeBakey’s first wife, Diana, died in 1972. His survivors include his second wife, the former Katrin Fehlhaber, who had been a film actress in Germany; their daughter, Olga-Katarina; two sons from his first marriage, Michael and Dennis; two sisters; and a number of grandchildren. Two sons, Ernest and Barry, died earlier. Dr. DeBakey was a perfectionist, intolerant of incompetence, sloppy thinking and laziness. Before mellowing in his later years, he had a reputation for sometimes tyrannical behavior in firing assistants for making relatively minor errors like cutting a suture to the wrong length.
“If you were on the operating table,” Dr. DeBakey said, “would you want a perfectionist or somebody who cared little for detail?”
Dr. Jeremy R. Morton, a retired heart surgeon in Portland, Me., who trained under Dr. DeBakey, said: “He could be sweet as dripping honey when it came to patients and medical students, but could be brutal with surgical residents.
“I guess he was trying to make us tough.”
