Pizzas galore!

In his training DeBakey had been most interested in vascular surgery, and during the war he had studied the problems of repairing damaged arteries on the battlefield. Now he and a colleague, Denton Cooley, set about turning Houston into the world’s leading centre for vascular treatment. In 1952 they made the first successful repair of an aortic aneurysm, a bulging of the artery that takes oxygenated blood from the heart to the rest of the body, until then usually fatal. In the same year DeBakey performed the first successful carotid endarterectomy, an operation to clear fatty deposits from the main artery to the brain. This was the first surgical treatment of a stroke patient.

One of DeBakey’s biggest breakthroughs came in 1953. He had had some success replacing diseased sections of the aorta with tissue grafts from cadavers, but this was an imperfect solution, since the grafts tended to wear out. After experimenting with synthetic materials Dacron turned out to be ideal as an arterial substitute: it was durable, and the body would generate new tissue over it. DeBakey stitched the first grafts himself on his wife’s sewing machine; Dacron grafts remain hugely important today, allowing surgeons to repair even large sections of damaged artery.

DeBakey had a rigorous approach to research, and his surgical innovations were usually only attempted on humans after months or years of animal testing to establish their efficacy and safety — this would later make him a target for animal rights activists. One advance, however, was the product of desperate improvisation. In 1964 he was operating on a patient with a blocked coronary artery. His attempts to remove the blockage had failed, and the diseased blood vessel had been all but destroyed in the process. Realising that the patient’s chances of survival were negligible, DeBakey decided to attempt a procedure he had previously only used in the laboratory, with modest results, on dogs. He removed a vein from the man’s leg and used it to bridge the section of diseased blood vessel: this was the world’s first successful coronary artery bypass, now a standard procedure.

By now DeBakey had an international reputation, and was called on to treat such celebrities as the Duke of Windsor, Frank Sinatra and the Shah of Iran. He attracted criticism for his apparent enjoyment of the attendant publicity but he was happy to exploit his high profile if he thought it would benefit the hospital.

The advent of the heart-lung machine in the 1950s made much more complex surgery on the heart possible, and in the following two decades this became DeBakey’s main interest. He was intrigued by the possibilities of artificial heart replacements, and in 1963 persuaded Congress to fund the research. Three years later he became the first surgeon to implant a partial artificial heart into a human.

In the laboratory DeBakey had developed a small pump, a left ventricular assist device (LVAD), designed not to replace, but to supplement, the function of a diseased heart. Operating on a woman to replace badly diseased heart valves, he found that she could not be weaned off the heart-lung machine after surgery because her own heart was failing. So he implanted the pump, which by taking over part of the heart’s workload allowed it time to recover. After ten days he was able to remove the pump.

In 1967 the world was stirred by news of the first heart transplant, conducted by Christiaan Barnard in South Africa. Within a year DeBakey had also transplanted a heart (and supervised the world’s first multiple organ transplant); however it was not him but his former colleague Denton Cooley who was the first American surgeon to repeat Barnard’s feat.

While Cooley and DeBakey had achieved brilliant things, the relationship between these powerful personalities became strained. The two were opposites. Cooley was a brash Texan, gregarious and ambitious; DeBakey was less impulsive, more serious, a Southerner to his fingertips. It was no surprise when in 1960 Cooley moved his practice to the neighbouring St Luke’s hospital. However, a more serious estrangement was to follow.

DeBakey had spent much of the 1960s trying to develop an artificial heart that might entirely replace the natural organ. By 1969 he had produced a working prototype that had been implanted in calves, although he was dissatisfied with the results; there was no thought yet of human trials. Then he was stunned to hear Cooley announce that he had implanted the world’s first artificial heart.

DeBakey suspected the theft of his artificial heart. Cooley claimed that he had developed his own device, but the revelation that he had been secretly employing his rival’s technician did not help his case. Cooley defended his conduct for the rest of his life, maintaining that it had been a measure of last resort. The patient survived three days with the implant, and died some hours after finally receiving a heart from a human donor. Cooley was censured by the US College of Surgeons and resigned his teaching position at Baylor College. The rift between the US’s two most celebrated heart surgeons, recorded in a 1971 Life magazine cover story headlined “A Bitter Feud” and a bestselling book, was not healed until 2007, when Cooley, then 87, arranged for DeBakey, 99, to receive an award.

DeBakey was discouraged by this and later attempts to implant artificial hearts, and in 1970 also abandoned heart transplantation, only resuming the operation in 1982 after the advent of the drug Cyclosporine, which reduced the problems of tissue rejection. For the remainder of his career his most important innovation was the continued development of the heart-assist devices.

A Nasa engineer who in 1984 had received a new heart from DeBakey offered his help, and this led in the 1990s to a new generation of miniaturised pumps small enough to be implanted in children. These are widely used today.

In 1995 DeBakey was consulted on the treatment of Boris Yeltsin who had suffered his third heart attack while campaigning. Yeltsin’s heart specialist, who had briefly trained under DeBakey, invited him to go to Moscow to offer his advice. DeBakey approved plans to carry out a quintuple bypass but on his recommendation surgery was delayed to allow Yeltsin’s condition to stabilise. DeBakey did not take part in surgery but supervised from an adjacent room, and the 88-year-old surgeon became a familiar face on Western television as he issued bulletins on the Russian President’s condition.

DeBakey did not retire but at 92 he gave up surgery, though he continued to assist occasionally at operations. In late 2006, while writing a lecture at home, he felt a sudden pain which he correctly self-diagnosed as a dissecting aortic aneurysm, a condition he had described in his book The Living Heart (1977 ) as “one of the most serious and grave forms of aneurysmal disease”. His prospects of survival were poor, and he resisted surgery. After he fell into a coma, however, his colleagues had little choice and operated.

Although DeBakey was in hospital for almost eight months, he became at 97 the oldest survivor of a surgical procedure he had himself invented half a century earlier. With typical determination he fought his way back to health, and at 99 was continuing his rehabilitation by visiting the hospital gym five times a week.

DeBakey said that he regarded his students as his most significant legacy, and although he could be terrifying, those who stayed the course were fiercely loyal to him. He was devoted to Baylor College, serving as its Chancellor from 1979 to 1996. For many years the college was in financial crisis, only surviving because DeBakey donated to it all his substantial surgical income and lived on his professor’s salary.

DeBakey received many honours, including the Congressional Gold Medal. The many institutions named after him include the DeBakey Heart Centre at Methodist Hospital in Houston, where he worked for over 60 years.

His first wife Diana, whom he married in 1936, died in 1972. He is survived by his second wife, Katrin Felhaber, their daughter and two of the four sons by his first marriage.

Michael DeBakey, surgeon, was born September 7, 1908. He died on July 11, 2008, aged 99