The Heart Healers (52 page)

René
Favaloro’s legacy as viewed by fellow Argentines.
Hannah Vinter. Shot Through the Heart: The Life and Death of René Favaloro.
Argentina Independent.
July 29, 2010.

Richard Cheney’s medical history.
Although I am privy to details of Mr. Cheney’s management through the practice of cardiology, because I have used a patient’s name, I have strictly confined my accounting to published sources of information, including his autobiography.

13. Expanding Horizons

Albert Starr recalls his laboratory.
Weisse AB.
Heart to Heart
.

Albert Starr recalls a moment of intuition
. Starr A. A cherry blossom moment in the history of heart valve replacement.
J Thorac Cardiovasc Surg.
2010;140(6):1226–1229.

Starr and my mentor Jeremy Swan.
Both men became consultants for Edwards Laboratories, and through their many meetings, became good personal friends. Both were also skiers. Starr made a diagnosis of CAD on himself when he developed angina pectoris on the ski slopes.

Starr describes his success with replacement of diseased mitral valves.
Starr A, Edwards ML. Mitral replacement: Clinical experience with a ball-valve prosthesis.
Ann Surg.
1961;154:726. For many years the Starr-Edwards ball-in-cage prosthesis dominated valve surgery. After years of being slammed against the cage struts, some of the balls became misshapen.

14. “The Ship Has Weather’d Every Rack, the Prize We Sought Is Won”

Cardiac transplantation before Shumway.
Stephenson LW. History of Cardiac Surgery. In: Cohn LH, Edmunds LH Jr, eds.
Cardiac Surgery in the Adult
.

Shumway and Lower report their early success with heart transplantation in animals.
Lower RR, Shumway NE. Studies on orthotopic homotransplantation of the canine heart.
Heart Surg Forum.
1960;11:18.

Christiaan Barnard reports his success.
Barnard CN. A human cardiac transplant: An interim report of a successful operation performed at Groote Schuur Hospital, Cape Town.
S Afr Med J.
1967;41:1271.

Barnard was actually scooped by three years.
Hardy JD, Chavez CM, Hurrus FD, et al. Heart transplantation in man and report of a case.
JAMA.
1964;188:1132.

Shumway’s recollection of his years with Lillehei.
Cooper, DKC.
Open Heart
. David K.C. Cooper is himself an eminent transplant surgeon who helped bring it to the United Kingdom. His book is a fascinating account of the many surgeons who practiced in the golden era of cardiac surgery. He was a friend of both Norman Shumway and Christiaan Barnard. His work was an invaluable resource, and many of the quotes from Shumway, Barnard, Lower, and Hardy can be found in this book.

Shumway’s obituary recalls his accomplishments, his unique surgical persona, and his self-effacing sense of humor.
Oransky I. Norman Shumway.
Lancet.
2006;367:896–897.

“I am God.”
The words were uttered by actor Alec Baldwin in the movie
Malice
.

The differing account of Barnard’s first transplant.
McRae D.
Every Second Counts: The Race to Transplant the First Human Heart
. New York: G.P. Putnam’s Sons; 2006.

The attitude toward organ transplantation between races.
Malan M.
Heart Transplant: The Story of Barnard and the “Ultimate in Cardiac Surgery.”
Johannesburg: Voortrekkers; 1968.

Christiaan Barnard counters his critics and telling view of himself and his career.
Barnard C, Curtis BP.
Christiaan Barnard: One Life.
New York: Macmillan; 1969.

Transplant recipients with unusual achievements.
All the names in this paragraph are real and have received extensive public acclaim.

15. Merging Streams

The history of electrophysiology
. Several authors have traced developments before and after Beck, Zoll, Bakken, and Lillehei. Among them is: Lüderitz B. Historical perspectives of cardiac electrophysiology.
Hellenic J Cardiol.
2009 January-February 2009;50(1):3–16.

Dr. Paul Zoll publishes a description of external defibrillation, along with an advertisement.
Zoll PM, Linenthal AJ, Gibson W, Paul MH, Norman LR. Termination of ventricular fibrillation in man by externally applied electric countershock.
N Engl J Med.
1956;254:727–732.

Successful CPR is announced by investigators at Johns Hopkins.
Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage.
JAMA.
1960;173:1064–1067.

Cedars-Sinai physicians publish the first description of a coronary care unit but are forgotten by history.
My colleague Dr. Morris Wilburne was a cardiologist at the old Cedars of Lebanon Hospital (now Cedars-Sinai Medical Center) in the early 1960s. Although he and his collaborator Dr. Joshua Fields clearly had the concept, they did not succeed in bringing the unit to a functioning reality. Consequently histories of CCUs had accorded them absolutely no recognition until 2011 when contemporary cardiology’s historian Dr. Bruce Fye unearthed an abstract written by Wilburne establishing his priority as the first to describe a CCU (Wilburne M. The coronary care unit: A new approach to treatment of acute coronary occlusion [Abstract].
Circulation.
October 1961;24:1071). Nonetheless, Hughes Day remains secure as the first to bring the CCU to realization. Science is consistent, if not entirely fair. Once again, implementation trumped idea. History remembers the person who makes an idea work, not the one who first has the idea. The story is recounted in: Fye WB. Resuscitating a
Circulation
abstract to celebrate the 50th anniversary of the coronary care unit concept.
Circulation.
2011;124:1886–1893.

The first CCU is established in the United States.
Day HW. Preliminary studies of an acute coronary care area.
Lancet.
1963;83:53–55. Day established his CCU in 1962, and published in the following year. Desmond Julian succeeded in establishing his CCU very soon after Day, so I am inclined to give joint credit. Science historian Thomas Kuhn, who wrote about paradigm shifts, has this comment about simultaneous innovation: “To the historian discovery is seldom a unit event attributable to some particular man, time, and place.” As Julian notes in his history of the CCU (see below), in 1809 Dr. Allan Burns in his book
Observations on Some of the Most Frequent and Important Diseases of the Heart
(reprint New York: Hafner Pub. Co.; 1964), in his chapter entitled “On disease of the coronary arteries and on syncope anginosa,” writes “where, however, the cessation of vital action is very complete, and continues long, we ought to inflate the lungs, and pass electric shocks through the chest.”

Dr. Desmond Julian recalls the rocky history faced by advocates of the CCU.
In: Julian DG. The history of coronary care units.
Br Heart J.
June 1987;57(6):497–502.

Dr. Bernard Lown expands the concept of CCUs to early identification of risk.
Lown B, Fakhro AM, Hood WB Jr, Thorn GW. The coronary care unit: New perspectives and directions.
JAMA.
1967;199:188–198.

Coronary care units become a breakthrough in treatment of heart attack.
Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: A two year experience with 250 patients.
Am J Cardiol.
1967;20:457–464.

For every great scientific advance there are naysayers.
Bloom BS, Peterson OL. End results, cost and productivity of coronary-care units.
N Engl J Med.
1973;288:72–78.

The invention of the balloon-tipped catheter.
Who thought of the balloon? Chonette recalls the idea emerged from the meeting but does not recall the participants. Ganz thought the idea might have been his, but maybe not. Marcus heard later from someone, maybe Swan, that a young Edwards engineer standing at the back of the room volunteered the idea. Unfortunately, Swan did not record his recollection of the event. Marcus likens the dilemma to the 1950s movie classic
Rashomon,
which shows divergent versions of “the truth” from the point of view of four participants. Director Kurosawa leaves the question unanswered, and so must we.

The first bedside measurement of cardiac function in critically ill patients.
Forrester JS, Diamond G, Chatterjee K, Swan HJ. Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts).
N Engl J Med.
1976;295:1356–1362. My memory of my early years of managing many critically ill patients is now a montage of images. The description of some critically ill patients (e.g., Alexi Kroon) is a composite of these images.

The falling rate of in-hospital mortality with heart attack.
Hanssen M et al. French Registry on acute ST-elevation and non ST-elevation myocardial infarction 2010. FAST-MI 2010.
Heart.
May 2012;98(9):699–705.

The history of management of heart attack.
Braunwald E. Evolution of the management of acute myocardial infarction: A 20th century saga.
Lancet.
1998;352:1771–1774.

16. The Clot Busters

Pathologists do not find clots in coronary arteries at autopsy.
Maroo A, Topol EJ. The early history and development of thrombolysis in acute myocardial infarction.
Thromb Haemost
2004;2:1867–1870. Topol went on to become a thought leader in his generation of cardiologists. He has recently written a nonfiction bestseller: Topol E.
The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.
New York: Basic Books; 2012.

Sol Sherry recalls the early years of thrombolytic therapy.
Sherry S. The origin of thrombolytic therapy.
J Am Coll Cardiol.
October 1989;14(4):1085–1092.

A Russian pioneers the modern era of thrombolytic therapy of acute myocardial infarction.
Russian cardiologist Dr. Evgeny Chazov had performed the procedure in Moscow some years earlier, but his publication had escaped notice because we read only the Western scientific literature, demolishing my idea that I had dictated an account of the first intracoronary infusion of a thrombolytic in acute myocardial infarction. When you think you are first, I learned, you usually are not. Chazov EI, Matveeva LS, Mazaev AV, Sargin KE, Sadovskaia GV, Ruda MI. Intracoronary administration of fibrinolysin in acute myocardial infarct.
Ter Arkh.
1976;48:8–19.

17. The Birth of Biotechnology

The creation of Genentech. In
celebration of seventy-five great entrepreneurs,
Bloomberg Businessweek
magazine posted Robert Swanson and Herbert Boyer’s “Giving Birth to Biotech” on October 17, 2004. The article is available at
www.businessweek.com/stories/2004-10-17/robert-swanson-and-herbert-boyer-giving-birth-to-biotech
.

The transatlantic battle over the most cost-effective thrombolytic agent in acute myocardial infarction.
The sometimes hilarious confrontation is described in: O’Donnell M. Battle of the clotbusters. BMJ
.
1991;302:1259–1261.

How America emerged as a leader in biotechnology.
In
Genentech:
The Beginning of Biotech
. Chicago: University of Chicago Press; 2011, Sally Smith Hughes, the author, with twenty years of experience in the field of science writing, weaves together interviews with corporate leaders, capitalists, and scientists in biotechnology to describe the creation of Genentech.

What happened to Genentech? The tumultuous merger with Roche.
Details of the issues in the $46.8 billion acquisition in March 2009 are nicely presented in “Anatomy of a Merger: ‘Hostile Deals Become Friendly in the End, Right?’”: Knowledge@Wharton (
knowledge.wharton.upenn.edu/article.cfm?articleid=2579
).