Oriented to Thoracic Transplant Recipients -- May 1999




By Bill Krasean, Kalamazoo Gazette 4/6/99

Laser-drilled holes in heart tissue have helped two area residents who had no other treatment options to get relief from persistent and intense chest pain.

One of the patients, Boyd “Buzz” Brenner, had been taking nitroglycerine tablets 10 to 20 times a day just to do minor tasks without pain.

Brenner and a patient who prefers to remain anonymous underwent the procedure at the Borgess Medical Center, one of the limited number of sites where the laser is coupled with a unique imaging device that provides a 3-D image of the heart.

The image guides Drs. Tim Fischell and Malcolm Foster with 1-millimeter accuracy to areas in the heart muscle where laser-burned channels will do the most good. (Ed note: Think of these channels as comparable to the holes on a cribbage board i.e. they do not go entirely through the heart muscle as the procedure mentioned further on does.)

Fischell said the laser is fed through a catheter the same way a balloon is fed through a catheter when cardiologists treat coronary artery disease with balloon angioplasty. The laser tip is placed inside the heart, where a brief burst of light energy is used to make a small channel that goes about halfway through the 10-millimeter-thick heart muscle.

Those people who are not candidates for the catheter laser have another option at Borgess. Dr. Mark Marbey, a cardiac surgeon will use another kind of laser to burn holes all the way through the heart muscle from the outside, after opening a small hole in the chest between the ribs.

Although burning holes all the way through the heart muscle may be desirable; cardiologists who use the catheter laser method don’t do that because of the risk of bleeding. If bleeding were to occur, the patient’s chest would have to be opened to stem the blood loss.

In the open-chest laser surgery, if bleeding occurs, it can be treated immediately. In both types of surgery the holes or channels speed the body’s normal production of tiny arteries, called collateral arteries, that help take up the slack for bigger arteries significantly narrowed or blocked by atherosclerosis.

The open-chest laser procedure has been approved by the Food and Drug Adminis-tration. The catheter procedure, however, has not been FDA approved and can be done only as part of clinical trials under way at Borgess and other American heart care centers.

Brenner was the first person to undergo the catheter procedure at Borgess. Cardiologists used a laser to burn 43 channels in his heart muscle to encourage the growth of tiny arteries.

He is among a growing number of people with deteriorating heart conditions who are no longer candidates for coronary artery-opening angioplasty or open-heart bypass surgery.

“They were helped earlier by angioplasty or coronary bypass surgery, but their coronary arteries are so obliterated with atherosclerosis there is nothing else we can do,” Fischell said. “They are people who have had one, two, or three open heart surgeries or four or five angioplasties... One colleague calls them frequent fliers of cardiac care.”

Yet they suffer from sometimes extreme chest pain, called angina, and need relief. Many are hospitalized periodically for intravenous infusions of drugs and discharged, only to return again in a few months because of the return of crippling pain.

The reason for the pain is a lack of adequate oxygen supply to weak, but still-living heart muscle, Fischell said. When deterioration of coronary arteries occurs, the body’s response is to create small supplementary arteries called collateral arteries.

Often, however, the tiny arteries aren’t adequate to replace those lost to atheroscle-rosis. Angina is a symptom.

The idea of drilling holes in heart muscle to reduce pain came from studies of reptiles, which do not have coronary arteries, Fischell said. Instead, oxygen and nutrients are carried to the heart muscle through channels in the muscle.

In the past decade, researchers speculated that if tiny channels were cut into heart muscle, they could replace blood flow lost through atherosclerosis. Experimental procedures using lasers to cut channels did offer temporary relief, Fischell said.

Within days, however, the channels were plugged with blood clots, he said. Despite the seeming failure, however, patients reported relief from chest pain even after the channels were blocked.

Subsequent studies showed that injury to muscle from the laser blasts prompted the body to accelerate the natural process of building collateral arteries, he said.

In the past five years, nearly 1,000 patients have been treated with the laser procedure.

Contributed by Dr Don Marshall, Kalamazoo

Lasers do work:

Tx Cal Miller of Indiana was the gentleman who underwent the transmyocardial (laser holes all the way through the heart muscle) procedure when it was still in the clinical testing stage. He personally reports: “The T.M.L.R. is working very well. At my last annual, August 1998 it (the heart) was still holding at 42% ejection fraction. I think as I had previously stated before this procedure in January 1995 it was at 29%. Upon retesting six months later it was also at 42%, so I’m very stable.”

Gene therapy: another potential way to make old hearts young

By Daniel Q. Haney, Associated Press

Boston (4/6/99) “Genes” ordered the surgeon. Then he injected a syringe of pure DNA and salt water into a man’s beating yellow-red heart.

Dr. James Symes stared for a moment into the man’s chest. The incision began just below the left nipple, ran through the lumpy layers of fat and muscle, then between the ribs, finally exposing the heart.

The surgeon moved the needle an inch. Again he slid it into the pulsing surface. And again. And again.

Ten minutes later, it was over. All that remained was for the patient to come out of anesthesia, heal up, return home to Monticello, AR, and wait to see if his heart felt better. On this gray December morning, a 55-year-old logging contractor named Joe Griffith became patient No. 20 in a groundbreaking medical experiment.

The goal: Give his heart some helpful new genetic material. If it worked as planned, these test-tube genes would prompt the growth of tiny blood vessels in just the right spots, shuttling blood around places where the coronary arteries were painfully clogged. Griffith would quite literally grow his own bypass.

Griffith’s surgeon at St. Elizabeth’s Medical Center had injected his heart with several billion identical copies of the gene. Each carries the manufacturing instructions for a protein known as vascular endothelial growth factor: Ordinarily humans make this stuff only while in the womb, when it triggers the construction of their circulatory system.

On this day, no one could say with certainty what these genes would do for Griffith. Might they, as he hoped, ease his chest pain? Restore his stamina? Just driving into the woods to check on logging crews left Griffith exhausted. Even a little relief would be welcome.

The experience of the previous 19 patients at St. Elizabeth’s encouraged him. There was, for instance, the very first in the experiment, a 67-year-old man treated in February 1998. He needed eight nitroglycerin tablets a day for angina that came with the slightest activity. All of his natural coronary arteries were plugged. So were three of the four new ones stitched in during earlier by pass surgery.

Three weeks after the gene injection, his angina began to ease. Two months after the operation, the pain was gone. He gave up nitroglycerin and took up swimming.

Animal tests suggest that the genes be come lodged inside heart muscle cells, which then secrete growth hormone for a week or two. This prompts growth of what doctors call collateral's, tiny blood vessels thicker than a hair but thinner than the skinniest strand of pasta.

Proteins like vascular endothelial growth factor, or VEG-F, are triggers. They set off a chain reaction of protein release that eventually ends in blood vessel growth. Once the process is under way, there’s no need for more VEG-F.

“It has surprised a lot of people in the gene therapy field to see that it’s possible to achieve these effects with something as simple and nontoxic as naked DNA,” says Dr. Jeffrey Isner, who oversees the experiment at St. Elizabeth’s.

Most of the patients have been as bad off as Griffith, a genial, low-key man with awful chest pain and no alternatives. He had his first coronary bypass operation at age 37. Over the years, his arteries were reamed with routers and squeezed with angioplasty balloons. Still, two of his coronary arteries were totally blocked. So too, were two veins that had been stitched in during bypass surgery.

Last April, a third bypass vessel closed off. The chest pain got so bad that Griffith could barely walk 100 yards without a rest. Ordinary medicine and surgery offered nothing more for him.

The afternoon before his gene operation, Griffith sat in pajamas on his hospital bed and told how the worsening angina had left him barely able to run his logging business:

“I leave home early for the office, get the crews going, go home to rest, get in my pickup, go to the job, stay a couple of hours, go home and take a nap, go to the office for a little while then go home exhausted.”

Griffith hoped for the best. “I’d be pleased with any help at all,” he said that day.

One Monday five weeks after the operation, Griffith woke up feeling better. After two months had gone by, he was back to work full time, managing crews from 5 a.m. to dark. He still had some chest pain, but nothing like before.

“I used to do most of my work from the seat of my pickup, but it reached the point where I couldn’t do that,” he said in his quiet way. “I was unable to do just about anything. Now I can get around without wearing my self out. I think I’m coming around.”

As for the first 18 patients in the program, all reported that their angina had improved. Of the 11 followed for more than three months, six were free of pain entirely. Their average nitroglycerin use had fallen from 60 pills a week to 2.

Tests, too, suggested they were doing better. X-ray movies called angiograms showed improved blood flow. And radioactive thallium scans revealed a one-third increase in the amount of heart muscle getting adequate oxygen.

An obvious drawback is the mini-thoracotomy, the operation Griffith had. Isner and Dr. Ronald U. Crystal of New York Hospital-Cornell Medical Center believe the genes must be injected directly into the heart muscle to work. Thus the need to cut open the chest.

One way around this would be to thread a catheter into the heart with a needle on the end of it. The approach seems to work in animals, but it is not yet ready for people.

However, releasing fluids into the heart through catheters is already routine. Some doctors say injecting the genes with needles is unnecessary. Just putting some genes into the heart’s circulation should be enough. A group led by Dr. H. Kirk Hammond of the Veterans Administration Hospital in San Diego recently started such experiments.

While cardiologists and surgeons are intrigued by these experiments, many seem cautious, even dubious, about the prospects. Some believe that genes are not needed at all. Squirting pure VEG-F into the heart might do just as well, even though the protein lasts only 10 minutes or so. Studies of this approach are also under way.

Some wonder if gene therapy has moved too fast from lab animals to humans without enough evidence that the newly created blood vessels will hold up over the long haul. “My personal view is that this has rushed pretty quickly to clinic, probably before we have understood it to the degree that would satisfy me,” says Dr. R. Sanders Williams, chief of cardiology at the University of Texas Southwestern Medical Center.

Others caution that too much is being made of small, preliminary studies in a handful of patients. “It’s tremendously promising, but it’s not ready for prime time,” says Dr. Robert Roberts of Baylor University.

April Showers on UpBeat’s Parade

It all started when one of my oldest friends passed away. Well it really didn’t start there either, UpBeat for April had already been started, but wasn’t “in the can” as they say, and then my friend had his funeral, which was untimely for both of us.

While we were away up in New England for about 5 days, our area of tidewater Virginia caught a severe thunderstorm with lightning. The latter caught a gum tree near our garage, which was the only good thing about it. (Gum trees and Kudzu slipped through the evolutionary strainer by their ability to out procreate anything.)

Upon return home a try at the computer revealed no video and no modem. Even though the plug had been pulled before we left, the high energy got into the telephone line and literally backed into the set — even frying the “slot” the modem resided in. The machine was rushed in for repairs.

Fortunately the greater part of the April UpBeat resided on a 3 inch disk. However, the only set around capable of even reading the disk had a much older version of Word on it, which really didn’t want to read the newer version.

Now here’s where a hitherto not much heralded fact came into play only to further obliterate normalcy. UpBeat every month has been sent by either disk or e-mail, lately the latter, to a very talented person and former working associate now with the administration of Cal State Fullerton University by the name of Jody Roginson. She takes the bytes off the air or disk and formulates them into pages ready for photo offset printing at a print shop in Anaheim that has been used since UpBeat’s infancy. Prior to that time it was done each month by permission on the Xerox machine at Anaheim Stadium.

Well without a modem the only way to get the material to her was by Express Mail on disk. Trouble was it was very hard to tell what material on the disk was “New Word” and what was “Old Word,” so everything went.

Amazingly, just as UpBeat arrived for final salvation, Jody’s 8-year-old Mac computer “went south” permanently, so she’s there looking at a now useless square piece of plastic. Again yet another borrowed machine entered the picture, only perfection was not to be had. When she opened some of the files on the new machine, there was no content. For instance, that’s why there was no PVCS column in April, it was floating around in that vastness of ether that contains all computer material when it “goes away.” There are skadillion bytes of great material in this ether, but Bill Gates is the only human who knows how to locate it, and he isn’t telling.

Well our “publisher” cobbles up six pages worth of material, even grabbing one of her sports publicity journals for filler and turns the finished product over to the printer with a sigh of relief.

We should be on track now, right? Nope. After printing, the gnome in the shipping department forgets that UpBeat always goes via UPS 2nd Day Air and instead allows it out the door via the infamous UPS Ground, an assured 7 day adventure in truck stops, warehouses, and transshipping points. It leaves California on the on April 20th and arrives in Virginia on April 27th.

Our staff of two here in the land of swamps and what’s left of blue crabs as they say, “Jumps right on it” with stamps and labels. As we start to coast towards the finish line, it becomes blatantly obvious that we’ve got about half a hundred more labels than we do UpBeats to put them on. Oh no, it’s one of those months when the press person shut down to take a phone call and forgot to start the run again.

Phone call back to CA results in a late day run of the extra copies with FedEx overnight and finally the April issue of UpBeat drew to a close. It was enough to cause some serious thoughts of maybe it would be easier if everyone just read the Web.

Just about then the local postmistress called to say that delivery would be delayed because for some reason the auto-sort barcode didn’t print on the labels used. So what would one expect?


There you are, you idiot! You’re floating blithely down the Mississippi River on an 8-day barge hotel cruise from Memphis to New Orleans. You open your carefully pre-organized pill container for your evening intake of what has been inculcated to be life essential pills. But wait!

There’s no cyclosporine! If you had any adrenaline left to flow after your prednisone diet, it would be gushing forth as you tear into the next day’s allocation. Oh my God, for the first time in memory, you have miscounted your pills and instead of 4, 25 mg. Cyclo. pills per day, you have only included 2. Quick calculations indicate that even though you prudently brought along two extra days supply for “just in case”, that won’t make up the difference. What to do?
1. Arrange for the barge to nose up to the bank, where you can jump off, and fight your way through the underbrush jungle, skunks, and snakes to and over the levee. There you can hopefully find a friendly native to take you for an exorbitant fee to the nearest airport, where you can catch a flight home.
2. Call a meeting of all the other passengers and check to see if per chance any of them are “pack’n Cyclo”.
3. Send an e-mail to your transplant center and tell them if they are right about the daily need for cyclo, you will miss the next Support Group meeting.
4. Find some way to blame your wife for making you miscount, and head for the bar for some heavy medicinal conditional adjustment.
5. Check with the Purser for the names and numbers of nearby drug stores at the next stop. Step onto the balcony of your stateroom and use your handy cell phone to call your hometown pharmacist. Tell him that apparently one of your Sandimmune boxes was mis-packed, and leave it to him to call a pharmacist in next town and make arrangements for you to pick up additional cyclosporine.

Solution number 5 is the most correctest one, and it does work. Just ask the idiot writer who did exactly as indicated late last month!

There may be hope yet for the Organ Donor Stamp. The main reason they did not carry over the original stamp to the new postage rate was the obvious potential of confusion between two stamps that looked alike, but were worth different amounts. The breast cancer stamp was carried over because it sells for 40 cents already with the surcharge going to the Cancer Fund.

Ed Heyn’s support group, Organ Transplants of Southwestern Michigan under the leadership of Tx Gary M. Rouse, is promoting a new design featuring the green ribbon, created by Senator Mike DeWine’s office. This new design has been submitted to the Citizens Stamp Advisory Committee.

The next step is the usual letters to our legislators in Washington, DC In the letters one should ask the legislators to sign on as sponsors of a bill to have the new design organ donor stamp printed.

Hospital Bill Headaches - Where to Go for Relief.

After Kathryn Hoback’s husband had a liver transplant, she received a “laundry basket of bills, including $5,000 for helicopter service.” Feeling overwhelmed, Hoback, who lives in Salem, Virginia, contacted Medical Recovery Services (MRS), a firm that reviews hospital bills in search of errors and overcharges. So far, MRS has recovered $4,000 for Hoback.

“I would say 90 to 95 percent of the bills we research have errors,” says Pat Palmer, founder of MRS in Salem, Virginia. After more than 10 years of investigating hospital bills, Palmer recalls two favorites: a woman who gave birth to a baby girl and was billed for a circumcision and a male heart surgery patient charged for time in the delivery room.

The majority of MRS clients have insurance that covers 70 to 80 percent of the cost of a hospital stay, leaving the patient responsible for the remainder. With hospital bills easily running into five figures, finding overcharges can mean real savings.

Palmer, a former Blue Cross and Blue Shield Association employee, started her enterprise after she discovered her father had been overcharged $400 in doctor’s bills. After getting him a refund, she began reviewing bills for friends and neighbors, recovering $15,000 for 22 clients in three months.

“Why are there so many mistakes? “There are individuals in the billing department who may not have any medical back ground, “explains Palmer. Her firm keeps half of what it recoups; if no errors are found, there’s no charge. For help with your bills, contact MRS at 1-800-280-9425. - Donna Wilkinson, Health, August, 1998 Contributed by Tx Vic Tenken, Santa Ana, CA

Once more with full-frustrated bitterness, I’m just darn tired of meeting 90-day heart transplants already on less prednisone than I am after 11 years! Sour grapes, heck yes, but somewhere medical protocols badly missed the boat on required dosage of prednisone. I don’t think the drug hit the Rx pad yesterday, and its negative side effects have long been well known. Why then ten years ago were transplants subjected to such massive addictive doses for so long, with many years of absolutely no effort to reduce or wean the patient off it? Then by the time “they” found out the right way to use it, it was too late for a great number of very compliant, and by then suffering, transplant patients?

If we want to go on with a further comment on “Ouija Board Medicine”, there’s the difference of opinion on transplant recipient flu shots that still exists today. Some centers absolutely require the shots; other centers will not endorse them for transplant recipients under any circumstances. Now this total contradiction of protocols has been going on for at least ten years. By now one would think there must be a body of recipients out there large enough to put some sort of scientific basis to the edicts.


One thing about being a Tx recipient, with or w/o cancer, is being thankful you can still meet so many people who are really sicker than you. (Well, I don’t know, it’s a thought that came to me - yes, maybe it’s the damn prednisone!)

The above mention of flu shot research was made in April, honest. Ask and ye shall be served: See Below

Influenza Vaccination in Heart Transplant Recipients

Sandra Fraund, MD et al, Hannover Medical School, Germany


Seventy-nine heart transplant recipients were vaccinated with a trivalent influenza virus vaccine 1996/97 containing the strains A/Singapore/6/86 (H lN 1), A/Wuhan/395/ 95 H3N2), and B/Beijing/l84/93.

The proportions of patients with protective levels of antibody (HI>_40) after vaccination ranged from 100% (A/Singapore [Hi N 1] to 31.6% (B/Beijing) and their mean fold titer increases were lower than those recorded for vaccination of 109 healthy subjects with the same batch of vaccine.

The vaccinations were tolerated well and did not result in serious side effects, such as graft rejections. Our findings indicate that influenza vaccination can induce protective antibody levels in a substantial portion of heart transplant recipients and lend support to the recommendation to vaccinate such patients annually against influenza. J. Heart Lung Transplant 1999; 18:220-225.

Two of Hearts

By Pauline Arrillaga - AP Writer

HOUSTON (AP) One is a Texas boy, born and raised in Houston, a hometown hero who began his medical studies at the University of Texas in Austin.

The other grew up in Lake Charles, La., reading the entire Encyclopedia Britannica by the time he enrolled at Tulane University.

The first is a guys’ guy whose wild side is marked by the “T” branded on his chest during a fraternity initiation. He juggled his studies while playing varsity basketball, excelling, of course, at both.

The second attended college and medical school simultaneously, completing two years of medical studies by the time his bachelor’s degree was in hand. He later gave up golf, hunting and fishing because it took time away from his true passion: medicine.

Somehow Dr. Denton Cooley and Dr. Michael DeBakey landed on the same path, one that took them to the height of the medical profession as pioneers of cardiovascular surgery.

Today 78-year-old Cooley and 90-year-old DeBakey continue to work full time, driven by the desire to solve the lingering mysteries of the human heart.

“They’ve both made tremendous contributions. It’s just a little bit of a different nature,” says Dr. O.H. Frazier, who trained under both surgeons and now leads artificial heart research at Cooley’s Texas Heart Institute.

“Maybe they both achieved more be cause of each other.”


At an hour when many still are crawling out of bed, no matter what their age, Dr. Denton Cooley is dressed in scrubs and making rounds at Houston’s St. Luke’s Episcopal Hospital.

An hour later, at 7:45 a.m., he’s performing his first surgery of the day a hernia repair on a former heart patient who insisted Cooley do the procedure.

He works steadily and quietly, speaking only to ask the surgical nurse for an instrument. His eyes, a cool blue topaz, never shift from his work until 35 minutes later. Then, when he surrenders his last tool, he gazes at the face of the man on his table and walks out the door and into the next operating pod.

With a quick change of gloves and gown, he’s at it again, this time repairing a chest incision that had failed to heal on a woman on whom he’d operated twice.

An hour later, with two more operations to go, Cooley pauses for a photo with a visiting doctor. The adoration is plain. “You are my teacher,” he gushes. “You are everybody’s teacher.”

Cooley’s lessons survive time.

In 1968, Cooley earned acclaim for performing the first successful heart transplant in the nation. Over the next year, he completed 20 heart transplants and, on April 4, 1969, became the first surgeon to implant an artificial heart in a human.

By 1972, Cooley had performed more than 1,200 coronary bypass operations and 10,000 open-heart operations. His surgical prowess amazed even his most talented peers.

“He was doing more heart surgery than anyone, and he stayed at that pace for years,” says Frazier.

“A surgeon once told me, ‘When I think about Cooley, it’s like thinking about infinity — I know it exists, but it’s too confounding.’ This guy would do no more than two heart operations a day; Cooley would do 20.”

Cooley still goes to the hospital every day, but he now sets aside only four days a week for surgery. On some days, he’ll perform three or four operations; on others, none.

He also continues with research, writing, working with surgical residents — and pursuing more “firsts.”

Last August, Cooley missed becoming the first to perform open-heart surgery over the Internet. A Seattle doctor beat him by a day.

“I still like to work,” he says. “It’s still challenging and enjoyable. I don’t think I’ll ever officially retire.”

Cooley admits that long operations tire him more than they did a decade ago. “Your back gets sore,” he says, “but I can still move all the parts.”

Cooley, a dentist’s son, was expected from an early age to follow his father. But in college he decided medicine would be more challenging.

He graduated from UT in 1941 and earned his medical degree from Johns Hopkins University in 1944. Later that year he assisted Dr. Alfred Blalock in the first “blue baby” operation to correct an infant’s congenital heart defect a moment Cooley considers “the dawn of heart surgery.”

In 1951, Cooley returned to Houston to join the faculty at Baylor University College of Medicine under DeBakey, then head of the department of surgery. For years, the surgeons worked side by side, developing techniques and tools that became the standard for modern-day heart surgery.

“We were very close,” says Cooley. “We were working together almost daily.”

But Cooley, who maintained an interest in pediatric heart surgery, eventually moved his practice to St. Luke’s and Texas Children’s Hospital, and in 1962 he founded the Texas Heart Institute at St. Luke’s.

His final split with DeBakey came after his decision to use the total artificial heart in 1969. Although the heart had been developed in DeBakey’s lab at Baylor, Cooley used it without permission of either the surgeon or the college.

Censured by the American College of Surgeons, Cooley resigned from Baylor. To this day, he maintains that his patient’s condition left him no choice but to use the heart.

“Dr. DeBakey was just personally opposed to the use of this device,” he says. “It was a final sort of rift.”

The operation and ensuing controversy represented a high, and low, of Cooley’s career. There would be more lows, primarily in his personal life.

In 1985, one of Cooley’s five daughters committed suicide, at age 28. He still wonders “if that didn’t represent a failure on my part.” And in 1989, in the midst of the oil and real estate crisis, Cooley filed for bankruptcy.

Nowadays, Cooley strives to spend more time with his family. He and his wife celebrated their 50th wedding anniversary this year, and photos of the event and of his 16 grandchildren fill his office walls.

But for Cooley, work will always be part of his world.

A $75 million complex to house the Texas Heart Institute is under construction. Cooley proudly displays sketches, calling the center “my pyramid.”

He also would like to see a permanent total artificial heart developed on which patients could live longer and better lives. His institute is working on a battery-powered model.

And while Cooley says he may retire from major surgeries when he turns 80, he admits, “I can’t really stop completely.”

“It is not the sprinter who is remembered, it’s the distance-runner,” he says. “That’s what I want to make out of my life and career, and fortunately I have the opportunity to keep going.”


Across the street from the Texas Heart Institute, eight medical students sit erect around a conference table at Methodist Hospital— wide-eyed and speechless.

Minutes before, they boisterously exchanged war stories about their day, griping about long hours, boasting of procedures performed for the first time.

Then Dr. Michael DeBakey walks in, and they become disciples before a deity.

When one student summons courage to ask what tool is used for a particular procedure, DeBakey responds: One he invented 46 years ago.

Another knows DeBakey had traveled to Russia a few years back but doesn’t seem to know why. In response to his question, DeBakey points to a photo of him on the wall— with Russian President Boris Yeltsin.

A third seeks an opinion on health maintenance organizations, and DeBakey dispenses a copy of an editorial he wrote for The Wall Street Journal, along with advice: “If you’re the best doctor you can be, you’re going to do well because you’re going to be needed.”

For the students, they are words to learn by. For DeBakey, the creed has guided him through a lifetime of accomplishments.

In 1932, as a medical student at Tulane, he invented his first surgical device. Since then, he has developed more than 50 others; performed more than 60,000 cardiovascular procedures, pioneering many of them; trained more than 1,000 surgeons; written more than 1,400 articles or books; and received 50 honorary degrees, hundreds of awards.

As longtime president and chancellor of Houston’s Baylor College of Medicine, he shaped the institution into one of the country’s top medical schools.

Since World War II, he has served as adviser to most American presidents and as doctor of choice for leaders around the globe, including the Duke of Windsor, the Shah of Iran and Yeltsin, acting as a consultant on his 1996 quintuple bypass surgery.

The inscription on a bronze bust of DeBakey at Methodist —“Surgeon, Educator and Medical Statesman”— may best summarize his role in 20th century medicine as the father of cardiovascular surgery.

“Many people are remarkable because they excel in what they do,” says Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, a division of the National Institutes of Health. “He not only excels, but he shares that and passes it on.”

Even at 90, DeBakey is up by 5 a.m. and at the office by 7. He spends most of his waking hours working, eating lunch at his desk, and goes to bed around midnight.

He still performs a few operations, including open-heart surgery televised last September on NBC’s “Today Show.” But he spends most of his time meeting with patients, lecturing and exploring advancements.

His latest project — a heart pump one-tenth the current size — is undergoing clinical trials in Europe. DeBakey hopes to begin similar tests in the United States later this year.

“As long as I feel mentally and physically active, I don’t see any point in retiring,” he says. “I’d be bored to death.”

DeBakey, who grew up admiring the family doctors who frequented his father’s drugstore in Lake Charles, La., made a name while in medical school, developing a roller pump that mimics the heart’s pulse. The device later became a major component of the machine that functions as heart and lungs during surgery, beginning the era of open heart operations.

In later years, DeBakey developed procedures to repair the aorta, the body’s main blood vessel, and the concept behind coronary bypass. In 1966, he was the first to successfully use a partial artificial heart — a left ventricular bypass pump.

Of Cooley’s decision in 1969 to use the total artificial heart that was developed at Baylor, DeBakey says: “I don’t have any feud with Dr. Cooley. After all, he was in my department, and I wrote articles with him. I worked with him very closely.

“What happened was that he used an artificial heart that was developed in my laboratory. That put the school in jeopardy.”

Last year, DeBakey celebrated his 50th anniversary at Baylor, but despite his zeal, DeBakey winces at the word “workaholic.”

“When you think of life as a living, active process, I don’t think it’s a pleasurable activity unless you have some challenge in that life —no matter what it is,” he says.

“I think, in a way, that is the philosophy of life.”

Transplant Patient Honored at Game

BALTIMORE (AP 4/24/99) — A boy who received multiple-organ transplants three times threw out the first pitch at Saturday’s game between the Baltimore Orioles and Oakland Athletics.

Daniel Canal, 14, of Wheaton smiled broadly as he bounced the ceremonial pitch on one hop to the team mascot.

Since the age of 8, Canal has suffered from a condition in which the intestine twists spontaneously, cutting off blood flow and causing it to die. As a result, he developed short bowel syndrome and could only get his nutrition intravenously.

After five years of waiting, Daniel received his first multiple transplants last May, but his body rejected the organs. He received a second quadruple transplant in early June but those organs also failed and doctors operated again, this time June 21. Daniel received a new stomach, liver, pancreas and small intestine, and is doing well.

Some medical ethicists questioned the wisdom of allotting 12 organs to a single patient when nearly 12,000 people are waiting for livers alone and says: “It’s a little tarnished, isn’t it?”

Tissue Engineering Growing as Option To Transplantation

By Raymond Hennessey

WASHINGTON (Dow Jones 5/6/99)— Growing human tissue to replace failing organs or their parts is emerging as an alternative to traditional transplantation.

Speaking Thursday at The Wall Street Journal Health Care Summit in Washington, Dr. Joseph Vacanti, professor of surgery at Harvard Medical School, said the shortage of organs available for transplant, and rapidly emerging medical technology, have helped to increase the attention given to tissue engineering.

“The challenge for us as surgeons in taking care of patients...is to take advantage of the biology that has been learned since 1954’ when the first organ transplant took place,” Vacanti said.

In many ways, Vacanti said, the tissue-engineering approach is better than replacement of an organ through transplantation. He cited the example of people wanting to build a building. They could find an abandoned building, rip it from its moorings, move it, and place it on the new site, or they can simply do what builders now do: construct it from the ground up.

Ideally, surgeons want living tissue that is free of scarring and has the capacity to grow, and it should come from the patient himself and should be able to be mass produced, Vacanti said.

Currently, doctors have been able to create parts of organs. Using a synthetic scaffold, cells are introduced and allowed to grow, creating new living systems. Vacanti showed instances of the creation of a new human ear, and new nose cartilage. Doctors can also build a single leaflet of a heart valve using tissue engineering, he said. Ultimately, Vacanti said the hope it to create all three leaflets of a heart valve to give surgeons the ability to avoid artificial valves or the current tissue valves, which are valves from dead pig.

One of the hurdles will be building scaffolding to deliver the growth cells, Vacanti said. But there have been advances. Recently, doctors have begun using a three-dimensional printer that can construct a polymer scaffold with the needed precision.

Also, Vacanti said he has begun using technology that was initially designed to make computer chips. This technology has shown promise in growing some small blood vessels, he said.

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