by Syed Tasnim Raza
Denton Arthur Cooley, founder and president and at the time of his death president-emeritus of the Texas Heart Institute (THI), died on Friday November 18, 2016. He had celebrated his 96th birthday only three months earlier. Texas Heart Institute, founded in 1962, became a premier heart surgery center in the world, where Cooley is credited with performing 100,000 heart operations over 45 years. There were many highly skilled surgeons working at THI, who opened and closed the patients' chests and Cooley would just come in to do the main part of the operation. At his peak, he could complete 30 to 40 operations in a day!
Perhaps Cooley was the Henry Ford of heart surgery. While heart surgery was developed by many surgeons until it matured into the modern specialty as we know it in 1950's and 1960's, under the pioneering work of C. Walton Lillehei and John Kirklin both of Minnesota, it was Cooley who turned it into an assembly line operation at the Texas Heart Institute in the 1970s.
Heart surgery developed in fits and spurts, beginning with a simple suture of a stab wound of the heart by Ludwig Rehn of Frankfurt, Germany in 1896. One of the big steps, particularly in surgery for congenital heart disease, came in 1944 at the Johns Hopkins Hospital in Baltimore, where Helen Taussig, pioneer pediatric cardiologist, proposed and Alfred Blalock, the famed chairman of surgery there, performed the first Blalock-Taussig shunt (also known as the Blue-baby operation) as treatment for cyanotic infants born with Tetralogy of Fallot, until they could grow up and a more definitive corrective operation could be performed. Denton Cooley was present for the first history-making Blue-baby operation on November 29, 1944.
He was an intern on Dr. Blalock's service and was assigned to do the blood gas analysis and other errands in the operating room. Cooley was so gifted and talented that he was offered a position as the cardiac surgery resident under Dr. Blalock only after two years of training in surgery (normally it would take five years). An operation for removal of blood clots from the pulmonary artery to prevent death from massive pulmonary embolism was first attempted by Dr. Frederick Trendelenburg in Leipzig, Germany in 1908. Many more attempts were largely unsuccessful (except a few sporadic successful cases) and had to wait for the development of the heart-lung machine by John Gibbon in 1953 before it could be attempted successfully. In 1961, Edward Sharp at Hopkins and Denton Cooley at Baylor became the first surgeons to perform successful operations for pulmonary embolism, utilizing the heart-lung machine.
After completing his training at Johns Hopkins, Cooley spent a year at the Brompton Hospital in London under Mister Russell Brock, one of the pre-eminent surgeons of England. In 1951, he returned to his native Texas, where he had already secured a faculty position in the Department of surgery at Baylor College of Medicine, where Michael DeBakey was the Chairman of Surgery. Thus began the long story of the collaboration of two giants and pioneers in heart surgery, and their feud that was very public and very nasty and lasted well over 40 years. For details of this feud please see the obituary of Michael DeBakey, I wrote in 2008.
Cooley had done two emergency operations to repair aortic aneurysms (ballooning of the aorta, which can rupture and cause death of the patient), during his training at Hopkins, and in both instances Dr. Blalock had been away. On the very first day at Baylor as Cooley and DeBakey were making ward-rounds they saw a patient with an aneurysm of the aortic arch extending into the Innominate artery. After DeBakey heard of Cooley's experience with two patients he had operated upon for repairing aortic aneurysms at Hopkins, he assigned him to do the operation for the patient at Baylor the next day, which he successfully completed early the next morning, even before Dr. DeBakey had scrubbed in the case, fully expecting to bail out the young surgeon, who would surely be in trouble by then. Thus Cooley started the era of surgery for aortic aneurysms.
Soon the two surgeons became too busy and two big to be in the same institution at Methodist Hospital of Baylor University, so Cooley conceived the idea of his own institute in collaboration with the Texas Children's and St. Luke's Hospitals. The Texas Heart Institute received it's charter from the State of Texas in August 1962 and was built with private donations and fundraising and supported in part from the professional fees collected by Cooley and the other staff physicians. The new building opened its doors in 1972 with eight operating rooms, where multiple operations were performed in each room every day. It quickly became the busiest heart surgery center in the United States and perhaps in the world.
Denton Cooley was a gifted surgeon. He made surgery look simple and elegant. He never rushed through operations yet he was known to be a very fast surgeon. This was mainly because he did every step of the operation right the first time and did not have to revise any stitches or waste time in between various steps of the operation. While I have visited over two dozen heart surgery centers in the United States and other countries, I never visited THI, which was a Mecca for many heart surgeons to visit to watch Cooley operate. My own mentor and chief, George Schimert always discouraged me from visiting Cooley by saying “Cooley makes surgery look so easy that many surgeons who watch him think they can do the same, and go back to their institution and do more harm than good by trying to copy him.” He further added, “You are a good surgeon and keep doing it your way. You won't become a Cooley by visiting Texas Heart.” I never did.
Denton Cooley was also a gentle soul. Unlike many surgeons who are known for their temper, particularly Michael DeBakey, who was known to be very harsh in his treatments of residents under training with him, Cooley is said to have a plaque in his operating room saying “I never criticize those who are trying to help me.” I heard Cooley speak at many professional meetings of cardiac surgeons and always noted how polite he was, even when he disagreed with other presenters. I met him a few times, the last time at Yale University Medical Center in 2010, where he was giving a talk at an aortic surgery symposium, and always found him to be gentle and polite.
Cooley was an athlete, a star basketball player, who played for his college team at the University of Texas in Austin, which he joined in 1937. Cooley always credited Blalock and Johns Hopkins for his fine training and after achieving great success in the profession he established the Denton Cooley Athletic and Fitness Center at Johns Hopkins. He was a giant in the field and will be missed.
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Syed Tasnim Raza is Associate Professor of Surgery at Columbia University Medical Center.