Denton Cooley Inventor and Pioneer Surgeon

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DR. DENTON COOLEY, ONE OF heart surgery's most noteworthy pioneers, originally planned on becoming a dentist and taking over his father's practice.

Although he was interested in medicine, he was worried that the academic track to a medical degree was too difficult. This fear was put to rest when he achieved the highest grades in his college fraternity. Soon after, Cooley transferred into medicine and eventually graduated from Johns Hopkins Medical School. During World War II, he also interned at Johns Hopkins, training under Dr. Alfred Blalock, where he was present at the world's first "blue baby" operation.

"There was a great superstition about the heart at the time," Cooley remembered during a recent interview, "and whether one could operate inside of the heart with expectation of survival. I went through what I called the closed era, when we operated on the surface of the heart, to the open era, when we were actually inside the heart doing much more extensive types of repairs."

The open era of heart surgery is credited to the heart-lung machine, an exciting innovation that Cooley studied in development. His laboratory re

search in this area started in 1952 and was initially slow, causing him to visit Minnesota.

"I had gone up to Minnesota to visit Lillehei in Minneapolis and then Kirklin over at Rochester. There, within the space of two or three days, I got to see what could be done. Lillehei was using cross circulation, which seemed to work well but obviously could not be used safely in adult patients. Then I saw Kirklin, who had a very elaborate machine, modeled after what Gibbon had devised, but it was very complex. From that experience, I decided I was going to go with the bubble oxygenator and pump."

Cooley felt that a bubble oxygenator, which Lillehei and DeWall had just developed, was simpler than the oxy-genator Kirklin was using, and he began developing a reusable bubble oxygenator made of stainless steel.

His first chance to use it in a human came when a desperately ill forty-nine-year-old man was referred to him. The patient had a ruptured ventricular septum caused by a heart attack. Cooley successfully repaired the hole in the ventricular septum on April 6, 1956. This marked the beginning of open-heart surgery in Texas. In time, other patients began to follow.

"Within an eight-month period, I had done ninety-five open-heart operations, which far exceeded what anyone else had done anywhere in the world," Cooley said. "At that time, we enjoyed almost a monopoly on open-heart surgery in that there were only two other institutions that were really active in the field, and they were both in Minnesota [at the University of Minnesota and the Mayo Clinic]."

Dr. Denton Cooley began performing open-heart operations in the mid-1950s, soon after the heart-lung machine had been developed. He helped develop the bubble oxy-genator.

many university groups around the world had developed open heart programs, and the modern era of cardiac surgery had begun. With their greatest obstacle overcome, teams of surgeons began to tackle ever-more-complex cardiac problems in both children and adults. Right after the introduction of the heart-lung machine, the pace of advance was so rapid that by the 1960s, surgeons were treating coronary artery disease, congenital heart defects, cardiac injuries, heart valve problems, and diseased or damaged major arteries in the chest.

As the field became more specialized, the role of the heart surgeon became more narrowly focused, and pedi-atric congenital heart surgery separated from adult heart surgery into a specialty of its own. For the most part, cardiac surgery in the adult addresses acquired heart disease. Nevertheless, a close connection between adult and pediatric heart surgery continues because advances in one subspecialty usually are applicable in the other, and this kinship will probably remain for the foreseeable future.

Currently, almost one million cardiac operations are performed each year worldwide with the use of the heart-lung machine. In most cases, the operative mortality is quite low, approaching 1 percent for some operations. Today, hundreds of thousands of physicians, scientists, and engineers are involved in a broad and deep effort to develop new and safer operations and procedures, new valves, new biomaterials, new heart substitutes, and new lifesupport systems. These efforts are supported by a vigorous infrastructure of basic science, biology, medicine, chemistry, pharmacology, engineering, and computer technology.

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