King of Hearts
After more than 60 years and nearly 200,000 surgical procedures, Dr. Denton Cooley continues to break new ground in the world of medicine
by Aaron Howard
The hands of Dr. Denton Cooley are deep inside his patient’s abdomen looking for an artery. Of course, the 71-year-old male patient is deep under anesthesia and doesn’t feel any pain as Cooley lifts away a handful of intestines to get to the aorta in the distal area of the gut.
Pain is what brought the patient here to the Texas Heart Institute. After a series of tests, his physicians back in California said it was a condition called intestinal angina. Just like angina associated with the heart, it’s a problem caused by low blood flow. Somewhere in the abdomen, there’s probably an aortic aneurysm – a major blood vessel whose wall is damaged and bulging.
So they sent the patient to Denton Cooley because they want a highly experienced cardiovascular surgeon to explore and fix the problem. Given Cooley’s reputation as “The King of Hearts,” the first surprise is that I’m watching him operate in the gut, not the chest. But Cooley is chief of cardiovascular surgery at St. Luke’s Hospital. That means the whole circulation, not just the heart. And Cooley wrote the book on surgical treatment of aortic aneurysms, one of 10 medical texts he’s authored.
The second surprise is that at age 81, Cooley still performs surgery. He does about three operations a week compared to the 12 a day he used to perform in the early 1980s. Even if he never did a single surgical operation again, it would be enough. Cooley has performed nearly 200,000 surgical procedures in his long career.
Over six decades, his enduring legacy is that he has participated in every major development in cardiovascular surgery. One look around the operating room will tell you that. That retractor, used to pull back the outer layers of the abdomen, is a Cooley invention. So is the oxygenator, which circulates oxygen-rich blood through the patient’s body during surgery. As is the headlamp and lens worn around the surgeon’s head to illuminate and magnify the eight-inch surgical incision Cooley is working in. And the Dacron graft that Cooley will use to repair the superior mesenteric artery – another one of his inventions, some 200 surgical products in all.
As an intern at Johns Hopkins School of Medicine in 1944, Cooley assisted in the first “blue baby” operation, creating a shunt for the relief of cyanosis in tetralogy of Fallot. Until then, this heart defect caused extreme cyanosis (shortage of oxygen at the cellular level), the characteristic blue skin color, which often progressed to death.
Seeing these blue babies suddenly turn pink as the clamps on their blood vessels were released after the shunt, Cooley turned to cardiovascular surgery.
Since coming back home to Houston in 1951, Cooley is best known for performing the first successful heart transplant in the United States and for being the first surgeon in the world to keep a patient on an artificial heart. Less appreciated by the general public are some of Cooley’s innovations in cardiovascular surgery. He introduced techniques for repair of post-infarction ventricular septal defects, excision of left ventricular aneurysms and the embolectomy for massive pulmonary embolism. He’s also designed several artificial heart valves and introduced the use of a bloodless solution in heart-lung machines, an advance that greatly decreased the risk of open-heart surgery.
As president and surgeon-in-chief, Cooley has led the Texas Heart Institute to become world famous in cardiology. More than 1,900 physicians have learned to treat cardiovascular disease here.
Dr. Paulo Moreno is a cardiovascular surgeon at one of Brazil’s top heart centers. “For me and a lot of surgeons in Brazil, Cooley is a landmark,” says Moreno, who has been a visiting surgeon at the Texas Heart Institute during the past year.
“I wanted to come to Houston to see who this amazing person is and to improve my knowledge. He’s not only a good surgeon, he’s an academic man. The way he teaches and inspires his team, he’s the soul of the institution.”
Still, there’s no guarantee that a center of excellence won’t lose its edge when its creator departs. That’s why Cooley’s fondest hope is that the Texas Heart Institute, like the Mayo Clinic and Johns Hopkins, will endure as a center of excellence after he retires. A big part of that legacy will unfold on Jan. 17 with the dedication of the Denton A. Cooley Building, a 10-story, 327,000-square-foot structure that will take the Texas Heart Institute into the new century. There’s no question as to who will perform the first surgery in one of the 11 Cooley Building’s 600-square-foot operating rooms.
Like Michael Jordan on a basketball court, Cooley’s got game in the operating room. Dena Houchin, R.N., Clinical Coordinator for Cardiovascular Surgery at the Texas Heart Institute, describes it as an extreme simplicity of style. “In terms of technique, Dr. Cooley uses a minimum of equipment. His idea is to use only what you need. He always looks for the simple way to make a repair. There’s never a wasted motion. He’s the opposite of cut and slash. He always seems to get right to the point.
“What takes him an hour to do would take most other surgeons three or five hours. When he trains residents, he almost makes it look too easy,” says Houchin.
As Cooley locates the aneurysm, he begins to sew in the graft that will restore normal blood flow in the abdomen. No doubt his patient will immediately appreciate the relief of pain in his gut. What he’ll never know is how much less post-surgical pain he’s going to experience. Because Cooley is so clean and quick, his patients usually experience less pain in the first 48 hours of recovery. That means fewer narcotics after surgery.
A week after watching the surgery, I’m sitting in Dr. Cooley’s office on the second floor at St. Luke’s Hospital. The office is cluttered with photographs, plaques, medals and books. One photo that captures my attention is that of a 19-year-old Cooley wearing basketball uniform No. 27. It was taken in 1939, the year that Cooley led the University of Texas to the Southwest Conference Championship.
The son of a prominent Houston dentist, an All-City basketball player and the academic head of his class, it would seem that Cooley had it all from the beginning. But Cooley has a different take on his success.
“I always deplore people, usually men, who claim to be self-made when they accomplish a lot,” he says. “They overlook the basic (advantages) they were given at birth: being white, male, Protestant and born into a whole, loving family. I was lucky to have this kind of head start.”
Originally enrolled in a pre-dental program, Cooley switched to pre-med after a visit to a medical student friend who was working in a San Antonio emergency room. Later, Cooley was about to take a rotating internship when a professor of surgery convinced the young medical student to take a straight surgical internship at Johns Hopkins. That’s where Cooley was stimulated to go into cardiovascular surgery.
“All of us have opportunities,” he says, “but not all of us seize those opportunities with insight.”
Given the chance to participate with Dr. Alfred Blalock in the first “blue baby” operation as an intern, Cooley seized the opportunity. Twelve months later, he was Blalock’s first assistant on the heart team and then coordinator of the new cardiac service. Cardiovascular surgery was at the cutting edge in the 1940s and 50s, and Cooley was there at the outset. In an era of cardiac exploration and discovery, Cooley pushed the limits.
“There was an obligation on my part to test new ideas,” he says. “Of course, I had the protection of an institute here at the medical center. The individual practitioner would be so vulnerable that he could not take those risks. But working here, I felt I was somewhat insulated from the critics.”
And Cooley certainly had critics, especially in 1969. That’s when he first implanted a highly tested but FDA-unapproved artificial heart in a patient, Haskell Karp, who was dying of advanced cardiovascular disease while waiting for a heart transplant.
The artificial heart had limited success and Karp died. His widow brought a suit against Cooley, alleging, among other things, that Karp did not understand what was being proposed to him and thus did not give a knowing consent. In the case that followed (Karp v. Cooley), the court found that the entire procedure had been explained to Karp, and a detailed consent form had been signed that described the procedure, its experimental nature and its great risks. The case remains a landmark example of informed consent in health law.
According to Cooley, taking risks means having the courage to fail.
“A child learning to walk sometimes falls,” says Cooley, “but he has the courage to get up again. We often lose that courage as we get older. One starts a family. Numerous obligations and all sorts of controls are put on you. So you become more cautious as you go along. Some of us try to ignore these concerns and maintain a determination to proceed to a new level.”
An avid lifelong golfer, Cooley last year sank his first hole in one. It was on a 165-yard par three hole, made in the presence of 11 chiefs of surgery from the major American medical institutions.
At 81 years of age, Cooley is still ready to take it to the next level.