Dr. Denton Arthur Cooley, legendary founder of the Texas Heart Institute and arguably the most gifted heart surgeon of his time, died Friday. He was 96.
Cooley had been in declining health the past year, though he’d gone into his office at the heart institute as recently as Monday. He died at home surrounded by family, said officials in the Texas Medical Center.
Over four decades, Cooley performed an estimated 65,000 open-heart surgeries at the institute, drawing patients from around the globe. At one time, his team was handling a tenth of all such operations in the United States.
Cooley’s surgeries included two particularly noteworthy ones – in 1968, the first transplant of a human heart in which the patient lived more than a few weeks; and in 1969, the first implantation of a mechanical heart. The latter, a Kitty Hawk-type of advance, set in motion one of Houston’s signature stories, a rift with Michael E. DeBakey immortalized in a Life cover story as The Feud.
“At the height of his career, he was probably the best known heart surgeon in the world,” said Dr. David Cooper, a professor of surgery at the University of Pittsburgh and author of “Open Heart: The Radical Surgeons who Revolutionized Medicine.”
Cooley stood above other surgeons because of his speed and technical prowess, a combination once described as “Woolworth volume and Tiffany quality.”
At the beginning of his career, the device that keeps patients alive during cardiac surgery — the heart-lung machine — was still in its infancy, a crude instrument that gave surgeons little time to complete an operation. Cooley performed with such precision that he demonstrated procedures such as bypasses could be safely done. He was among a small group of doctors who ushered heart surgery from a niche field into mainstream medicine.
“I was talking to a pilot friend of mine one time — he flew 747s — about Charles Lindbergh,” said O.H. “Bud” Frazier, another pioneer of heart surgery at the Texas Heart Institute. “My friend said there’s not a pilot alive today that could fly the Spirit of St. Louis by dead reckoning. Dr. Cooley is sort of the same way. There’s not a surgeon alive today that could do what he could do.”
Cooley was a native Houstonian, who would witness the city’s transformation from a provincial afterthought, known for its proximity to oil fields and refineries, to a metropolis famous not only as a world energy center but as a destination for cutting-edge medicine.
He was born on Aug. 22, 1920, to Ralph Clarkson Cooley and Mary Fraley Cooley, whose families were long established in Houston. A grandfather had helped found the Houston Heights neighborhood in 1890, and his father was a prominent dentist. The physician who delivered Cooley was Dr. Ernst William Bertner, who would later found the Texas Medical Center.
After graduating from San Jacinto High School, Cooley attended the University of Texas on a basketball scholarship. There, he was a three-year letterman and part of a team that won the Southwest Conference in 1939. Even late in life, he fondly recalled his playing days at Texas, and in 2003, the university opened the Denton A. Cooley Pavilion next to its basketball arena, a place for the men’s and women’s teams to practice.
Rick Barnes, the Texas basketball coach at the time, once invited Cooley to speak with his players. What stood out to Barnes was Cooley’s humor and the stunning trajectory of his life.
“There have been basketball players that have come through UT that have done more for the sport,” Barnes said. “But when you look at his contributions to society, it’s really quite astonishing.”
Cooley majored in zoology, graduating in 1941 with honors, then entered medical school at the UT Medical Branch at Galveston. He later transferred to Johns Hopkins University in Baltimore and graduated at the top of his class.
In the next six years, the pillars of Cooley’s life were set into place.
During postgraduate training, in 1944, he had an opportunity to assist Dr. Alfred Blalock with the first “blue baby” operation, a procedure to treat a small child with a congenital heart problem that robs the blood of oxygen. This was, in many ways, the dawn of heart surgery.
A few years later, he met and married Louise Goldsborough Thomas, a registered nurse at Johns Hopkins. Their first child, Mary, was born in 1950. The couple would go on to have four more daughters.
“He’s enormously proud to have had a very long married life, had five children and, lots of grand and great-grandchildren,” said Dr. Charles Fraser Jr., cardiac surgeon-in-chief at Texas Children’s Hospital. Fraser married Cooley’s youngest, Helen, and as both a heart doctor and his son-in-law, came to know him well.
“I think everybody in the family realizes that he sacrificed for many, and they sacrificed for many,” Fraser said. “My wife didn’t get to see her dad a lot, because she was daughter number five, and by the time she came around, he was super famous. But she has enormous respect for him.”
Among Helen’s highlights: meeting the pope and Presidents Ronald Reagan and Bill Clinton when her father received the Presidential Medal of Freedom and National Medal of Technology, respectively.
Cooley served briefly in the Army Medical Corps and was stationed in Adolf Hitler’s hometown of Linz, Austria. He returned to Houston in 1951 with his young family to take a position at Baylor College of Medicine under its newly appointed chief of surgery, Michael E. DeBakey, who became a mentor and, later, rival. The Texas Medical Center was barely a dream then, but during the next five years, Texas Children’s, St. Luke’s Episcopal Hospital and The Methodist Hospital all opened, providing ample opportunity for a young surgeon to practice his trade.
A pivotal moment in Cooley’s career came in 1955, during a meeting of the American Association of Thoracic Surgeons, when he watched a film of Dr. C. Walton Lillehei performing open-heart surgery with an early version of a heart-lung machine. Those early machines were large and complicated, and worse, they could cause damage to the blood.
But the experience inspired Cooley and his team to produce his own machine. Cooley primed it with a sugar solution rather than blood, which reduced the risk of blood-borne infections. Because less blood was needed, the technique allowed open-heart surgery to be performed, safely and efficiently, in large numbers of patients, including Jehovah’s Witnesses, whose faith prohibits the use of blood. Cooley considered the technique one of his most important contributions to open-heart surgery.
Because of the small capacity of the heart-lung machines, children, with their lower volumes of blood, were better candidates for heart surgery, and Cooley began to fix congenital heart defects in infants. In the process, he built the foundation of the cardiac heart program at Texas Children’s.
“We revealed to the world that the open-heart surgery had begun,” Cooley said in a 2015 interview. Lacking the diagnostic and imaging tools that surgeons use today, Cooley often went into an operation without a diagnosis, and had to locate the problem and fix it, all within the 40 minutes allotted by the heart-lung machines of the era.
“It cannot be overstated how extraordinary this was. Just the whole notion of operating inside the heart was entirely radical,” Fraser said.
During the 1950s and 1960s, surgeons worked furiously on two levels – developing techniques to keep patients alive during open-heart surgeries, and operating quickly so they could be taken off imperfect machines. Cooley excelled in such an environment.
“In many people’s opinions, including mine, he is the finest heart surgeon to ever live,” said Dr. James Willerson, who replaced Cooley as president of the Texas Heart Institute. “He was the most rapid. Had the finest hands. His knowledge, his commitment to help people.”
When he was young, Willerson spent a summer watching Cooley perform as many as 12 procedures a day, moving from one room to another. And that went on five days a week, from before dawn to evening.
Cooley left Baylor in 1962 to found the Texas Heart Institute. He retained a faculty position at Baylor, where he, DeBakey, and others had moved into the development of an artificial heart. If successful, such a device could change medicine forever. Before that happened, however, the long-imagined concept of transplantation became a reality. Cooley and DeBakey would soon be at the center of a revolutionary period in medicine.
“The two transformed what had been a medical backwater into the cardiovascular surgery center of the world,” wrote Thomas Thompson in “Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier,” the classic work on DeBakey and Cooley’s leading role in the heart transplant era. “In less time than it takes to age a good bottle of wine, Houston found itself with not only the most celebrated, but the two most celebrated heart institutes extant, standing side by side, headed by two master surgeons.”
Together, the two achieved a number of firsts, including repairing an aortic aneurysm, or ballooning in the wall of the body’s largest blood vessel; repairing a ruptured abdominal aortic aneurysm; and repairing a defect developing in the wall separating the chambers of the heart after a heart attack. They also performed the first successful carotid endarterectomy, done to remove a blockage in the main artery leading to the brain.
But their relationship ultimately could not withstand the pressures of ego, competition and personality. Cooley, the junior associate though hardly an apprentice, at times felt slighted. And it was not DeBakey’s manner to offer a nurturing touch. Their rift began, at least publicly, with an explosion, though it had been building for years.
One of the physicians in DeBakey’s lab, Dr. Domingo Liotta, moved to Cooley’s Texas Heart Institute after concluding that DeBakey’s faith in the perfectability of the heart had waned. On April 4, 1969, Cooley stunned the world by implanting the artificial heart developed by Liotta into the chest of patient Haskell Karp, who had severe heart failure. Within three days, Cooley replaced the artificial one with a donor heart, but Karp died shortly thereafter.
DeBakey was irate. Cooley had not gotten — or asked for — the required approval for using the artificial heart, which DeBakey said was identical to one that had been developed in his lab. He did not believe the device was ready for use, and he feared that doing so could jeopardize federal research funding. The controversy roiled the medical center, with Cooley resigning from Baylor’s faculty and being censured by the American College of Surgeons. Other doctors felt all but forced to pick sides.
Cooley had decided that there was no downside to trying the artificial heart, as Karp was certain to die with his failing one. But DeBakey, who was out of town when the procedure took place, felt undermined by what he saw as a seat-of-the-pants decision, one that flouted the rules of institutional medicine. DeBakey thereafter refused to acknowledge Cooley, though their offices were within walking distance.
The two did not mend their rift for nearly 40 years. They reconciled a year before DeBakey died in 2008, at the age of 99. It was Cooley, awakened to “the folly of continuing pointless feuds,” who reached out to DeBakey. Both then acknowledged the rivalry spurred them to greater achievements.
As time passed, pursuit of the perfect artificial heart would fall to others, while Cooley continued to garner fame with his prodigious surgical output. He gathered device specialists, such as Bud Frazier, to innovate further with heart-assist devices and pumps.
Cooley admitted he was eager to see his institute at the forefront of cardiac medicine.
“I’ve always been ambitious, and I wanted to see that any breakthrough that came along would be at our institution,” Cooley told Modern Healthcare magazine. “I was mildly upset when the first (human heart) transplant was done in South Africa.”
In fact, even when sending Dr. Christiaan Barnard a congratulatory telegram on that first heart transplant in December 1967, he could not resist a dig.
“Congratulations on your first transplant, Chris,” Cooley wired the surgeon. “I will be reporting my first hundred soon.”
Five months later, Cooley performed his first, despite having little experience with organ-transfer techniques. When the heart of a 15-year-old girl who’d committed suicide became available in May 1968, he rushed to the hospital to transplant it in a 47-year-old man. The man went on to live 204 days; in comparison, Barnard’s patient had only survived 18.
Over the next year, Cooley performed 22 heart transplants, including three in a single five-day period.
After watching Cooley operate, Barnard had said: “It was the most beautiful surgery I had ever seen in my life…No one in the world, I knew, could equal it .”
Julissa Nevárez, sister of Texas Rep. Poncho Nevárez, was one of Cooley’s blue-baby patients. Initially told she wouldn’t live past 10, she was successfully treated by Cooley in 1978, when she was 7.
“He gave my parents hope when there was none,” said Julissa Nevárez, a schoolteacher in Del Rio. “I’m very blessed and thankful for his God-given talent. He kept me alive.”
Nevárez still has a signed pillow from Cooley and remembers “the hoopla when he came into the room – the cameras, the doctors-in-training. He was a real rock star.”
Cooley stood out for many reasons, Frazier said, with his grace and cool precision during the pressure of surgery, but modesty may not have been a strong suit. Cooley, as a defendant in a medical liability trial, was asked if he considered himself the best heart surgeon in the world. When Cooley said that he was, he was then asked if he was being rather immodest. “Perhaps,” he replied. “But remember, I am under oath.”
Cooley, who played upright bass in a swing band of Houston doctors called The Heartbeats, is remembered for an ever-present “Irish wit” and was a great raconteur, Frazier said. And though he was born into the middle class and would go on to earn a hefty income, he was still a product of the times he grew up in — the Great Depression. For much of his life, he found it hard to part with money.
“I remember we were in New York one time, and we needed to go to a meeting that was very close to the hotel,” Frazier recalled. “But it was raining, so he got a cab to take us to the meeting just two or three blocks away. He got out of the cab, and he gave the guy a tip, and then he felt something hit him in the back of the head. It was the quarter he gave the driver for a tip.”
Money became an issue for Cooley in 1988. He filed for bankruptcy that year, a victim of the then-foundering Houston real estate market. His medical practice never suffered, he said later, but he was on the hook to repay a reported $100 million in debts.
Fraser, his son-in-law, recalled how large Cooley’s legacy loomed, even across the world.
Fraser traveled once to South Africa to give a prestigious “Christiaan Barnard” lecture. He took Helen, and one evening, while they were waiting for a plane, they found themselves next to the hospital where Barnard had performed the first transplant.
It was about 5:15 p.m. and Fraser wanted to see the museum, but it had just closed. He explained to the attendant that he had come all the way from Houston, had just given the Barnard lecture and was a well-respected pediatric surgeon. The attendant was unimpressed. Then Fraser mentioned that the woman with him was Cooley’s daughter.
“The bells went off, lights came on, and we were ushered through like royalty,” Fraser said. “We go into this museum, and they have wax effigies of Christiaan Barnard. You really feel like you’re back in that time, and there was this handwritten letter from Dr. Cooley to Barnard. It was a humbling experience.”
Cooley was preceded in death by his daughter Florence and his wife, Louise, who passed away in October. He is survived by his other daughters, 16 grandchildren and 17 great-grandchildren.
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