Denton Cooley

Denton Cooley: The Fastest Hands in Cardiac Surgery

On 4 April 1969, Denton Cooley took a dying man named Haskell Karp, removed his heart, and put a machine in its place. The total artificial heart, designed by Domingo Liotta, kept Karp alive for sixty-five hours until a donor organ arrived. It was the first time in history a human being had been sustained by a wholly mechanical heart. It also detonated the most famous feud in American medicine, cost Cooley his university appointment, and left a question hanging over his reputation that never entirely lifted.

Houston Boy

He was born on 22 August 1920 in Houston, the son of Ralph Clarkson Cooley, a dentist, and Mary Augusta Fraley Cooley; his grandfather Daniel Denton Cooley had developed the Houston Heights neighbourhood. He went through Montrose Elementary, Sidney Lanier Junior High and San Jacinto High School, finishing in 1937, and took a basketball scholarship to the University of Texas at Austin. At six foot four he played forward and centre, lettered three years from 1939 to 1941, and was on the team that took the Southwest Conference championship in 1939. He graduated in zoology in 1941 having discovered, somewhere in the pre-medical coursework, that he wanted to cut.

Hopkins, Blalock, and the Blue Baby

He started medicine at the University of Texas Medical Branch in Galveston and finished at Johns Hopkins, taking his degree in 1944 and staying for surgical training under Alfred Blalock. In November 1944 he was in the room — an intern assisting — for the first "blue baby" operation, the Blalock–Thomas–Taussig procedure that inaugurated modern cardiac surgery. Vivien Thomas, Blalock's laboratory partner, was the other figure in that theatre. Cooley was 24, and he had seen the field being born.

The Army Medical Corps called him up in 1946; he ran surgical services at the station hospital in Linz, Austria, and left as a captain in 1948. He returned to Hopkins as an instructor, then spent 1950 and 1951 in London with Russell Brock at the Royal Brompton Hospital, learning the European approach to the chest.

Houston Again, and the Rivalry

Michael DeBakey invited him back to Houston in 1951 as an associate professor at Baylor College of Medicine, working at Methodist Hospital. For a decade the two of them together made Houston the world capital of cardiovascular surgery, developing new methods for resecting aortic aneurysms. In 1960 Cooley shifted his practice to St. Luke's Episcopal Hospital, and in 1962, using private money, founded the Texas Heart Institute — the base he would run as surgeon-in-chief for more than forty years.

The institute's output was industrial. Cooley ran multiple operating rooms in parallel, moving between them, and he and his teams eventually logged more than 120,000 open-heart operations. Between 1962 and 1967 he and colleagues developed artificial heart valves that cut mortality for valve replacement from roughly seventy per cent to eight. From the early 1960s he built a specialty in bloodless open-heart surgery for Jehovah's Witness patients, a discipline that punishes any surgeon who is slow or imprecise. He operated on infants and children when few would. His working motto was three words: "modify, simplify, and apply."

Two Firsts and a Rupture

In 1968 he performed the first successful human heart transplant in the United States, on a patient named Everett Thomas. The following April came the Karp operation. The artificial heart Cooley implanted had emerged from a research programme in which DeBakey was the principal investigator, and DeBakey's view was that Cooley had used it without authorisation. Cooley resigned from Baylor in 1969. The two men, working blocks apart in the same city, did not speak for close to four decades. They reconciled publicly in 2007, when DeBakey was 99 and Cooley 87.

It is the episode that defines him for historians and the one he never apologised for. Asked under oath in a courtroom whether he considered himself the best heart surgeon in the world, Cooley answered: "Perhaps. But remember I'm under oath."

A Life Outside the Theatre

He married Louise Goldsborough Thomas on 15 January 1949 and stayed married sixty-seven years; they had five daughters. He played upright bass in a swing band called The Heartbeats from 1965 into the early 1970s, golfed for sixty-eight years, and in 1988 filed for bankruptcy after Houston real-estate debts went bad. In 2000 he was asked to review Dick Cheney's cardiac records during the presidential campaign. He wrote more than 1,400 scientific papers and twelve books, operated until he was 87, and made patient rounds until he was 96.

The honours were extravagant: the René Leriche Prize, the International Surgical Society's highest, in 1967; the Presidential Medal of Freedom from Ronald Reagan in 1984; the National Medal of Technology from Bill Clinton in 1998; the Grand Hamdan International Award in 2000; the American Surgical Association's Medallion for Scientific Achievement in 2010; honorary fellowships of five Royal Colleges of Surgeons and decorations from eleven foreign countries.

Why Denton Is Called a Genius

The word was used of him explicitly. On his death, James T. Willerson, president of the Texas Heart Institute, said the world had "lost a medical genius and a great humanitarian." But honesty requires naming what kind of genius is actually being claimed, and in Cooley's case it rests overwhelmingly on craft rather than intellect.

The skill consists of speed, economy, and unhesitating decision inside a chest. Cardiac surgery in the era before modern bypass and cardioplegia ran on a clock: every extra minute of arrested circulation cost the patient brain and heart tissue. A surgeon who could complete a repair in half the time got results a slower one could not, regardless of who understood the physiology better. Cooley had that — an athlete's hands, no wasted motion, and the nerve to keep going. It is why he could operate without transfusion on Jehovah's Witnesses, why he could run several theatres at once, and why the raw volume reached six figures. Add to it a genuine gift for simplification: reducing an operation to its irreducible steps, which is what "modify, simplify, and apply" meant in practice.

The counter-case is real. Cooley was not the originator of the ideas he executed. The blue-baby operation was Blalock, Thomas and Taussig's; the artificial heart was Liotta's design out of DeBakey's programme; heart transplantation was Christiaan Barnard's. His signature achievement was to do things first, fastest and most often, which is a different distinction from having thought of them. And his most historic operation is inseparable from an ethical rupture that many colleagues never forgave. Call him one of the great technicians in the history of medicine — that is an enormous claim, and a defensible one — rather than one of its great minds.

Legacy

Cooley died in Houston on 18 November 2016, aged 96, and was buried at Glenwood Cemetery. The Texas Heart Institute remains one of the busiest cardiac centres on earth; the Denton A. Cooley Cardiovascular Surgical Society now numbers hundreds of surgeons across more than fifty countries; and a basketball pavilion bearing his name stands in Austin, where the hands started.

Achievements

• National Medal of Technology and Innovation — 1998
• Presidential Medal of Freedom — 1984
• Commander of the Order of the Sun of Peru‎
• Grand Cross of the Civil Order of Alfonso X the Wise — 1970
• Fields: medicine, surgery and cardiac surgery