Dr. Denton A. Cooley, the renowned surgeon who was the first to implant a totally artificial heart in a patient and in the process set off one of medicine’s greatest feuds, died on Friday at his home in Houston. He was 96.
The Texas Heart Institute, which Dr. Cooley founded, confirmed his death. He stopped performing surgery on his 87th birthday but had never retired, remaining active at the institute as its president emeritus. The institute said he last showed up there on Monday.
A former college basketball star who was a towering presence in the operating room, Dr. Cooley had by age 50 performed more than 5,000 cardiac operations, including 17 heart transplants.
For more than six decades his name was inextricably linked to that of his mentor and former partner, Dr. Michael E. DeBakey, the developer of the artificial heart. Their pioneering techniques for surgery on the heart and blood vessels have helped tens of thousands of patients.
But those advances were overshadowed on April 4, 1969, when Dr. Cooley, working independently of Dr. DeBakey, performed his groundbreaking implantation without Dr. DeBakey’s authorization. At the time, Dr. DeBakey and a medical team were developing the artificial heart — it was still an experimental device — at Baylor College of Medicine in Houston.
Dr. DeBakey felt betrayed. Suddenly his protégé was his archrival. So began a feud that would last 40 years, reveal much about the personalities and ambitions of the two renowned surgeons and end only a year before Dr. DeBakey’s death in 2008.
Dr. Cooley long defended his action as a doctor’s obligation to do whatever is necessary to save a patient’s life. “If you are a ship out in the ocean and someone throws you a life preserver, you don’t look at it to see if it has been approved by the federal government,” he said in an interview for this obituary.
The implantation was performed at the Texas Heart Institute; the patient was Haskell Karp, 47, from Skokie, Ill. About 16 months earlier, Dr. Christiaan N. Barnard had performed the world’s first human heart transplant in South Africa, a milestone that led many other surgeons to try the operation. One was Dr. Cooley, a professor of surgery at Baylor and the chief of cardiovascular surgery at St. Luke’s Episcopal Hospital in Houston, who in 1968 performed what he claimed was the first successful heart transplant in the United States.
The rush to transplantation led researchers like Dr. DeBakey to renew their attempts to develop an artificial heart to keep patients alive until a donor heart could be found. He was believed to be the first to perform surgery using a partial artificial heart, known as a ventricular assist device.
Dr. DeBakey, who had led a campaign to persuade the federal government to support such research, had been developing his artificial heart with a colleague, Dr. Domingo S. Liotta of Argentina, under a grant from the National Institutes of Health. Dr. DeBakey believed the device, which had been tested only on calves, was not ready to be tried on a human patient.
But Mr. Karp’s failing heart could not pump enough blood. When efforts to repair it failed, Dr. Cooley enlisted Dr. Liotta to deliver the artificial heart from Dr. DeBakey’s laboratory and, with a 16-person medical team in a three-hour operation, removed Mr. Karp’s heart and implanted the artificial one, a half-pound device made of plastic and Dacron connected by tubes to a bedside control console.
The device worked for 64 hours, longer than it had in animal tests, while a frantic search began for a donor heart. When one was found, Dr. Cooley performed the operation. The new heart sustained Mr. Karp for another 32 hours, until he died of pneumonia.
(The first totally artificial heart intended for permanent use, the Jarvik 7, was implanted in Dr. Barney B. Clark at the University of Utah in 1982. He survived for 112 days. Since then, the federal government has approved the use of partial artificial hearts.)
Dr. DeBakey, who was Baylor’s chancellor, accused Dr. Cooley of committing an unethical and “childish” act to claim a medical first. He contended further that in using a device that was still under development, he had broken federal rules and jeopardized Baylor’s federal research support.
Dr. Cooley said that use of the device to save a patient’s life, even experimentally, did not violate the grant contract. He later maintained the operation was also an act of patriotism: He did not want the Russians to be the first to implant a total artificial heart and beat the United States as they had with their early space program.
Dr. Cooley resigned from Baylor, and the American College of Surgeons censured him for his unauthorized use of the device, which is now in the Smithsonian Institution in Washington.
For decades after that, Dr. Cooley and Dr. DeBakey rarely spoke to each other or were even in the same room. (The feud became so intense and so widely talked about that it became the subject of a cover story in Life magazine.)
“Once Mike and I became rivals,” Dr. Cooley said, “he seemed to go out of the way to establish the fact that it was he who was responsible for all of the developments” in heart surgery techniques, many of which he and other members of Dr. DeBakey’s staff had performed.
The two reconciled in October 2007, two years after Dr. DeBakey had recovered from an operation at age 97. In a ceremony at St. Luke’s, Dr. DeBakey accepted a lifetime achievement award from the Denton A. Cooley Cardiovascular Surgical Society. After presenting the award, Dr. Cooley stepped down from the stage and knelt next to Dr. DeBakey, who sat in a motorized scooter. The two shook hands warmly.
Dr. Cooley had sought the reconciliation for years. “Because I owe a real debt to the people who have helped me in my career,” he said, “I would have been somewhat derelict if I had not had the chance to tell Mike DeBakey that.”
Denton Arthur Cooley was born in Houston on Aug. 22, 1920, to a wealthy family. His paternal grandfather, Daniel Denton Cooley, was a founder of the planned community Houston Heights. His father, Ralph, was a prominent dentist.
Dr. Cooley attributed his surgical skills to his athletic prowess. As a freshman at the University of Texas, he was told by his basketball coach to add at least 25 pounds to his 6-foot-4 frame to avoid “getting murdered” on the court. He gained even more weight and went on to play forward and center for the team. A member of Phi Beta Kappa, he graduated in 1941 with a degree in zoology.
He was attracted to surgery at age 17 when he visited an emergency room in San Antonio and observed a friend sewing up knife wounds inflicted in Saturday night brawls. After starting medical school in Galveston, he transferred to Johns Hopkins in Baltimore, earning a medical degree in 1944.
After serving in World War II and then continuing his training on a fellowship in England, where he studied with the heart surgeon Russell C. Brock, Dr. Cooley returned to Houston to work under Dr. DeBakey. Over the next few years, the two surgeons had important roles in virtually every major development in heart and blood-vessel surgery.
Dr. DeBakey and Dr. Cooley devised operations to repair potentially fatal bulges in aortas and to bypass arteriosclerotic damage in neck and leg arteries that could lead to strokes.
Dr. Cooley also came up with a way to reduce the amount of transfused blood used in the heart-lung machine that “breathes” for the patient during open-heart operations. The technique reduced the incidence of infections like hepatitis B at a time when no vaccine existed to prevent that debilitating and potentially fatal liver infection. It also made it easier to perform surgery on patients whose religious beliefs prevented them from receiving another person’s blood.
Dr. Cooley said that “if there is any contribution I should be recognized for,” it is reducing the need for blood transfusions in open-heart operations.
Dr. Cooley, who believed that the outcome of an operation was related to its length, became an exceptionally fast surgeon despite athletic injuries that damaged a few fingers and a wrist.
“I was always surprised how seemingly slow all his movements were in operating,” Dr. Roland Hetzer, a onetime colleague and former director of the German Heart Institute in Berlin, said in an interview there in 2010. “But every stitch was just perfect the first time, and he never had to do something a second time. So in the end he was very fast, a very good technical surgeon.”
In 1962, Dr. Cooley founded the Texas Heart Institute at St. Luke’s and became its president. He also taught at the University of Texas and Baylor medical schools in Houston.
He worked in an era when federal regulation of the development of new medical and surgical devices was limited. Doctors could make their own devices and instruments and use them on patients with little outside oversight. Human experimentation committees, whose approval is needed before doctors can conduct an experiment on a patient, did not yet exist.
“All the progress we made in that period would take us a century now,” Dr. Cooley said. “We would just try something in the lab, have some personal conviction that it was a meaningful thing to do and try, and then we would go ahead and apply it.”
At his peak, Dr. Cooley was said to be the busiest heart surgeon in the United States, performing many operations a day using an assembly-line approach. Patients were assigned to separate operating rooms where younger doctors opened their chests and exposed the hearts. Dr. Cooley then scurried between operating rooms to do the crucial part of each operation. Some of his critics have questioned the quality of the surgery.
“My athletic experiences taught me endurance and competitiveness, with perhaps an emphasis on endurance,” he said.
In 1984, President Ronald Reagan presented Dr. Cooley with the Presidential Medal of Freedom, the nation’s highest civilian award, for “charting new territory in his search for ways to prolong and enrich human life.”
Dr. Cooley had homes in Houston and in Galveston, Tex. His wife of 67 years, the Louise Thomas Cooley, died before him, as did a daughter, Florence Talbot Cooley.
His survivors include four other daughters, Mary Cooley Craddock, Dr. Susan Cooley, Dr. Louise Cooley Davis and Helen Cooley Fraser; 16 grandchildren; and 17 great-grandchildren.
Dr. Cooley had his failures, both professional (a sheep-to-human experimental heart transplant was unsuccessful) and personal (he declared bankruptcy from failed real estate investments in the early 1980s).
And though he and Dr. DeBakey reconciled, their rivalry never completely abated. Dr. DeBakey has been called the greatest surgeon ever. Before his death in 2008, he said in an interview that Dr. Cooley was “one of the best cardiovascular surgeons” he had ever known.
Asked in a separate interview whom he considered the greatest surgeon, Dr. Cooley replied, “Besides myself?”
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