Once radical, now commonplace Surgery: Since it was first performed in 1962, heart bypass has become a practical, relatively safe procedure. Now the operation may be the only thing that can save Russian President Boris N. Yeltsin.

Sun Journal

September 22, 1996|By Jonathan Bor | Jonathan Bor,SUN STAFF

In 1967, Eugene Pottenger was lifting boxes of fruits and vegetables at his wholesale produce business in DeKalb, Ill., when he felt a strange tightening in his neck. It seemed like no muscle strain he had known.

Pottenger, then 53, was about to gain an accidental place in the annals of medicine.

Pottenger mentioned the tightening to his doctor. Initially, the physician thought the problem was trivial, but a treadmill test found signs that Pottenger's coronary arteries were dangerously clogged -- the possible precursor to a heart attack.

It was his good luck to be referred to the Cleveland Clinic in Ohio, where he met an Argentine doctor who was eager to test an idea. Dr. Rene Favaloro, a young surgeon who had left his rural practice to learn chest surgery, offered Pottenger a heart bypass operation.

Favaloro's idea was to steal a vein from his patient's leg, and to graft a short loop onto the afflicted coronary artery. The graft would give the blood a detour around the obstruction, leaving the blockage in a dry bed where it would do no harm.

"This was a new deal," recalls Helen Pottenger, the patient's wife. "He said my husband had only about three months to live if something were not done and about a 50-50 chance [of living longer] if we tried this.

"It was much better than the three-month suggestion, so we tried it."

Thanks to Favaloro, heart bypass surgery was about to become a practical, commonplace operation. It now may also be the only thing that can save Boris N. Yeltsin, the haggard Russian president, who has been undergoing hospital tests for several days to prepare for the operation.

Pottenger survived the operation and his heart disease, although he needed two more bypass operations to repair other arteries. He died two years ago at age 79, the victim of cancer that doctors said might have been triggered by the asbestos he inhaled while installing insulation as a teen-ager.

Fiercely patriotic, Favaloro returned to his native Argentina in 1971 to establish a heart institute, where he has trained hundreds of young doctors in the latest treatments.

"He's a guy who has enough energy to light up all of Argentina," says Dr. Delos Cosgrove, a thoracic surgeon at the Cleveland Clinic. "He was a national hero upon his return. You'd go down the street, and people would wave to him."

After his first series of operations, Favaloro says now, it became clear that bypass surgery would revolutionize the treatment of coronary artery disease.

Patients felt their chest pains subside; many returned to work and lived many years longer than once seemed possible. "After the first 20 or 30 cases," he says from his office in Buenos Aires, "I didn't have any doubt in my mind." Favaloro didn't perform the first bypass, although he is widely credited with popularizing the procedure by performing many in succession, publishing his results and teaching others the necessary techniques.

According to most accounts, the first bypass was performed in 1962 by Dr. David Sabiston at Johns Hopkins Hospital. It's a distinction he is ready to accept.

"I had the idea," says Sabiston, professor of surgery at Duke University. "I took a vein from the leg, put it on the aorta and it worked for several days. It worked very well."

But the patient had a stroke and a died a few days later, apparently from a new clot that formed near the graft. "That's why I didn't do it again until it had been done by others," Sabiston says.

With mixed modesty and bravado, Favaloro credits many forebears with making his work possible. First is Alexis Correl, a French surgeon who won a Nobel Prize in 1912 for developing methods for suturing blood vessels.

Correl performed a bypass on a dog in 1910. The operation took about five minutes, but the dog's heart reacted poorly to rough handling. The heart began fluttering abnormally before the operation was over, and the dog died. Still, the surgeon had quietly laid a foundation for others to build upon.

After World War II, surgeons successfully used bypasses to treat blood-vessel obstructions in the leg. The technique was popularized by Dr. Michael DeBakey, the Houston surgeon who would also play a major role in refining the heart bypass.

Just as important was the work of Dr. F. Mason Sones Jr., a Cleveland Clinic cardiologist who in 1957 developed a way to locate coronary obstructions with X-rays. Doctors fill the coronary arteries with radioactive dye, which causes obstructions and other irregularities to show up nicely on film.

"Before, we had absolutely no road map for these coronaries," says Dr. Vincent Gott, a Hopkins surgeon who performed his first bypass in late 1968.

It would have been impossible to suture coronary arteries -- each 2 millimeters in diameter -- without the ultra-fine surgical threads that were being developed at about the same time.

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