Tribute to René Favaloro, Pioneer of Coronary Bypass
Material things are temporary: only ideals last forever,
and within this context, the battle-cry should be:
education and scientific development for a society
in which social justice is the priority"
PRIDE IN HIS ACCOMPLISHMENTS, BUT UNEASE
FROM BEING KNOWN AS
"THE SURGEON WHO OPENED THE PANDORA BOX"
Favaloro felt strongly about social justice, focusing on
the impact of the growing split between
the rich and poor on inequities in healthcare.
His foundation was dedicated to promoting
equal access to health care for all in the community.
In a speech he delivered at Leiden University
(Leiden, the Netherlands) in February 1997,
Favaloro spoke at length of his fears that the profit motive was
unduly influencing physicians' choices in treatment.
Although he was proud of his most famous accomplishment, he said,
"But when I think that, on the one hand only a few countries
(like the Netherlands) provide health care systems based on
the population needs without any distinction, and on the other hand
our new techniques somehow contributed to the excessive enrichment
of some physicians, private clinics, and industrial companies related
to our field, my mind becomes confused and
I cannot avoid feeling some guilty complex.
I still listen to the words of one of the most famous
cardiovascular surgeons of our times when he introduced me
in a symposium in Detroit many years ago as
'the surgeon who opened the Pandora box for all of us.'"
Favaloro wrote books on the history of his field,
and on education in Latin America.
In his book on education, Don Pedro y la educaciónhe
argued for principles of participatory democracy,
and more equal distribution of riches,
and working towards justice for the greater commonwealth.
In a speech he delivered in Tel Aviv, Israel,
Favaloro complained of the increasing materialism of modern culture,
"I would like to ask especially the younger people to understand
that material things are temporary:
only ideals last forever, and within this context, the battle-cry should be:
education and scientific development for a society in which
social justice is the priority."
"When I think that, on the one hand only a few countries
(like the Netherlands) provide health care systems based on
the population needs without any distinction,
and on the other hand our new techniques somehow
contributed to the excessive enrichment of some physicians,
private clinics, and industrial companies related to our field,
my mind becomes confused and I cannot avoid feeling some guilty complex"
The death of René Gerónimo Favaloro on 29 July 2000,
at the age of 77, leaves a void in the field of cardiovascular
surgery:
we have lost one of our most respected and
significant contributors.
Although he was always hesitant to carry
the moniker of “father” of coronary artery bypass surgery,
he is the surgeon we should credit with introducing
coronary bypass surgery into the clinical arena.
Indeed, Dr. Favaloro's pioneering contributions
to cardiovascular surgery will be an enduring legacy
to his homeland of Argentina and to humanity.
Born on 12 July 1923 in La Plata, capital of the province
of Buenos Aires, Dr. Favaloro would devote much of life
to his homeland, helping to improve
the quality of health care there.
After he received his medical degree
in 1949 from La Plata University,
many believed that Favaloro would soon develop a career
as a distinguished thoracic surgeon.
Instead, he decided to fill in for an ailing colleague,
who was a country doctor in the small farming community
of La Pampa.
Favaloro would spend the next 12 years in La Pampa—
his social conscience awakened.
He educated his patients about preventive medicine,
established the first “mobile” blood bank in this area,
and built his own operating room,
where he trained general and surgical nurses.
He later wrote about this period in his life
in his book Memoirs of a Country Doctor.
Despite his rewarding work in La Pampa,
Dr. Favaloro's interest in thoracic surgery remained keen.
I
n 1962, he went to the Cleveland Clinic,
where he worked with Mason Sones,
Willem Kolff, and Donald Effler.
Favaloro studied the thousands of cineangiograms
that Sones had performed.
At that time, Sones had documented
indirect revascularization in a patient who had undergone
surgery with the Vineberg technique 7 years earlier.
Although Favaloro and his colleagues would perform
this technique on thousands of patients,
they were also beginning to investigate
the use of saphenous vein grafts
for direct revascularization.
Previously, the saphenous vein had been used only for
patch reconstruction of occluded coronary arteries,
but the technique had a high rate of
postoperative thrombosis and was eventually discontinued.
Favaloro reasoned that an alternative method
of reconstruction would be to use the saphenous vein
to connect the unoccluded proximal and
distal sections of the vessels,
thus bypassing the obstruction.
On 9 May 1967, Favaloro performed the first documented
saphenous aortocoronary bypass, in a 51-year-old woman
with total occlusion of the proximal third of the right coronary artery.
Eight days later, Sones would confirm by angiography
that the bypass was patent; 20 days later,
angiography showed
total reconstruction of the artery.
By 1968, Favaloro and his colleagues were combining
the revascularization technique with valve
replacement and ventricular aneurysmectomy,
and performing the first bypasses for acute infarctions.
In 1971, Favaloro returned to Argentina, where
he used his knowledge to establish the Favaloro Foundation—
a center similar to the Cleveland Clinic's
that was based on research,
teaching, and clinical activities.
The center would provide well-trained surgeons
and modern equipment to treat all people,
whether they could afford such care or not.
He developed an intense educational system
that trained surgeons and cardiologists
from all over Latin America,
who in turn filled positions in Latin American countries
that did not previously have this expertise.
In later years, it was not unheard of for Favaloro
to travel anywhere in Latin America and to come upon
at least one of his graduates,
further demonstrating that his vision and altruistic actions
reached far beyond the walls of the Favaloro Foundation.
Through the years, Dr. Favaloro received many accolades
and international awards. He belonged to numerous honorary
and scientific societies.
In 1992, he received the International Recognition Award
at the international meeting of the
Cooley Cardiovascular Society,
held that year in Puerto Rico.
He visited me several times at the
Texas Heart Institute beginning in 1960;
René was always an incredible inspiration.
As a surgeon, Dr. Favaloro will be remembered
for his ingenuity and imagination; but as a man
(whose outspoken views on the country that he loved
often displeased the Argentine government),
he will be remembered for his compassion and selflessness.
A well-read student of Latin American history,
Favaloro lived what he learned and never forgot
the importance of his roots.
I am privileged to have known Dr. Favaloro and
to say that he was a friend.
He was the first to convince the surgical wo
r
ld
that direct revascularization was a way not only
of improving the comfort of patients, but of prolonging lives.
Subsequently, he has provided card
iovascular surgeons
the means to improve the health and quality of life
of countless patients throughout the world.
I extend our sympathy from the Texas Heart Institute to
Dr. Favaloro's family, colleagues, and friends;
and to the people of Argentina,
who have lost a fervent patriot,
a talented surgeon, and a compassionate hero.
President and Surgeon-in-Chief, Texas Heart Institute, Houston
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