Take heart

In this magnificent book, Thomas Morris provides us with a thoughtful, engaging and rigorous account of how cardiac surgeons through history have sought to undo the ravages wrought on the heart and its associated major blood vessels by abnormal genes, imperfect development, bacterial infections such as rheumatic fever, venereal diseases, unhealthy lifestyles and a host of other factors. He also offers an insight into the nature of scientific discovery, the mindsets of the characters driving it and the ever-present role of luck.

It was, indeed, a simple mistake made in 1947 by a young researcher called Arthur Voorhees that led to a chance observation which resulted in the development of the first artificial grafts to replace damaged blood vessels. Having in error placed a silk stitch into the one of the chambers of the heart, he noticed that it became covered with normal heart tissue. This emboldened him to sew a silk handkerchief into a tube and use it to replace a dog’s aorta. The makeshift artery functioned for just one hour, but when a year later he was sent a sample of a tough fabric used for the construction of parachutes, he was able to fashion a more robust prototype.

This pioneering work was picked up by the cardiac surgeon Michael DeBakey, who, using his wife’s sewing machine, stitched together the first polyester Dacron graft, with which he successfully replaced a patient’s diseased lower aorta.

Like the pioneering US air force test pilots of Tom Wolfe’s The Right Stuff, Morris’s pantheon of surgeons took tremendous risks; not with their lives but their consciences, livelihoods and reputations. Often faced with the vitriolic disapproval of their colleagues, and overshadowed by a catastrophic collection of their own failures, the discoverers of the armatorium of cardiovascular surgical techniques showed remarkable intransigence.