Sir Brian Barratt-Boyes
Heart-valve replacement pioneer
Thursday 16 March 2006
Brian Gerald Barratt-Boyes, heart surgeon: born Wellington, New Zealand 13 January 1924; Surgeon-in-Charge, Cardio-Thoracic Surgical Unit, Greenlane Hospital, Auckland 1964-88; CBE 1966, KBE 1971; married 1949 Norma Thompson (five sons; marriage dissolved 1986), 1986 Sara Monester; died Cleveland, Ohio 8 March 2006.
In 1962, Brian Barratt-Boyes was only the second heart surgeon in the world to replace a heart valve, using one from a cadaver. This can be done because heart valves have no blood supply and are not rejected by the immune system. The patient, Marilyn Hollingsworth, is alive and well today, having undergone a second replacement 25 years later, also performed by Barratt-Boyes.
The world's first valve replacement had been done by Donald Ross a few weeks earlier at Guy's Hospital, London. Ross published his case report in The Lancet in 1962 and Barratt-Boyes published a report of 44 patients, 41 of whom survived, in Thorax in 1964. He perfected and simplified the technique over the years.
A few years earlier, in 1958, Barratt-Boyes had performed New Zealand's first cardiopulmonary bypass. He was also one of the first surgeons to implant pacemakers - made in the university workshop before they became commercially available in 1961.
Later, in 1970, he developed techniques of cardiac arrest and hypothermia techniques to save babies born with heart defects. He was knighted the following year for his achievements. Jointly with John Kirklin, he wrote a textbook, Cardiac Surgery (1986), which for some years was the standard text on the subject. He turned down lucrative offers around the world to stay in his native New Zealand.
Barratt-Boyes was born in Wellington in 1924, and schooled at Wellington College. He went on to Victoria University, also in Wellington, before studying medicine at Otago's Medical School, graduating in 1946. He continued his training as a surgeon, initially in New Zealand, and spent 1953-55 at the Mayo Clinic in Rochester, Minnesota. Here he worked under the surgeon John Kirklin and they became firm friends. He followed this with a year in England as a Nuffield fellow in Bristol.
Sir Douglas Robb, New Zealand's pioneer of heart surgery, Chancellor of Auckland University, and a former President of the British Medical Association, then recruited him back to Greenlane Hospital in Auckland, where he spent the rest of his career, retiring in 1988.
Barratt-Boyes made Auckland a world centre for heart surgery, and argued that its relative isolation - compared with the Mayo Clinic - was an asset.
The New Zealand Herald has published many tributes from his former patients, among them Marilyn Hollingsworth, his first heart valve replacement, and Geoff Southgate, now 45, who when aged five was one of the first 10 children on whom Barratt-Boyes performed hole-in-the-heart repair; Barratt-Boyes also replaced both his heart valves.
Brian Barratt-Boyes was aggressive, autocratic, patriarchal and tough. His peers found him opinionated and intolerant; his juniors found him aloof, demanding, and intimidating; bureaucrats found him a formidable opponent; patients found him formal. But he also inspired loyalty, replied personally to children's thank-you letters, and adored being a grandfather.
Barratt-Boyes was outspoken at what he perceived as government under-funding. He argued in 1969 that patients needing heart surgery were dying because of shortage of resources, and that New Zealand led the world in heart disease, which accounted for 52 per cent of deaths. In 1975, he said patients needing heart surgery were dying because of finance curbs. In 1986, he said the waiting list for life-saving heart surgery had risen by more than 100 in a year to 358, the vast majority urgent cases.
He had heart disease himself, and later said that he tried to deny it for a long time. He had a struggle to give up smoking. From the Heart (1987), a biography by Donna Chisholm, revealed that he first had heart pains in Bangkok in 1963. He tried to treat himself until 1974 when a former colleague performed a coronary artery bypass operation.
It was the first of four heart operations he underwent. The last was in Cleveland, Ohio, when he had two heart valves replaced - the operation he pioneered. He could have had the operation in Auckland but wanted the services of the world leader in heart valve surgery, Toby Cosgrove. He died two weeks later from complications.
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