Rene Favaloro: 1923-2000: Heart surgeon

Argentine heart surgeon Rene Favaloro made his name in America where, in 1967, he performed the world's first documented heart bypass surgery. Favaloro was a rural doctor in his native Argentina, but became a pioneer of coronary surgery in the United States before returning to his homeland. During his career, he would claim to have performed some 18,000 heart bypass operations. In the end, the state of the Argentinean health system would prove too much for Favaloro. The doctor devoted his life to the provision of free, quality health services there. Increasing frustration and financial desperation led him to take his own life in 2000.

Interest in Medicine Began Early

Rene Geronimo Favaloro was born July 14, 1923, and raised in a modest home in La Plata, Argentina. His mother, Ida Y. Raffaelli, was a dressmaker, and his father, Juan B. Favaloro, was a carpenter. Favaloro's uncle was the only person in the family to have earned a university education, and he had become a doctor. Favaloro was convinced even as a boy that his own destiny lay in medicine, as well. He studied medicine at La Plata University, graduating in 1948. In 1950 he took a temporary post working as a country doctor in Jacinto Arauz, a small, impoverished town in the province of La Pampa, 300 miles west of Buenos Aires. He ended up staying in Jacinto Arauz for 12 years. "The lessons of his rural practice were never lost on him," Pearce Wright wrote in a London Guardian obituary, "and he maintained that all doctors in Latin America should be required to work among the poor."

Favaloro left Jacinto Arauz for America to begin his post-graduate studies. When Favaloro arrived at the Department of Thoracic and Cardiovascular Surgery at the Cleveland Clinic in 1962, he spoke very little English. However, the language barrier did not hold him back. Favaloro soon established himself as a pioneer in his field, although he was prone to breaking into a string of Spanish expletives when things were not going his way in the operating room.

In 1967 Favaloro performed the world's first documented coronary bypass surgery. Eugene Pottenger, a 54-year-old produce wholesaler from Illinois, had been given just three months to live because of the severe blockage of an artery to his heart. Pottenger was hooked up to an artificial heart-lung machine, and Favaloro "harvested" a vein from the patient's leg to use as a replacement for the clogged coronary artery. The procedure has become "a mainstay of modern medicine," according to the London Times, and boasts survival rates of 20 years or more.

At a Glance . . .

Born Rene Geronimo Favaloro on July 14, 1923, in La Plata, Argentina; died on July 29, 2000, in Buenos Aires, Argentina; son of Ida Y. Raffaelli (a dressmaker) and Juan B. Favaloro (a carpenter); married Maria (deceased); children: raised four of deceased brother's children. Education: National College and Medical School at the University of La Plata, MD, 1948; Rawson Hospital, Buenos Aires, postgraduate coursework; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, post-graduate studies, c. 1962.

Career: Instituto General San Martin in La Plata, intern, resident, staff position, 1940s; Jacinto Arauz, Las Pampas, Argentina, general practitioner, 1950-62; Cleveland Clinic, heart surgery and research, 1962-72; performed first documented coronary bypass surgery, 1967; author of more than 300 scientific papers, 1960s-2000; Favaloro Foundation, founder, 1992-2000.

Others would claim to have already performed the procedure. In the world of medical achievement, however, nothing is accomplished until it is documented in a medical journal. Favaloro and the Cleveland Clinic were the first to appear in print, in the Journal of Thoracic and Cardiovascular Surgery in August of 1969. Favaloro maintained the procedure was nothing more than a logical next step from the work he and his team had been doing. "Medicine is only evolution and it doesn't matter who is first," he was quoted as saying in the London Times. Still, he added, "in this case there is no doubt that the Cleveland Clinic was first."

Returned to Argentina

The pioneering heart surgeon turned his back on a lucrative medical career in the United States in order to bring his expertise back to his homeland. "Although he could have had a brilliant medical career at one of the most prestigious and well-endowed medical centers in the United States—which would have made him very rich—Favaloro resigned," according to the London Guardian. He returned to Argentina in 1972 to create a top-level teaching clinic and performed the nation's first heart-transplant operations. Favaloro raised the $55 million it took to found his heart clinic, the Favaloro Foundation, which opened its doors in 1992. There, he treated thousands of patients, often at no charge, and trained hundreds of surgeons.

The 25th anniversary of Favaloro's first bypass surgery was celebrated at the Cleveland Clinic in 1992. Pottenger, the first patient, was still alive at 79 and attended the event. Favaloro constantly downplayed his achievements. "I'm still a simple country doctor," he said in 1992, according to the London Times. "De-spite the technology, the most important thing is to talk to the patient and make contact with the patient. The patient is not only the illness, he has a soul."

Favaloro was author of more than 300 scientific papers and wrote the study Surgical Treatment of Arteriosclerosis in 1970. He also wrote an autobiography, The Challenging Dream of Heart Surgery: From the Pampas to Cleveland, in 1994. While Favaloro was known and honored the world over for his achievements, he was disenchanted with this level of international success. Truth be told, his international renown contrasted sharply with the lack of recognition—and practical support—he received in Argentina.

Clinic Struggled With Financial Difficulty

Argentina has struggled with financial depression since the 1990s when, like many other Latin American countries, it instituted free-market reforms. Millions of Argentines lost their health-care coverage while the government slashed subsidies to Favaloro's clinic. The Favaloro Foundation was often the only hope for chronic patients, and the doctor refused to turn away those who could not pay. After years of championing the cause of universal health care, Favaloro was growing distraught. According to the national newspaper La Nacion, as quoted by the Guardian, the Favaloro Foundation was reportedly owed $18 million by state-owned medical centers and hospitals. His dream was on the brink of financial ruin. He pled for help from the government and private investors to no avail. Accord-ingtothe Seattle Times he wrote in a letter to a friend, "I am going through one of the worst moments of my life. I have become a servant knocking on doors looking for money to keep the foundation alive."

Favaloro died July 29, 2000, at age 77. He was found by his secretary in the bathroom of his Buenos Aires apartment. From the gunshot wound to his chest, the gun lying nearby, and letters of farewell found in the apartment, police attributed the death to suicide. Favaloro's wife, Maria, had died in 1998. Though they had no children of their own, they raised four children of one of Favaloro's brothers, who died young. Argentine President Fernando de la Rúa, acknowledged Favaloro's "deep love and attachment to his country," according to the Lancet, and declared July 31 a day of national mourning.

Favaloro was honored in Europe for his work just weeks before his death. He attended the opening of the Georges Pompidou European Hospital in Paris on June 26 and 27, 2000. While there, he confided his troubles to fellow Argentine heart surgeon Juan Carlos Chachques, who is director of the Paris hospital. "I have no doubt that this tragedy is a direct consequence of the financial situation in which Argentina's health system is embroiled, Chachques is quoted as saying in Lancet. "Dr. Favaloro faced the appalling prospect that everything he had worked to achieve … was on the point of disintegration."

Selected writings

Surgical Treatment of Arteriosclerosis, (study) 1970.

The Challenging Dream of Heart Surgery: From The Pampas to Cleveland, (autobiography) 1994.

Sources

Guardian (London, England), August 3, 2000, p. 22.

Lancet, August 5, 2000, p. 492.

Seattle Times, August 27, 2000, p. A25.

Times (London, England), July 31, 2000, p. 19.

—Brenna Sanchez

Rene Geronimo Favaloro

Argentinian physician Dr. Rene Favaloro (1923–2000) was a world-renowned heart surgeon who performed the first successful planned bypass surgery of the coronary artery in 1967 at the Cleveland Clinic in Ohio. He later taught his technique for grafting arteries.

Humble Beginnings

Rene Geronimo Favaloro was born on July 14, 1923, in La Plata, Argentina. His father, Juan B. Favaloro, was a carpenter. His mother, Ida Y. Raffaelli, was a dressmaker. Both of his parents were Sicilian immigrants. Favaloro was inspired to become a doctor by an uncle who was a physician.

Favaloro received his bachelor's degree in 1941 and served with the Argentine Army during World War II. In 1946, when Favaloro was discharged as a lieutenant, he began his medical studies at the University of La Plata. In 1949 he received his medical degree and then served an internship at Polyclinic Hospital in La Plata.

When a country surgeon in Jacinto Arauz, a very poor village 300 miles away from La Plata, fell ill and needed a few months away from his practice, Favaloro went to serve in his place. For the rest of his life Favaloro took to heart the lessons he learned in Jacinto Arauz. According to Eric Nagourney, writing Favaloro's obituary for the New York Times, the doctor had once said that all doctors in Latin America should be required to work among the poor. Favaloro had told the San Diego Union Tribune: "They would be able to see the combination of dirt and fumes. The people have only one room where they cook, they live, they make love, where they have their children, where they eat." His sojourn in the village also kept him focused all his life on advocating health care for everyone, no matter what their economic situation, and it inspired him to establish his Fundacion Favaloro in 1975.

Favaloro's brother, Juan Jose, also became a surgeon, and the two set up a medical practice in La Pampa. They had the only X-ray machine in a 150-kilometer radius. Favaloro spent the next 12 years taking postgraduate courses and performing general surgery at Rawson Hospital in Buenos Aires. Favaloro married his high school sweetheart, Maria Antonia Delgado. The couple had no children.

Bypass Pioneer

In 1962, Dr. Donald Effler invited Favoloro to come to the Cleveland Clinic to observe the work of the Department of Thoracic and Cardiovascular Surgery and serve as an apprentice to Dr. Delos M. Cosgrove, co-chair of the world-famous heart center there. He also studied with Mason Sones, considered to be the father of coronary cineangiography—the reading and interpreting of coronary and ventricular images.

Two other surgeons had already performed heart bypass surgery—Dr. David Sabiston at Duke University in 1962 and Dr. Edward Garrett, an associate of the renowned Dr. Michael DeBakey, in 1964. But both of these surgeries were done in response to deteriorating conditions while the patient was on the operating table, and neither procedure had been reported in a medical journal. Favaloro's heart bypass operation on a 51-year-old woman in 1967 was the first to be planned and reported in a medical journal. His technique was to stop the heart, take a section of vein from the patient's leg, sew one end into the aorta, and attach the other end to the blocked artery. It soon became a standard procedure that continued into the 21st century.

As Favaloro perfected the operation, it popularity spread. Within one year 171 bypasses had been performed at the Cleveland Clinic. Nagourney quoted a friend of Favaloro, Dr. Robert H. Jones of Duke University, who noted that Favaloro was "really the person who should get credit for introducing coronary bypass into the clinical arena." In the past, various methods had been attempted to treat persons with heart disease, but none had succeeded as well as Favaloro's surgical method.

Lifetime of Service

In 1971, Favaloro left Cleveland to return to Argentina, giving up a lucrative career to serve the people of his homeland. There he began to raise funds for a $55 million heart clinic he planned to build. In 1975 he established his foundation for that same purpose. By 1980 he was able to establish a center for cardiovascular surgery, training surgeons and cardiologists in his methods and ideas. The medical center and teaching unit were located in the Guemes private hospital in Buenos Aires. The Society of Distributors of Newspapers and Magazines donated an eight-story building as a private research center. Favoloro's clinic was finally completed in 1992, and his Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation had its own home. Favaloro continued as the institute's director.

Throughout his career of service Favaloro remained a world figure. He was an active member of numerous professional organizations in the United States, Latin America, Europe, and the world including the American College of Surgeons, the American Association for Thoracic Surgery, the American Medical Association, the International Society of Cardiothoracic Surgeons, the Pan American Medical Association, the Third World Academy of Sciences, and other organizations.

Favaloro had several dozen teaching assignments throughout the international medical world. As an author and editor he wrote several books and served on the editorial boards of the Spanish-language version of the Journal of the American Medical Association (JAMA), the International Journal of Cardiology, the Journal of Cardiac Surgery, and Clinical Cardiology. Favaloro was a prolific author, writing more than 350 scientific papers, and six books, including two that have been translated into English, Surgical Treatment of Coronary Arteriosclerosis, published in 1970, and The Challenging Dream of Heart Surgery: from The Pampas to Cleveland, published in 1992. The topics of his other books included his personal memoirs of life as a physician.

Favaloro did not limit himself to print media. He developed a television program called "The Great Medical Issues," offering medical information on prevention and treatment of diseases. The program won two awards in Argentina during the mid-1980s. Another television series he created included 24 programs focused on drugs and aimed at young people.

Criticized Economic Policies

Favaloro harbored some discontent at the state of medicine in Argentina, criticizing the social and moral costs of managed health care. In a letter to the editor of La Nacion, a Buenos Aires newspaper, he noted that his foundation was owed $18 million from hospitals and state-owned medical centers. Nagourney quoted Favaloro, weeks before his death, writing that "I am going through the saddest period of my life. In the most recent times, I have been turned into a beggar," referring to the increasingly difficult task of finding enough money to perform necessary medical care and surgeries, particularly for the poor.

In a paper Favaloro wrote and presented at Leiden University in the Netherlands in February 1997, and that was reprinted for Interscientia, Favaloro explained the nature of cardiosurgery and its advances but also took on the social meaning of such changes. Favaloro noted a direct corollary between socioeconomic status and heart diseases and focused on the widening gap between the rich and the poor in education and health care. He commented that "…we are without doubt submerged in a materialistic, hypocritical and dehumanized society that has been developing slowly but steadily and which appears to have no limits to its appetites. All means are justified to increase power and pleasure through economic gains. It is of no importance that the greatest part of the population is excluded and survive in misery and lack of welfare." Favaloro was not referring only to Latin America or to Third World nations. He noted problems in getting adequate health care even in the United States. In his closing remarks, Favaloro said, "I did not present you with an indisputable truth. It would be a disgrace to say I am the owner of the truth. I would be gratified if my words only raised some doubts in your minds."

A National Hero

On July 29, 2000, Favaloro shot himself to death at his home in Buenos Aires. Argentina grieved at the loss of a national hero. According to Geoff Olson, writing for the Vancouver Courier an article in La Nacion "described his death as one more blow to 'the sad land of psychoanalysis and tango.'" Olson also referred to the national money crisis that had plagued Argentina for many years, which some observers blamed on privatization and a global economy that brought lower wages and dire financial conditions for workers. The fiscal downturn meant cutbacks in government funding for Favaloro's foundation. Also, according to Olson, "Two weeks before his death, in a memo to his staff, he excoriated economic globalization, stating that free-market reforms are 'better referred to as a neo-feudalism that is bringing this world toward a social disaster where the rich are getting richer and the poor are getting poorer.'"

Whether Favaloro's suicide was a deliberate statement against the state of the world in which he had to beg for money to cure people, or whether it was simply the act of someone desperately sad, can never be known. What is certain is that Favaloro left behind him a legacy of passion and dedication to serving the human race.

Periodicals

Heart Wire, August 11, 2000.

Interscientia, July 1997.

New York Times, August 1, 2000.

People's Union for Civil Liberties Bulletin (Delhi, India), October 2000.

Perteneser (Argentina), July 2000.

Texas Heart Institute Journal, 2000.

Vancouver Courier, February 11, 2002.

Online

"Altruism," George Mason University Objectivist Club,http://129.174.139.240/gmuoc/mt/archives/000071.html (December 31, 2003).

"Dr. Rene Favaloro," Favaloro Foundation,http://www.fundacionfavaloro.org (December 31, 2003).

"Dr. Rene Favaloro, Prince Mahidol Awardee," Prince Mahidol Award Foundation,http://kanchanapisek.or.th (December 31, 2003).

"Rene G. Favaloro? A great man and a great ideal," Sociedade Brasileira de Cardiologia (Brazilian Society of Cardiologists),http://publicaoes.cardiol.br (December 31, 2003).

"The Right to Health: Is it at Risk?" Canadian Conference on International Health,http://www.csih.org (October 28, 2003).