Revitalized Hearts

Jack March, 53, is a tennis pro who puts in up to eight grueling hours a day on the courts at Cleveland's Shaker Racquet Club. John P. Callahan, 51, a funeral director in Terre Haute, Ind., regularly plays 36 holes of golf in a day; he hunts and fishes and has built his own log cabin. John Williams, 55, works full time as a regional vice president of National Cash Register Company in St.

Petersburg, Fla.

What makes these men's activities remarkable is that they have all had drastic surgery to improve the circulation in their hearts by bypassing severely diseased portions of their coronary arteries. Without such surgery, it is doubtful that they--or an estimated 60,000 other Americans similarly afflicted--would be alive today. Just five years after becoming known to surgeons, the coronary-bypass operation is the most frequently performed radical lifesaving procedure in U.S. hospitals.

Actually, say the surgeons who pioneered its development, the operation should be performed far more often than it is. Each year close to 700,000 Americans die of heart attacks or other effects of coronary arteriosclerosis --hardening of the arteries that power the heart's main pumping chamber. Approximately one-fourth of these deaths occur before age 65 and are thus considered premature. Most of these younger victims, as well as a portion of those who are over 65, could have useful, satisfying years added to their lives if their hearts were repaired. Otherwise, even if they survive, they are likely to become cardiac cripples.

Fewer Deaths. Bypass surgery began with an unplanned and extreme measure taken in November 1964 by Dr. H. Edward Garrett at Houston's Methodist Hospital. Operating on a 42-year-old truck driver named Heriberto Hernandez, Garrett had expected to ream out a short stretch of clogged coronary artery and stitch over it a split piece of vein removed from the patient's own leg--what surgeons call a patch graft. Two main arteries proved to be so diseased that this procedure was not feasible. Garrett, who is now at the University of Tennessee's Medical Unit in Memphis, boldly decided to use a longer piece of vein, also from Hernandez's leg. He ran it from healthy tissue in the aorta directly to an unclogged portion of a major coronary artery--thus bypassing the blockage completely.

This imaginative operation was not widely noted. But meanwhile, at the Cleveland Clinic in 1967, Argentine-born Dr. Rene G. Favaloro hit upon the same idea. His chief, Dr. Donald B.

Effler, gave the go-ahead, and the coronary bypass soon gained fame and popularity--and an ever higher degree of safety and dependability.

There are still differences of opinion and unanswered questions about bypass surgery. Some cardiologists who treat heart disease medically but not surgically point out that the vein grafts sometimes become diseased or fail for other reasons. Moreover, though surgeons maintain that deaths among patients still hospitalized should not exceed 3%, in fact they exceed 20% at some institutions. Effler is unimpressed by their caution, and retorts: "The only way a cardiologist can attract attention nowadays is by attacking surgeons." But Effler concedes that it is still too early to tell how many extra years of life the operation will confer. The best evidence of the operation's value comes from the Cleveland Clinic team's own records. Among 1,000 patients closely observed for one to three years after their operations, the mortality rate was 27.7%. This is only half as many deaths as occurred among patients with similar problems who did not have the operation; of that group, 56.2% died within the same period.

High Costs. Critics contend that the Cleveland team's figures look good because it accepts only patients with a high chance of survival. Effler counters that the limitations of surgeons' time and facilities make it irrational to operate on hopeless cases. On the other hand, Houston's Dr. Denton A. Cooley insists that he takes patients in desperate stages of heart disease and that his survival rates are as encouraging as those of any other center.

Costs for the operation are high.

Two thousand dollars is the average fee for one or two primary surgeons, plus $300 to $500 for the anesthesiologist, at least $300 for cine X rays of the heart, and perhaps as much for the use of a heart-lung machine. The grand total can run up to $8,000. But few patients seem to mind either the costs or the discomfort. When Clarence Christie, 42, of Riverside, Ill., suffered a heart attack in 1971, his doctors gave him six months to live unless he underwent a bypass. "It was like a torture chamber," says Christie of the intensive-care period that followed the operation. But Christie, now back at work as an insurance executive, feels that the results justified the pain. "I eat what I want to, I drink what I want to," he says. "When it's fixed, it's fixed."

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