Spokane Journal of Business

Emergency bypass surgery comes far in 50 years

Pioneering procedure became standard of care in emergencies

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A procedure pioneered in Spokane by medical teams led by cardiologist Dr. Francis Everhart and cardiac surgeon Dr. Ralph Berg in 1971 changed the standard of care for people having a heart attack and has led to further advances in emergency cardiac treatment still in use today.

The procedure is emergency coronary artery bypass surgery for people having a heart attack. The 50th year anniversary of the first emergency bypass procedure is next month.

Coronary arteries are the blood vessels going to the heart. Coronary artery bypass procedures are surgeries done to bypass constricted or blocked areas in these blood vessels of the heart with arteries or veins. Bypass surgery was pioneered as an elective procedure by Dr. René Favaloro at the Cleveland Clinic in 1967. He used a saphenous vein from the leg to bypass a blocked coronary artery. Favaloro was a friend of Berg and came to Spokane, after he developed the bypass procedure, to operate with Berg.

Favaloro’s procedure was rapidly adopted by cardiac surgeons, including those in Spokane. However, it was always done electively – not as an emergency procedure.

Everhart came to Spokane in 1968 in response to a job offer from Berg. Everhart was one of the first cardiologists to work exclusively with adult patients at what was then Sacred Heart Hospital.

Up until 1971, the standard of care for someone having a heart attack was to admit the patient to the hospital, and keep them at bed rest for three weeks, then have them gradually get up and move cautiously for the next three weeks, and then discharge them. Depending on the degree of damage done to the heart muscle, patients could either do well or they might die soon after discharge.

Heart attacks are just that—attacks. Typically, people develop severe symptoms suddenly. About a third of patients die instantly. The other two-thirds typically make it to a medical facility.

Under the standard of care of the day, it was assumed that trying to do anything to the heart during a heart attack would increase the risk of these serious rhythm issues. Even minimal exercise was a potential risk. Doing a heart catheterization was out of the question.

It was known that when the coronary arteries in somebody who had died following a heart attack were examined, there were clots in the vessels. The prevailing wisdom at the time was that these clots formed after the heart attack because the heart was weakened by the damage and not beating as strongly.

After examining many hearts and also looking at the coronary arteriograms done in people with coronary artery disease, however, Everhart begin to look at the anatomy differently. He thought that the clot could actually be the cause of a heart attack rather than a post-heart attack occurrence. If this were the case, he theorized, removing the clot or bypassing the clot soon after the initial event could possibly prevent a tremendous amount of heart muscle damage.

Everhart started talking about this theory with the cardiac surgeons and a number of the other cardiologists at Sacred Heart Hospital, most notably, Berg.

Berg’s partner, Dr. Robert Kendall, and several of the other cardiologists were also intrigued and interested.

After having Berg’s assurance that he would operate on the patient having a heart attack if he felt that there was acceptable anatomy, Everhart started performing catheterizations on patients having heart attacks in order to inject dye into the coronary artery that could be viewed via a coronary arteriogram to locate blockages in vessels that provide blood to the heart muscle.

He catheterized five patients initially, but Berg chose not to operate on any of them. What Everhart did learn was that heart catheterizations could be done on patients who were having heart attacks without causing any serious issues.

It was then a question of having an appropriate patient.

The initial patient who had surgery for an acute heart attack was a 44-year-old man who had been admitted to the hospital with chest pain and failed to respond to conservative treatment after several days. He was scheduled for an elective heart catheterization in the morning. At 5 a.m., the patient had a heart attack. This information wasn’t brought to the attention of the cardiologist, who proceeded with the “elective” heart catheterization.

A critical blockage, referred to as a “widow maker” was found. Berg was already operating, so Kendall was called, and he agreed to proceed with the surgery recognizing that he was performing a bypass procedure on a patient who was having a heart attack. Following surgery, the patient did exceptionally well and was released from the hospital soon after the operation. He did much better than most people who had had heart attacks and were treated in the traditional manner.

Following this initial success, many more operations were performed at Sacred Heart Hospital with results far better than those achieved in patients treated with the traditional standard of care.

Everhart and the other cardiologists and surgeons began presenting their results to the rest of the world. They initially were accused of misrepresenting their data. Some of the premier cardiologists in the world didn’t believe the data. They also didn’t believe that this could happen in a relatively small community and in a nonacademic facility.

In the late 1970s Spokane cardiologist Dr. Marcus DeWood began publishing results in prestigious journals and presented the data in important medical meetings to put the information out to much larger national and international audiences. 

Soon, a growing number of cardiologists and heart surgeons began following Spokane’s lead and emergency bypass surgery for heart attacks eventually became the standard of care.

This, then, led to the development of chemicals to dissolve clots so that surgery wasn’t always necessary. The use of angioplasty and stents also eliminated the need for some surgeries.

My personal interest in this is entirely professional. I’ve never met Everhart. Our interaction has been exclusively by telephone and email. I met Berg several times over the years, but it was always professional. Berg died several years ago. Everhart is retired and lives in Florida.

I came to Spokane and started seeing patients in September 1971. My experience at that time with people having heart attacks was discouraging. That changed with patients having emergency bypass surgery. Almost overnight, my patients started doing extremely well and that pattern has continued to the present time.

There’s no way of knowing how many patients these procedures have saved. I am sure it’s in the millions.

This, in my opinion, is due to pioneering work of Everhart and Berg 50 years ago in Spokane. I feel that the work done by Everhart and the other physicians is worthy of consideration for a Nobel prize in medicine.

 

Dr. Robert Hustrulid is an internal medicine specialist in Spokane Valley with over 50 years of experience in the medical field.

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