History of Medicine

                     THE VIBRANT LIFE AND TRAGIC DEATH OF

RENÉ FAVALORO

 

            René Favaloro, an Argentinian cardiac surgeon, is best known to the world as the “father” of coronary artery bypass surgery. His life in medicine, however, ranges well beyond cardiac surgery.

         René was born in La Plata, Argentina, in 1923, the son of an artisan carpenter of Sicilian origin. After medical school and internship in La Plata, he decided on a career in surgery. But he declined a residency when he was required to sign a declaration of allegiance to the Peronist party. Coincidentally, a letter came from an uncle in a remote village in the Pampa asking him to fill in while the local doctor was absent for medical treatment. René accepted and traveled to Jacinto Aráuz, a village in flat, desolate land whose inhabitants, mainly of German descent, labored at raising livestock and farming in barren land with unpredictable weather conditions. The previous doctor soon died, and René brought in his brother,

René Favaloro (Wikipedia)

recently graduated from medical school, to set up a more modern clinic. They expanded their area of activity, acquired used X-ray equipment, medical books and journals, a reliable automobile, and materials for local and spinal anesthesia. They taught midwives to be nurses and others to educate villagers about hygiene, clean water, and ways to stay healthy. Cesarian sections, gallbladder surgery, hernia repair, and many other procedures became possible. He tabulated the blood types of all the residents, thus establishing a “mobile blood bank” in case of emergencies. René married and built a house, but after twelve years of hard work and little vacation, decided to broaden his horizons. He wanted to study thoracic surgery.

         His old professor of surgery, José María Mainetti, encouraged him to go to the Cleveland Clinic. René took some quick English lessons and flew north. George Crile, one of the Clinic's founders, greeted him and referred him to the cardiac surgery service under Dr. Donald Effler. Effler found that Favaloro had not passed any U.S. exams and spoke halting English and told him he could work only as an unpaid aid. Using modest savings, René carried out aid duties and earned enough confidence to be allowed to scrub in on operations. He learned English, crammed every night to pass the National and State Board exams, and was accepted as a cardiac surgery resident. 

The timing was propitious. A brilliant cardiologist at the Cleveland Clinic, Mason Sones, was the first to use a rapid frame motion picture camera to photograph dye in the coronary arteries and clearly demonstrate obstructive lesions. Favaloro worked with Sones

Mason Sones with Favaloro (Wikimedia Commons)

intensively and before long tried bypassing the lesions using a saphenous vein graft. The coronary artery bypass graft (CABG), as the procedure was called, replaced the less effective Vineberg operation (implanting a mammary artery in the myocardium) and became a favored operation worldwide. Favaloro justifiably earned many honors, especially for his rigorous collection of data to establish the value of the procedure. 

During his time at the Cleveland Clinic, he was still mindful of the lagging state of surgery in his native city and wanted no less than to bring the Cleveland Clinic to La Plata. At the height of his fame, he resigned his position at the Clinic, moved to La Plata in June of 1971, and began to assemble a cardiac institute. As Chief of Cardiac Surgery at the Clinica Güemes Hospital, he and his brother put together, in 1975, the Favaloro Foundation, a nonprofit organization devoted to cardiology and cardiac surgery. Tragically, René’s brother died in an accident one year later and René helped raise his four children, two of whom became physicians. In 1978 an eight-story building was donated to the Foundation as a research institute. Two years later, René performed the first cardiac transplant in Argentina and established a teaching unit in the hospital. 

René's worldwide reputation helped him raise funds for a new institute that combined cardiology, teaching, and research into one unit: The Institute of Cardiology and Cardiovascular Surgery. It resembled the National Heart, Lung, and Blood Institute in the U.S. and opened in 1992 as part of the Favaloro Foundation. It was a nonprofit entity, providing care to all, regardless of ability to pay. About 25% of surgical patients had no insurance. By the seventh year, the Institute had trained at least 400 cardiologists and cardiac surgeons for work throughout South America and beyond.

Planet Heart (Corazón Planetario), by Gyula Kosice, at the Favaloro Foundation 
(Wikimedia Commons)

Outside his medical work, René was an active member of the National Commission on the Disappearance of Persons, a group investigating the tragedies of thousands of “disappeared” citizens during the military Junta regime. He took an interest in Argentina’s history and wrote two books on the life of its founding father, San Martín. He wrote a book on his life as a country doctor and another on his life at the Cleveland Clinic. His favorite fictional character was said to be Don Quixote, and many friends felt his entire life resembled a quixotic quest.

Maintaining a nonprofit foundation requires money, and when times were prosperous the Institute received adequate funds. However, in the late 1900s Argentina’s finances fell into serious trouble. The usual subsidies from government and private agencies dried up. René struggled with the Institute’s increasing debt, but to no avail. Letters to the government went unheeded. In desperation, on July 29, 2000, at the age of 77, René shook the conscience of Argentina to the core when he pointed a revolver to his chest and ended his life. He left a long letter detailing his accomplishments in his home country and the corruption he was surrounded with. He said a goodbye to his family and ordered that his body be cremated and his ashes scattered in the hills near Jacinto Aráuz, where he had labored for twelve years as a rural physician.

Public outrage helped the Favaloro Foundation survive the crisis and René would be happy to know that the Foundation now is a major cardiac center in Argentina, as he dreamed it would be.

 

SOURCES:

 

Captur, Gabriella, “Memento for René Favaloro.” Texas Heart Institute Journal 2004; 31(1): 47-60.

Favaloro, René, “Landmarks in the Development of Coronary Bypass Surgery.” Circulation 1998; 98(5): 466-78.

Favoloro suicide letter, available at:    https://web.archive.org/web/20160305021334/http://www.avizora.com/publicaciones/biografias/textos/textos_f/0013_favaloro_rene_anexo_01.htm

Fye, Bruce, Caring for the Heart: Mayo Clinic and the Rise of Specialization, 2015; Oxford Univ Press, pp 315-342.

Rubenstein, Robyn, et al, “René Gerónimo Favaloro (1923-2000): A Man Who Struggled with Matters of the Heart.” American Surgeon, January 2018, 7-11.

Favaloro, R, Recuerdos de un Médico Rural, 2^nd edition, Editorial Sudamericana, 2018.

Favaloro, R, De la Pampa a Los Estados Unidos, digital edition, Random House, 2012.

"Argentina Searches it Soul over a Suicide," New York Times, August 7, 2000.