Houston, Texas - World-renowned cardiovascular surgeon Dr Michael DeBakey has died at age 99. One of the few heart surgeons to gain international recognition outside of medicine, he passed away of natural causes on Friday evening at the center that bears his name, part of the Baylor College of Medicine and Methodist Hospital in Houston.

Dr Michael DeBakey

In a career spanning more than seven decades, DeBakey will be remembered as many things: an original and inspiring medical inventor and pioneering surgeon as well as a great teacher and a medical statesperson. The recipient of 50 honorary degrees and more than 200 awards, the most recent of which was the Congressional Gold Medal this year, DeBakey was still touring the world lecturing well into his 90s.

Among his most famous inventions and achievements were the roller pump, which became a vital component of the heart-lung machine and heralded the beginning of open-heart surgery, the left ventricular assist device that bears his name (and its forerunners), the mobile army surgical hospital (MASH), and the concept of lining a bypass pump and its connections with Dacron velour, later applied to arterial grafts. He also developed more than 70 surgical instruments and performed the first successful carotid endarterectomy, establishing the field of surgery for strokes.

Although DeBakey operated on many celebrities, including former US presidents John F Kennedy, Lyndon B Johnson, and Richard M Nixon; ex-Russian president Boris Yeltsin; and royalty in the form of the Edward VIII (the Duke of Windsor), Mohammad Reza Pahlavi (the shah of Iran), and King Hussein of Jordan, he was just as happy performing pro bono surgery for patients with little means. "Once you incise the skin, you find they are all very similar," he once famously said [1].

As news of DeBakey's death spread over the weekend [2], the accolades poured in. Baylor College of Medicine president Dr Peter G Traber said in a webcast that DeBakey "created the foundations of modern surgical practice" and always looked for new ways to treat patients ravaged by heart disease [3].

"Michael DeBakey is a legend in cardiovascular medicine and is personally responsible for developing the field of cardiovascular surgery," said AHA president Dr Timothy Gardner [4]. "He single-handedly started surgery of the aorta . . . and his pioneering work in heart surgery was critical in bringing this life-saving therapy to millions of patients throughout the world. DeBakey's legacy will live on in so many ways. . . . His advances will continue to be the building blocks for new treatments and surgical procedures for years to come."

And doctors were not the only ones with fond memories [5]. A former patient's daughter recalls: "In 1963, Dr DeBakey operated on my father at Houston Methodist for an aortic aneurysm. I was only six at the time and did not realize that he was my father's only hope. My father passed away when I was 15, but Dr DeBakey gave us the gift of 10 extra years with our dad. Dr DeBakey was one of the first people to contact my mother to express his condolences when Dad passed away."

Born on September 7, 1908 in Lake Charles, LA, one of five children of Lebanese immigrants, Michael Ellis DeBakey was inspired to become a doctor by hanging out at his fathers' pharmacy listening to doctors chat, while he attributed his surgeons' skills to his mother's passion for knitting and sewing, which she taught him. He received a science degree before studying medicine at Tulane University, in New Orleans, graduating in 1932. From 1935 to 1937 DeBakey studied in Europe, at Strasbourg and Heidelberg universities, before returning to Tulane to teach surgery.

He later recalled that in the year he finished medical school [6], "there was virtually nothing you could do for heart disease. If a patient came in with a heart attack, it was up to God." It was then that he developed the roller-pump, which was the first in a series of inventions and observations that would often find him up against prevailing medical opinion. He was one of the first people to recognize the importance of blood banks and transfusions, for example, and to publicize a link between smoking and lung cancer.

From 1937 to 1948, he was on the Tulane Medical School surgical faculty, taking military leave from 1942 to 1946 to serve in the Second World War, during which his efforts helped change the nature of wartime medicine. He was determined that rather than the wounded being transported huge distances to hospitals, surgeons—who were previously confined to hospitals— should work near the battlefield, and the result was the establishment of the MASH unit. He finished the war as director of the surgical consultants' division, Office of the Surgeon General in Europe, and was awarded the Legion of Merit for his service. In 1946, having been promoted to colonel, he helped introduce specialized treatment centers for returning veterans before going back to Tulane as an associate professor.

From 1948 he was professor of surgery and chair of the department of surgery at Baylor University College of Medicine, in Houston, TX. In 1953, he was the first to conduct successful excision and graft replacement of aneurysms of the thoracic aorta and obstructive lesions of the major arteries, and he performed the first successful carotid endarterectomy.

In the 1960s, DeBakey developed the concept behind the coronary bypass, by noting that in many forms of arterial disease, the portions above and below a diseased segment of artery were normal. Therefore, the damaged portion could be bypassed to restore blood flow and prevent MI. A year later, in 1964, he and his colleagues performed the first successful coronary bypass.

In 1965, DeBakey forged new ground with the first demonstration of open-heart surgery to be transmitted overseas by satellite. Via telemedicine, staff at a hospital in Geneva, Switzerland, were able to view an aortic-valve replacement being performed in Houston.

Together with his equally famous colleague Dr Denton Cooley, who was also at Baylor, DeBakey was among the first in the US to perform human heart transplants in the late 1960s, but their efforts failed because of the deaths of recipients whose bodies rejected the new organs. It was not until the immunosuppressant cyclosporine became widely available during the 1980s that transplants became more customary, and DeBakey returned to the procedure in 1984.

Nevertheless, from the earliest days of heart-transplant surgery, DeBakey foresaw that the demand for organs would exceed supply, so he dedicated himself to the development of an artificial heart. In 1966 he was the first to successfully employ a partially artificial heart—a left ventricular bypass pump.

But it was Cooley who carried out the first implantation of a completely artificial heart in 1969, leading to a famous dispute between the two men. DeBakey claimed the device was his invention and had been used without permission and that Cooley had been motivated by a juvenile desire to make medical history. However, Cooley was adamant that the patient, Haskell Karp, had been so ill that there had been no choice but to operate. Forty-seven-year-old Karp lived for nearly five days after implant of the artificial heart, but then received a heart transplant and died 36 hours later. Cooley left Baylor and established the Texas Heart Institute at St Luke's Episcopal Hospital in the Texas Medical Center. The two surgeons were not reconciled until recently, when they publicly shook hands at a ceremony at St Luke's.

DeBakey performed more than 60 000 cardiovascular procedures and trained more than 1000 surgeons during his career and was also author of more than 1400 articles, chapters, and books, including two New York Times best-sellers: The Living Heart and The New Living Heart Diet.

He also worked tirelessly to improve standards of healthcare, both in the US and overseas. He held numerous appointments, including an unprecedented three terms on the National Heart, Lung, and Blood Advisory Council of the National Institutes of Health. He also helped establish the National Library of Medicine.

In the late 1990s he succeeded in developing the ventricular-assist device that bears his name. He performed his last operation at 90 and continued to travel the world giving lectures until he was well into his 10th decade.

But in early 2006 [7], he underwent surgery for a damaged aorta—a procedure he had developed. At first he had hoped that his aorta would heal itself and refused to be admitted to a hospital. He was near death when his doctors and his wife decided to proceed, despite his age. The incident provoked a furor as he had a do-not-resuscitate (DNR) order. But as he recovered, DeBakey told his doctors he was glad they had operated despite his earlier refusals, and the surgery gave him two extra years of life.

Michael DeBakey is survived by his second wife, Katrin Fehlhaber, their daughter and two sons from his first marriage. His first wife, Diana Cooper, whom he married in 1936, died of a heart attack in 1972.