September 11, 2023
Drs. Denton Cooley and Domingo Liotta examine patient Haskell Karp after the artificial heart operation. The large control unit was placed next to Karp. (Credit: National Library of Medicine)
Dramatic announcements regarding advances in cardiovascular surgery from the Texas Medical Center were nothing new. Headlines were made when the first left ventricular assist device was implanted there in 1966 by Michael E. DeBakey, MD, FACS, and when the first heart transplant in the US was performed by his colleague and rival, Denton A. Cooley, MD, FACS, in 1968. This case, however, was different.
The recipient of the new mechanical heart was Haskell Karp, a printing estimator from Skokie, Illinois, who suffered from profound congestive heart failure after four myocardial infarctions. Dr. Cooley recommended a heart transplant for Karp, who had been languishing at St. Luke’s Episcopal Hospital in Houston, but finding a donor was challenging, and results for this procedure, at the time, had disappointing clinical outcomes.
Dr. Cooley discussed with Karp the option of ventriculoplasty, with the backup of a “new kind of pump” in case that operation was not successful.
The new pump resided in Dr. DeBakey’s research lab within the Baylor College of Medicine Department of Surgery. After the great success of the left ventricular device in 1966, hopes had been high that construction of a dual chamber device would be the next quick step to a total mechanical heart—the solution to the problem of scarce donors.
Funded by a National Heart Institute (NHI) grant, Dr. DeBakey’s lab team had made considerable technical progress in developing the device, but by late 1968, success—as measured by survival in animal experiments—had not been achieved. It was at this point that Dr. Cooley approached one of the research residents involved, Argentinian surgeon Domingo Liotta, MD.
Dr. Cooley convinced Dr. Liotta, who expressed frustration at the deliberate pace of work involved in developing the dual pump, to join forces in a surreptitious attempt for rapid advancement with human implantation. Over the next few months, more animal experiments were performed using valves provided by Dr. Cooley.
Although the animals all still died shortly after implantation, incremental improvements in physiological responses seemed to be present. At this point, Dr. Cooley began to search for a possible human recipient. Karp appeared to be a suitable candidate.
Dr. Liotta quickly constructed three new pumps and, on the night of April 3, took them from Dr. DeBakey’s lab. Dr. Cooley had already recruited a technician to build duplicates of the Baylor pump control and power mechanisms; these also were delivered to Dr. Cooley’s office at St. Luke’s that night.
On April 4, Dr. DeBakey left Houston to attend a meeting with NHI officials in Washington, DC, to discuss progress on the artificial heart.
At the same time, and with the medical photography team on hand, Dr. Cooley attempted ventriculoplasty on Karp but could not wean him from cardiopulmonary bypass. To the astonishment of onlookers, Dr. Cooley removed Karp’s heart and replaced it with the Baylor pump. Because of the large size of the control apparatus, Karp remained in the operating room rather than being transported to the intensive care unit (see image). Karp briefly awoke and was extubated before being placed again on the ventilator.
A 1968 sketch of the Baylor artificial heart design (top) looks similar to Dr. Domingo Liotta’s drawing of the heart implanted in Haskell Karp. (Credit: National Library of Medicine)
Alerted about a groundbreaking event, reporters were on hand for an impromptu news conference when Drs. Cooley and Liotta, along with other members of the operating team, announced what had transpired.
When informed about the events back home, an aghast Dr. DeBakey told NHI officials he had no knowledge of Dr. Cooley working in this research area and that Dr. Liotta was on his own lab staff, funded by the NHI.
Over the next hours, Karp’s condition deteriorated, with evidence of the organ dysfunction that had plagued the animal experiments. On Saturday, April 5, Dr. Cooley and a tearful Mrs. Karp went on national television to plead for an organ donor as it became obvious that the artificial heart would not be able to sustain Karp’s life much longer.
A donor heart was found in Massachusetts and flown to Houston for cardiac transplantation the following day; however, Karp died on April 8 of Pseudomonas pneumonia complicated by multisystem organ failure.
By then, Dr. DeBakey, who also was president of the Baylor College of Medicine, had returned to the Texas Medical Center, and an investigation was initiated. Dr. Cooley insisted that the Karp heart was an independent design from Dr. DeBakey’s work but other testimony refuted this; Dr. Liotta’s drawing of the Karp device was nearly identical to a sketch of the pump from Dr. DeBakey’s lab (see image on this page).
When the comprehensive and confidential report was completed, the conclusion was that Drs. Cooley and Liotta had inappropriately taken the artificial heart from Dr. DeBakey’s lab and implanted it in Karp without consent of the university’s Protection of Human Subjects in Research Committee and contrary to the stipulations of the NHI grant.
Dr. Liotta’s employment was terminated and, a short time afterward, he left the US. Dr. Cooley resigned from Baylor after refusing to sign an agreement stipulating that permission must be received by the university ethics board prior to performing experimentation on humans. He was the only faculty or staff member out of more than 1,300 who did not sign the agreement.
Dr. Cooley was censured by the Harris County Medical Society and the ACS for his role in the artificial heart case but went on to great success as surgeon-in-chief of The Texas Heart Institute.
Nearly 40 years passed without contact between Drs. DeBakey and Cooley, two giants of cardiovascular surgery separated by only a few hundred yards on the Texas Medical Center campus but also by an impenetrable wall of betrayal and deceit.
In 2007, shortly after Dr. DeBakey received the Presidential Medal of Freedom at age 99, former residents of the two legends arranged a meeting and rapprochement, and any lingering ill will was—at least superficially—put to rest.
The pump now resides in the Smithsonian National Museum of American History, floating in a formalin-filled Lucite box. Its official designation is the “Liotta-Cooley Artificial Heart,” a name that is, fittingly, both accurate and entirely wrong.
Dr. Craig A. Miller is a board-certified vascular surgeon in Columbus, OH. He is a Scholar-in-Residence at the Medical Heritage Center of The Ohio State University College of Medicine, and the Michael E. DeBakey Fellow in the History of Medicine at the National Library of Medicine. Dr. Miller also is the author of The Making of a Surgeon in the 21st Century, The Big Z: The Life of Robert M. Zollinger, MD, and A Time for All Things: The Life of Michael E. DeBakey, and he is a member of the ACS History and Archives Committee.
Miller CA. A Time for All Things: The Life of Michael E. DeBakey. New York, Oxford University Press, 2019:444-488.