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2007 American Association for Thoracic Surgery Scientific Achievement Award Recipient: Gerald D. Buckberg, MD, DSc

2007; Elsevier BV; Volume: 134; Issue: 5 Linguagem: Inglês

10.1016/j.jtcvs.2007.07.026

1097-685X

Friedhelm Beyersdorf, Constantine Athanasuleas,

Cardiovascular Issues in Pregnancy

“We find freedom by following our dreams!” The American Association for Thoracic Surgery (AATS) Scientific Achievement Award, established in 1994 by the AATS, has honored individuals who have achieved scientific contributions in the field of thoracic surgery worthy of the highest recognition the Association can bestow. Dr Gerald Buckberg has been elected to be the sixth recipient of this Award, thus joining Drs Kirklin, Shumway, DeBakey, Cooley, and Carpentier. Dr Gerald Buckberg is a man with many different talents, characteristics, ideals, and goals that together form the unique personality who gave so much for cardiovascular surgery and for the many persons who are lucky to know him well. Dr Gerald D. Buckberg is a Distinguished Professor of Surgery in the Division of Cardiothoracic Surgery at the David Geffen School of Medicine at the University of California at Los Angeles (UCLA). He is a member of multiple surgical societies, including the AATS, the American Surgical Association, and the Society of Thoracic Surgeons. He is known for his seminal contributions in the field of myocardial protection and, more recently, for his work in cardiac failure. The unique intellectual basis for achieving the milestones in myocardial protection is broad and has eventually evolved into several principles that include independence (scientific, personal, and intellectual), persistence, focus, self-assurance, leadership, joy of generating new ideas, braveness, humor, and intense communication. Using this armamentarium, he is still able to produce a great variety of creative ideas and innovative methods that have more recently been applied to the field of heart failure, in which he has worked in elucidating the anatomy and pathophysiology of this condition more clearly. As a consequence of this latter work, Dr Buckberg has been appointed as a Faculty Associate at the California Institute of Technology (Caltech) in the Option on Bio Engineering. Dr Buckberg is the best example for those characteristics that are asked for today in cardiovascular surgery: creativity, innovation, research to open new fields in the treatment of cardiovascular diseases, and the personal independence to pursue these goals despite the (necessary) critiques and controversies. Dr Buckberg was born in 1935 in New York City. He was always proud to have achieved his goals despite (or because of) the fact that he had grown up in the Bronx, saying “This is not bad for a guy from the Bronx.” Dr Buckberg earned his Bachelor of Science degree from the Ohio State University in 1957 and his MD from the University of Cincinnati College of Medicine in 1961. He was honored with the S. F. Hoffheimer Award for being the number 1 student in his graduating class. From 1967 to 1969, he was stationed at Wright–Patterson Air Force Base for military service. He began his surgical career at the Johns Hopkins Hospital in Baltimore, Maryland, and finished his residency in surgery at UCLA in 1967. His early interest in research led him to go to the Cardiovascular Research Institute at the University of California San Francisco under the guidance of Julien Hoffman, whom he has admired ever since. During these years, he read and studied intensively his future “bible,” written by Claude Bernard, An Introduction to the Study of Experimental Medicine, which he provides as the first and most important reading for all research fellows who train with him. After coming back from the University of California San Francisco to UCLA, he was appointed as Assistant Professor of Surgery in 1970 and has started an unparalleled career as a successful surgeon and researcher in the field of cardiovascular surgery. In the late 1970s, his research interests centered on the area of myocardial protection and led to the introduction of blood cardioplegia, which is used currently by more than 80% of the surgeons in the United States for adult and pediatric heart operations. Three years later, he introduced warm blood cardioplegia to “resuscitate” the heart before (“warm induction”) and after (“warm terminal reperfusion” and “hot shot”) cold cardioplegic arrest. These techniques are being adopted with increasing frequency in Europe and Asia. He has also developed techniques to simply, safely, and rapidly deliver cardioplegic solutions to allow their distribution to all segments of the heart and ensure their protective effects. These techniques are now known as antegrade, retrograde, or simultaneous cardioplegic delivery. In 1986, investigative studies by him and his team led to a new approach to the treatment of acute myocardial infarction. The concept of “controlled reperfusion” has been developed to salvage and restore early function to the heart muscle in patients with acute coronary occlusions after time intervals previously thought to cause irreversible damage (ie, >6 hours). During these studies, he developed and refined the concept of ischemia–reperfusion injury, which was previously thought not to exist. He showed that ischemia alone causes some damage to the tissue, but unmodified normal blood reperfusion after an ischemic insult will ultimately lead to apoptosis and necrosis. This combined ischemia–reperfusion damage can be reduced or even avoided if the composition of the reperfusate and the conditions of the reperfusion are controlled carefully during the initial reperfusion phase. Additional methods have been developed by Dr Buckberg to increase the safety of operating on patients with cardiogenic shock after acute myocardial infarctions, whereby previous conventional methods have been associated with prohibitive mortality (approximately 50%). In 1992, he introduced the concept of “unintended reoxygenation injury,” when cyanotic newborns are started on cardiopulmonary bypass to correct the congenital defect causing cyanosis. These studies called attention to the role of active interventions, including avoiding too much oxygen and adding antioxidants, to limit this and provided the first evidence of a new biochemical pathway that causes this damage. This pathway is offset by the cardioplegic solutions used routinely in daily clinical practice that were developed at UCLA. For developing these innovations in myocardial protection, he received, in the year 2000, the first Lifetime Achievement Award from the Society of Thoracic Surgeons for contributions to patient care and surgeons because of work on protecting the heart during cardiac surgery. In 1998, Dr Buckberg organized the reconstructive endoventricular surgery, returning torsion, original radius, and elliptical shape to the LV (RESTORE) team, an international group of surgeons and cardiologists from the United States, Europe, Asia, and South America, to treat congestive heart failure by altering ventricular geometry. The surgical approach changes cardiac size and shape, whereby the dilated spherical shape (like a basketball) is made elliptical, like a football. The basis of this structural alteration is linked to the concept of the helical heart spatial configuration, which he studied experimentally and believes to be a revolution in cardiac structure/function thinking. This concept, used by the RESTORE team, was built on the contributions of Dr Vincent Dor in Monaco and Dr Torrent-Guasp from Spain. At the AATS meeting in 2001, Gerry Buckberg gave the Basic Science Lecture on the “Helix and the heart” and introduced a novel way to refocus attention on cardiac structure and function based on a simple heart model containing an external wrap and an internal spiral forming a helix. This concept provides a paradigm shift in conventional thinking that can create a straightforward method used routinely in surgical practice to deal with the leading cause of death in the United States and worldwide. In 2003, he was appointed Faculty Associate at Caltech to study the helical heart in their Bioengineering Option. This appointment is uncommon and given each 2 to 3 years to individuals who will collaborate on innovative studies that expand the basic efforts at Caltech to interface with major disease entities. Since 1998, Dr Buckberg has directed his surgical efforts to becoming a mentor to teach a novel approach to treating congestive heart failure (Figure 1). This work consists of being both visiting professor at major universities, organizing a collaborative RESTORE team in Asia and South and Central America (with representatives from leading centers in each country), holding training sessions in various cities in the United States, and visiting key sites to foster understanding of concept and teaching simple application of a reproducible surgical method. Dr Buckberg has received an Honorary Doctor of Science degree from both Ohio State University and the University of Cincinnati in June 2007 to recognize his distinguished career as a cardiac surgeon and researcher and extraordinary contributions to the practice of medicine and the advancement of science. His relentless pursuit of truth has guided his thinking and teaching. He has passed this gift on to many of his trainees, who have become expert cardiovascular surgeons and scientists. His seminal work on myocardial protection is a great example of how the process works from bench to bedside. Dr Buckberg is passionate about asking new questions and is not afraid to challenge traditional views. Recently, he focused his sharp mind on how the heart works. Very basic indeed, but for Gerry Buckberg, the prior answers were old and largely contrived. Delving into the history of form and function, once again he is confronting the world with a fresh new view of how the heart works. And again he has taken old dogmas and cleaned out the cobwebs by designing elegant yet simple experiments in the laboratory to find new truths. In the process, he has made friends and enemies. Editorials are often heated, but that is the stuff that Dr Buckberg is made of, fearing no one. He loves the book Who Moved My Cheese [Johnson, S. New York, NY: Putnam Publishing Group; 1998] and often quotes from it: “What would you do if you weren’t afraid?” As an extension of this, he never takes no for an answer, but he also never mixes up being liked with being good. Gerry Buckberg developed his own creativity through a mixture of positive thinking, self-confidence, living his own dreams, a willingness to always learn something new, nonacceptance of authority, independence, and an unparalleled intellectual capacity. He discovered the secrets of life in finding positive aspects even in miserable situations that he, like everybody else, got to know during the dark sides of life. He is a living example of courage (“Those who lack courage will always find a way to justify it,” Albert Camus). He never thinks of yesterday, only of tomorrow, and has an unparalleled will to win. Aside from his scientific achievements, he is an accomplished artist. Perhaps this is why he always sees things that are often not apparent to others. He used to paint for decades, went to art classes, and won awards for his paintings, such as the first prize for “beginners oils” in 1966 from the Los Angeles Physician’s Art Society. However, he learned about this prize the next day because he was chief resident in the operating room during the selection. Gerry now has so many drawings in his atelier that he could easily have several exhibitions only with his pictures. There were times in his life when painting was his best way of expressing himself (Figure 2). In addition to art, he also loves sports, especially swimming. He takes swim classes every morning at 5:45 am in the UCLA pool and is one of the fastest long-distance (10 miles) swimmers in his age category. The UCLA pool is famous for swimming facilities per se but also for the “prayer bench” (those sitting on this bench watch the beautiful girls walking by and routinely use religious exclamations like “Holy Ghost” and “Jesus Christ”). For 11 successive years, he took part in the “Pacific Ocean Race” for the “10-mile swim” but remains afraid of sharks, who have rarely been seen there. Even though he swam very fast during these competitions, there was a 1-legged man in his age group who was always ahead of him. He took his second place position and always expressed great admiration for the other man. After many years of intensive swimming and winning many national and international contests, he was awarded “All American Swimmer” (Figure 3), an award that is very highly recognized and only rarely given to cardiac surgeons (Denton Cooley is also an “All American” sportsman in basketball). In addition, he has trained for running very intensively over the years and has participated in marathon races but eventually had to give it up because of hip problems. Dr Buckberg has heroes in his life, whom he admires for different reasons. Those heroes include his parents (Figure 4), Julien Hoffman, Claude Bernard, Auguste Rodin, and Albert Einstein. Albert Einstein was not only creative up to a level that in itself is unique and has never been achieved again, but he was also completely independent of external influences, never depended on the statements of authorities, had always gone his own way (regardless of the consequences), retained a positive attitude (even if it was often difficult), did not care about superficial signs of power, and was honest. Albert Einstein said, “Try not to become a man of success, but rather to become a man of value.” This proverb made a great impression on Gerry, and this might explain some of his behavior over time. At the AATS meeting in 2001, when he gave the Basic Science Lecture about the “Helix and the heart,” there was a 5- to 10-minute standing ovation after the talk. However, after the last sentence, he simply left the stage, and Francis Fontan asked him why he did not remain at the podium to enjoy the response. Gerry told him that his message was complete when the talk was over. Francis Fontan commented on this by saying, “You gave them your mind but took your body away.” There are other proverbs by Albert Einstein that are also true for Gerry and might explain his actions in certain situations much better than can be done in a thousand words. Two of these include the following: “Imagination is more important than knowledge. Knowledge is limited; imagination encircles the world.”“The true value of a human being is determined primarily by how he has attained liberation from the self.” Dr Buckberg is an innovative and open-minded surgeon and researcher who has developed and influenced cardiac surgery like only a few others. He has created many parts of cardiac surgery as it is practiced today all over the world by following his mantra that “life is not much fun unless you probe the unknown.” Dr Buckberg