Journal of the New Zealand Medical Association, 21-April-2006, Vol 119 No 1232
Sir Brian Gerald Barratt-Boyes
Sir Brian Barratt-Boyes was born in Wellington on 13 January 1924. He was an outstanding person in so many ways; highly talented with flawless dexterity and skill as a surgeon, innovative and insightful as a scientist, a brilliant teacher, and a wonderful man. He was held in the highest regard by colleagues and patients.
His death, following a fourth cardiac bypass operation, has left colleagues with an overwhelming sense of sadness and of loss, but also wonderful memories, of times of immense joy, of immense satisfaction, of being extremely challenged, and memories of a man with enormous determination, with attention to the finest detail, of a man who had achieved so much, and of a man living life to the fullest.
Sir Brian’s life has affected the life of many others in innumerable different ways and will continue to do so in the future.
Sir Brian’s academic journey began in Wellington at Johnsonville Primary and Wellington College and followed on to Otago University where he graduated MB, ChB in 1946. He was an outstanding pianist and at one stage considered a concert career. He became a fellow of the Royal Australasian College of Surgeons in 1952 being the first to not have undergone any training outside of New Zealand and was awarded a Master of Surgery in 1962. He undertook a Fellowship at the Mayo Clinic in Cardiovascular Surgery from 1952–1955. During this time he worked in the Cardiac Catheterization Laboratory and did seminal work on measurements of normal heart pressures and cardiac outputs. It was here that he met his friend and colleague, John Kirklin.
In 1956 he held a Nuffield Travelling Scholarship at Bristol University. In 1957 he returned to New Zealand as a senior thoracic surgeon at Green Lane Hospital. In 1965 he became the surgeon in charge.
He became a Fellow of the Royal Society in 1970 and was awarded an Honorary Professor of Surgery at the University of Auckland in 1971. He was awarded an Honorary Fellowship of the American College of Surgeons in 1977, the Royal College of Surgeons in 1985, and the American College of Cardiology in 1989. He was awarded an Honorary DSc by Colorado University in 1985. He was President of the Cardiac Society of Australia and New Zealand from 1986–1987.
He received numerous Honours and awards from almost every country in the world, including from his Holiness the Pope. Last year he was awarded the Distinguished Alumni Award from the Mayo Clinic for accomplishments in medical practice, education, and research.
In 1966 he was awarded a CBE, and in 1971 he was knighted at the age of 47 for his pioneering work on replacing the aortic valve of the heart with a homograft valve. His original idea was to invert the valve so that the cusps were not in the way when it was inserted, allowing visibility for the valve ring to be sown in. His second major achievement was his perfection of the technique of hypothermia and circulatory arrest. The idea originated from a Japanese registrar who came to Green Lane Hospital for training.
Sir Brian tested the technique first in the laboratory and then in babies, allowing surgeons to operate on a still, bloodless heart. This technique changed the practice of paediatric heart surgery and opened up the treatment of many congenital heart defects that previously were untreatable. Again the results of cardiac surgery at Green Lane Hospital were among the best in the world and the Green Lane Hospital surgical results became the standard by which other cardiac centres compared their own results.
His third monumental achievement was his book coauthored with the American surgeon John Kirklin which was simply called Cardiac Surgery. This book recorded many of the results of surgery at Green Lane Hospital. The American Journal of Cardiology called it “absolutely magnificent, it is one of the very best medical books ever published, it is a classic from the beginning”. The International Journal of Cardiac Surgery said “This work is phenomenal and almost defies adequate description”. It is considered the bible for cardiac surgeons worldwide and is now in its third edition.
Many of Sir Brian’s achievements are not listed on his curriculum vitae such as training many cardiac surgeons who are now scattered worldwide saving the lives of 1000s of patients each year; critiquing and challenging other surgeons’ work; developing new cardiac units throughout Asia; and teaching junior doctors and nurses.
Sir Brian was extremely hard working, he demanded the highest standards of medical care without compromise, and he imbued a group of wonderful people with the same high standards; the surgeons, cardiologists, anaesthetists, perfusionists, pathologists, and nurses all had enormous respect for each other and there was an intense focus on teamwork and improving patient care. Huge strides were made in understanding the anatomical detail of congenital heart defects and developing new surgical techniques.
His influence worldwide was enormous. His reputation being so high that doctors at Harvard Medical School, arguably one of the most prestigious in the US where patients with complex heart disease are referred for treatment, referred a gravely ill famous patient to have surgery in New Zealand by Sir Brian, knowing that the patient would receive the very best treatment in the world.
That Sir Brian chose to live and work in New Zealand in the face of numerous offers to work overseas deserves the utmost admiration and has benefited this nation enormously. Sir Brian was indeed one of New Zealand’s favourite sons.
In 1989 at an American College of Cardiology Convocation, at which Sir Brian was awarded a very prestigious Honorary Fellowship, this citation was made using the term physician, and calling him the greatest physician of the century. The term physician was used not because they had forgotten that he was a surgeon, but because they wanted to acknowledge his enormous contributions to medicine in general as well as his humanistic and caring attributes.
Sir Brian lived the history of cardiology and cardiac surgery, to which he had contributed so much, with himself undergoing four cardiac operations and left main coronary artery stenting. He pioneered the first use of cardiopulmonary bypass in New Zealand in 1958. The first coronary artery bypass at Green Lane Hospital was performed in 1969 and in 1974 he underwent the same operation.
In the early 1980s internal mammary artery grafting was introduced. In 1983 he underwent repeat bypass grafting using a left internal mammary graft. In the 1990s complete arterial grafting was developed and in 1997 he underwent his third bypass operation using a free right internal mammary artery graft. Recently left main artery stenting has been introduced, and in 2004 his left main coronary artery was stented. Two weeks before his death he underwent aortic and mitral valve replacement.
Sir Brian was revered by his patients and, up until his death, Sir Brian was still receiving letters from grateful former patients and he always wrote back thanking them for their kind words and wishing them all the best in the future.
Sir Brian retired from surgical practice in 1989 to his beloved farm “Green Hills” near Waiwera. He grew grapes, played tennis, worked on his book, and spent time with his family.
Sir Brian continued his research on the long-term results of valve replacement right up until he went to Cleveland for his fourth heart operation. This was not a retirement project but important, original work that would influence the care of future patients He also continued to lecture throughout the world and to give advice about the design of new heart valves.
Sir Brian wanted to be remembered as a surgeon who helped both the young and the old. There is no doubt that he will be remembered for that, as well as for the wonderful legacy of surgeons that he has trained throughout the world; but he will also be remembered as a lovely man who had a wonderful journey and who enriched many lives. Sir Brian’s impact on young surgeons and their careers will be an ongoing legacy.
Sir Brian’s life demands respect and admiration, but it was his gentleness, his love of life, and his compassion that made colleagues and patients love him.
Sir Brian is survived by five sons (David, Mark, John, Stephen, and Simon) and his wife Sara whom he married in 1986.
Rārangi maunga, tū tonu, tū tonu
Rārangi tangata, ngaro noa, ngaro noa
You have gone,
but your mountain is everlasting
Professor Harvey White (Director of the Coronary Care and Green Lane Cardiovascular Research Unit, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland) wrote this obituary.
The photograph is courtesy of Remembering and appears at their interactive memorial site entitled Always in our hearts: http://www.remembering.co.nz/tribute2.asp?REMID=102
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