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Cardiovascular Surgeon
Chief and Program Director, Division of Peripheral Vascular Surgery, UT
Director, Heart/Lung Transplantation, Baptist Memorial Hospital


It was 1964. Lyndon Johnson had taken over the presidency after John F. Kennedy’s assassination. The Beatles invaded the U.S. Johnson signed the Civil Rights Act into Law. The Vietnam War began. The Nobel Peace Prize was awarded to Martin Luther King. Arnold Palmer won the Masters for the fourth time and Mariner 4 launched from Cape Kennedy to take pictures of Mars. In this wild mix of historical events, the world’s first successful coronary artery bypass procedure was performed by Ed Garrett Sr., MD, who was at the center of Dr. Michael DeBakey’s open heart surgical team at Baylor University in Houston, Texas.

No doubt Dr. Garrett’s first born and namesake, H. Edward Garrett Jr., was focused on riding bikes and doing the kinds of things that an inquisitive eleven year old boy enjoys, rather than noticing that his 38 year old father, a brilliant vascular surgeon and pioneer in what would become a freestanding specialty, was beginning a long and distinguished career. (See related story below.)

The younger Garrett was, however, acutely aware that his father worked very hard and was not at home much. He decided early on that whatever he became when he grew up, he would not be a doctor. Little did he know that, not only would he follow in his father’s footsteps to become a doctor, he would continue his father’s legacy and become one of the country’s most gifted thoracic and vascular surgeons.

Interestingly, the younger Garrett proclaims that his father received notoriety from the fact that he repaired the Duke of Windsor’s abdominal aneurysm during his tenure at Baylor training with Dr. Michael DeBakey. For you history buffs, King Edward VIII of England inherited the throne at age 42 when his father died. After only 11 months as king, he abdicated to marry Wallis Simpson, a divorcee who was married at the time. When King Edward married Wallis in 1937, he became the Duke of Windsor and he and the Duchess were exiled from Great Britain. The Duke came to the U.S. for his surgery at Baylor, obviously a success…for he lived to be 78. The marriage was a success as well, lasting 35 years.

The younger Garrett’s vocation became clear after experiencing a variety of summer jobs during college. While working in a hospital lab in his sophomore year, he discovered that he liked surgery. That discovery prompted his decision to go to medical school and become a surgeon. He obtained his undergraduate education from Emory, his father’s medical school alma mater, and received his MD from Vanderbilt Medical School, where his father had completed his surgery residency. Barnes Hospital, affiliated with Washington University School of Medicine, was the site of the younger Garrett’s internship and residency in surgery, followed by a fellowship in cardiothoracic surgery. He left St. Louis to do a fellowship in peripheral vascular surgery and train with his dad, who was then the director of the training program at UT.

Garrett joined his father’s practice in 1987 and today The Cardiovascular Clinic is still focused on providing optimal care for each patient. The group participates in numerous clinical and device trials focused on improving surgical techniques, better stent and graft materials, and minimally invasive procedures. Beginning in 1992, the repair of aneurysms with stents was among the first new treatment modalities which intrigued Garrett. “At the time, I think fixing aneurysms with stents was just a tremendous leap forward in terms of the whole concept. For me, it was the beginning of working toward minimally invasive approaches. When we began treating aneurysms with stents, we treated 30-40 percent of them with stents. Today 80 percent of aneurysms are treated with the stent, which is mostly an improvement in the technology, allowing us to tackle difficult problems and challenging anatomy.”

For Garrett, the most exciting and promising trials presently being conducted at his clinic involve: treatment for atrial fibrillation (AF), stents for aortic dissection and minimally invasive valve technologies. One treatment modality available now is the minimally invasive treatment for AF (convergence); also on the horizon are the percutaneous aortic valve procedure and cardiac stem cell implantation. His website can be found at www.edgarrettmd.com.

The convergent procedure is an example of the first new co-disciplinary minimally invasive approach to potentially cure chronic and difficult-to-treat AF, the most common arrhythmia predisposing patients to stroke, combining the best of the cardiologist’s (electrophysiologist, or EP) and the surgeon’s expertise to map and ablate the areas causing the AF. Historically, each approached the problem, respectively, the EP with catheter-based attempts and the surgeon with minimally invasive incisions, however, neither of the approaches was successful enough. “Fifty percent is not really what you want in a procedure. It became apparent that they (the cardiologist and the surgeon) complemented each other…by combining the approaches, the results have greatly improved, so it looks like this is the future of AF treatment.” It is unique because it uses the catheter and surgical approach together in a minimally invasive procedure while the patient’s heart is beating; the lesion pattern is mapped for ablation both inside and outside the heart.

The percutaneous aortic valve procedure, viewed by Garrett is one which the U.S. is “a little behind the curve on.” Garrett received training in Germany on the percutaneous aortic valve procedure, pending FDA approval, but several thousand have been done in Europe. When the procedure is approved in the U.S., he is anxious to offer it for very sick, high risk patients who cannot tolerate an open heart surgery. “We don’t know the durability of the valve yet but it’s a tremendous step forward.” As described by Garrett, “…you can take an animal valve and mount it on a stent, then crush that stent down into a catheter and deliver it through the vascular system and ‘blow it up’ - the stent holds it in place.” Remarkably to Garrett, there is a fairly low incidence of stroke. “The concern was that when you crush that calcium in the valve, it could break loose and…cause a stroke. That can happen but it is a fairly low risk compared to what I would have guessed.” Although this procedure is for high risk patients, Garrett said, “It is too new to know how long the valve will last. The longest patient is 4 years out now, whereas, a surgically implanted valve is expected to last 14-15 years.” If the technology proves its effectiveness and durability, he said, “There are still unanswered questions but it is here to stay if for no other group other than the high risk group. And it may end up being the preferred method for a larger group.”

“The material used for stents has changed dramatically over the years and is part of what makes the advances possible,” said Garrett. “The development of nitinol, a metallic alloy made of nickel-titanium, has made a huge difference in terms of what you can do with stents.” Nitinol has the properties of “superelasticity” and “shape memory” which enable it to maintain vessel patency and flexibility. The evolution of stent materials will continue, according to Garrett, who cited “a material being developed in Belgium that allows side branches to stay open but clots everywhere else, so it may completely change treating pathologies like aneurysms and dissections. Instead of having to carefully cannulate side branches and put in separate stents …it may be possible to just lay the stent in there… it almost seems magical…the right things stay open and the other right things close off. It is a product of the technology as much as anything.”

Although he has been doing robotic mitral valve repairs and robotic lung resections for 4 years with very good success, future initiatives for Garrett will include robotic minimally invasive coronary artery revascularization as well as percutaneous aortic valve surgery. New developments come much quicker compared to 20-30 years ago, he added. Although he envisions there will always be a need for open heart surgery in certain patients, “We are certainly chipping away at what we can do minimally invasively. I think we are not too far away from being able to treat acute type A aortic dissections with these minimally invasive techniques.”

Though unsure of how healthcare reform is going to affect the practice of his specialty, Garrett is concerned “that it will stifle research and development.” His advice to colleagues is to “maintain high quality care and remember why we went into medicine.”

Off call, Garrett likes to spend time with his family and grandchildren. He and his wife, Rose, have three children and two grandchildren by their oldest daughter. Their son is in his first year of law practice and their youngest daughter is in pre-med. Garrett’s prescription for health is his faith and taking vacations. When his schedule allows, the outdoors beckons to Garrett’s passion for fishing, hunting and water skiing. His advice for colleagues and loved ones: “Prevention is always better than treatment; start early.”





Related Story

H. Edward Garrett Jr., MD

A Legacy of Firsts

BY CONSTANCE ADCOCK



H. Edward Garrett Jr., MD, is the Professor of Surgery and Chief of the Division of Peripheral Vascular Surgery at UT and the Director of the Heart/Lung Transplantation Programs at Baptist Memorial Hospital (BMH). He performs surgery at BMH, Memphis; BMH, DeSoto; and Methodist Germantown. He has carried forward his father’s legacy of surgical expertise, cutting edge research

and the most effective treatment modalities for his patients. Like his father, he has achieved a number of “firsts” during his prolific career.

* Performed first lung transplant in Memphis
* Performed first double lung transplant in Tennessee
* First mother-daughter living lung donor in Memphis
* Performed first robotic case at BMH, Memphis
* Performed first abdominal aortic aneurysm repair with stent graft in Memphis
* Performed first thoracic aortic aneurysm repair with stent graft in Memphis
* Performed the first cardiomyoplasty in Memphis
* Implanted the first Abiomed ventricular assist device in Memphis and had the longest living patient supported on the device.
* First left ventricular assist device XVE, HMII, Thoratec IVAD and PVAD in Memphis
* First Paracor Heartnet placement in Memphis


Part of the Garretts’ continuing legacy to medicine, The Garrett Sr. Auditorium, recently completed and named in honor of the late Dr. Garrett, was first envisioned by his wife. It is part of the Baptist Memphis Education Center which includes state-of-the-art AV technology, communications and presentation media and also provides classrooms and conference space for healthcare/educational conferences and community activities. The initiative was spearheaded and supported by Ed Garrett Jr., whose family was among the generous benefactors.


Dr. Garrett will also be honored as a 2011 AHA “Heart Hero” this month.

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