When available medical instruments weren't up to the task, cardiovascular surgeon Raymond Heimbecker built his own. When funding for research into promising drugs was denied, he used his own money. When he exhausted an already brutally long work week, he spent countless personal hours in laboratories, tinkering with machines and thinking about matters of the human heart.
Part of a cadre of Canadian cardiovascular doctors who set the global medical community on its ear when it came to advances in heart surgery, Dr. Heimbecker pioneered or took part in so many new procedures that several became firsts: He and his colleagues performed the world's first replacement of a complete human heart valve; Canada's first adult open-heart surgery; and this country's first modern heart transplant – "modern" meaning the patient lived well beyond a few days or weeks, thanks to new anti-rejection drugs.
An inveterate tinkerer, he was involved in the early design and construction of various components in heart-lung machines. The eponymous Heimbecker Heat Exchanger controlled the temperature of blood that was recirculated to the heart during surgery.
"He was a tremendously innovative man," said Toronto heart surgeon Bernard Goldman, who studied under Dr. Heimbecker. "In a period of trial and error in heart surgery, to be able to stay with it, despite the deaths and desperately ill patients, to try and always find another procedure that would not only function but be durable. … He was truly accomplished."
Dr. Heimbecker died Feb. 13 at his home in Collingwood, Ont. at the age of 91.
He was born in Calgary in 1922, the smallest premature baby in Alberta to survive to that time. Since there were no incubators, he was put in a shoebox warmed by a light bulb. "His nickname at school was Gandhi," said his daughter Connie Heimbecker, chuckling. "His poor mom was always trying to get weight on him. She used to get notes from the public-health nurse saying, 'you're not feeding your kid enough.' "
Despite the shaky beginnings, young Ray became a rugged lad, mountaineering, skiing and horse-wrangling. His uncle, Norman Heimbecker, co-founded the family firm, Parrish and Heimbecker, a Winnipeg-based grain– and agribusiness company.
He graduated from the University of Saskatchewan in 1944 and earned a medical degree from the University of Toronto three years later. Two master's degrees followed, in physiology and surgery.
At Johns Hopkins University in Baltimore in 1949, he was asked to review the status of a then-primitive heart-lung machine, and concluded it was a "pie in the sky" contraption "with absolutely too many barriers to make it a feasible tool," according to a chapter Dr. Heimbecker wrote in the 2005 volume Heart Surgery in Canada. (It was at Johns Hopkins where Dr. Heimbecker assisted in early operations on "blue babies" – newborns with heart defects that gave them a bluish tinge.)
But seven years later in Toronto, his supervisor and mentor, Wilfred Bigelow, asked him to look at the machines again. Himself a storied surgeon, Dr. Bigelow was the first person to look inside a beating human heart. He developed the pacemaker and pioneered the use of hypothermia in heart surgery.
"My answer to Bigelow was: Yes," Dr. Heimbecker recalled. If developed and fine-tuned, the machines "might revolutionize the surgical world." For the next two years, Dr. Heimbecker repaired to a dingy, windowless sub-basement of the University of Toronto's Banting Institute to scrutinize all manner of pumps, motors, connectors and blood filters. Prototypes were constructed in his home workshop and fabricated by local manufacturers.
But instrument companies wouldn't build the machines, believing they had no future. Friends and colleagues were even more blunt. "Ray, you're wasting your time. Ray, it can never become a safe, practical apparatus. Ray, there is no future in open-heart surgery. You will surely starve," were some of the refrains he heard.
By early 1957, a machine he had determinedly jury-rigged had been tested in more than 100 animal experiments, and the big moment came a year later when a 25-year-old Ontario woman suffering from a heart defect became the first adult to have open-heart surgery in Canada. "The operating room was electric that day,' recalled Dr. Heimbecker, who supervised his chugging apparatus. It worked beautifully, pumping and recirculating 20 units of fresh blood from the Red Cross for 25 minutes. The patient survived and thrived.
That triumph was preceded by another.
By now on staff at Toronto General Hospital, Dr. Heimbecker and another mentor, Gordon Murray, discovered that heart valves could survive transplantation without being rejected. In late 1955, Dr. Heimbecker harvested a valve from a cadaver and assisted as it was placed into a patient, also 25, whose aortic valve was leaking. This was the world's first successful complete heart-valve replacement.
The year 1962 was historic, too. In March, Dr. Heimbecker and a team performed the first successful open-heart replacement of the human mitral valve. Four days later, he and another team were the first to implant an aortic-valve graft.
In December, 1967, the world was stunned by the news from South Africa of a successful human heart transplant, even though the patient died 18 days later. Seven months later, the procedure was carried out in Canada for the first time, but regrettably, the patient died within hours. The human body simply rejected the organs.
All along, Dr. Heimbecker and other doctors were denied grants to study anti-rejection drugs – by the Ontario Heart Foundation, which just said no, and the Medical Research Council of Canada, which called it "a hopeless field of research." So Dr. Heimbecker and two colleagues pooled $150,000 in research funds and went on to establish that Cyclosporin A was a miracle drug that prevented organ rejection. He used the drug in April, 1981, when a 50-year-old man who could barely move received a new heart, an operation carried out at University Hospital in London, Ont., where Dr. Heimbecker was the first chief of cardiovascular surgery. The patient survived for 12 years.
Today, survival rates for heart transplant patients have improved to 75 per cent at five years, 62 per cent at 10 years, and 36 per cent at 20 years, according to a 2011 study which looked at results at the University of Ottawa Heart Institute.
Dr. Heimbecker became a booster of pig valves for human hearts, as they were durable and, as he put it, "readily available in a full range of sizes."
He was named to the Order of Canada in 1997.
An avid sailor, fisherman and diver, he was friends with the undersea explorer Jacques Cousteau, and also conducted research into decompression sickness, known to divers as "the bends," and its treatment in hyperbaric chambers.
In the Out Islands of the Bahamas, where he loved to sail, he came to be known as the kitchen-table doctor "because I would visit the people and conduct surgery on the kitchen table," he told the Barrie Advance a few years ago.
Dr. Heimbecker was predeceased by his wife, Kathleen, and a son, Harry. He leaves children Raymond Jr., Kathleen Mooney, Anita Gilray, Connie Heimbecker, and seven grandchildren.
Editor's note: In an earlier version of this obituary, heart surgeon Bernard Goldman was incorrectly identified as Brian Goldman. The article also implied that Dr. Heimbecker and two colleagues used their own money to pay for research on Cyclosporin A. In fact, the financing came from the doctors' research funds.