The infant on the table at Green Lane Hospital in the spring of 1969 was four months old. Her chest had been opened down the middle. Her body temperature, which would normally sit at 37 degrees, had been brought down through a heat exchanger in the bypass circuit to about 18 degrees Celsius. Her heart was not beating. Her brain was, by any ordinary measurement, switched off. The surgeon standing over her, masked, his shoulders very still, had perhaps an hour to take her heart apart, fix what was wrong with it, sew it together again and bring her back. He was forty-five years old, three years a knight in waiting, and the technique he was using had never been done routinely on babies anywhere in the world before Green Lane started doing it.
His name was Brian Gerald Barratt-Boyes. The infant on the table belonged to a generation of New Zealand children whose congenital heart defects, ten years earlier, would have been a death sentence by school age. The defect inside her chest was inoperable by the methods Barratt-Boyes had learnt at the Mayo Clinic in 1953, because those methods needed a heart big enough to be plumbed into a heart-lung machine, and her heart was the size of a walnut. The technique Barratt-Boyes was using instead—cooling her to the point where her tissues needed almost no oxygen, then stopping her circulation altogether for the actual surgery—was something he had borrowed from a Japanese surgeon called Hikaru Hikasa, modified for use in clinical paediatric practice, written up in 1971 in a paper that went around the world, and made the basis of the Green Lane paediatric cardiac unit’s international reputation. Children with what New Zealanders called blue baby disease were being flown to Auckland from across the country, and increasingly from across the South Pacific, because Auckland was the place where they survived.
This is the story of the boy from Johnsonville who became the surgeon they came to see. He was born in Wellington in January 1924, the second of three children of a man who sold paper for a living. He died in Cleveland, Ohio, in March 2006, of complications from a valve replacement operation performed using a technique he had pioneered fifty years earlier, on a generation of valves he had helped invent. By the standards of New Zealand medicine, and by the standards of paediatric cardiac surgery as a global discipline, no New Zealander has had a larger effect on what doctors can do for the human heart.
A Wellington boyhood
Brian Gerald Boyes was born in Wellington on 13 January 1924, the second of three children of Edna Myrtle Barratt and Gerald Cave Boyes. The hyphenation came later: the family adopted Barratt-Boyes formally during his childhood, joining his mother’s surname to his father’s. The Boyes household was suburban and respectable rather than wealthy. His father worked in the paper trade. The family lived in Johnsonville, on the green hills north of central Wellington, and Brian went to the local primary school there.
He was bright. He was sent to Wellington College, the boys’ secondary school in central Wellington, between 1937 and 1940. The College of his time was a state school of the old style—academic, sporting, formal, with a uniform and a debating society and a strong tradition of pushing its best students into medicine and law. Brian sat through it with an obvious quickness for science. He played sport. He left in 1940, sixteen years old, with the country at war, and went up to Victoria University College the following year as a science undergraduate. He was already aiming at medicine.
The route into medicine in 1940s New Zealand was through Otago. Wellington had a science department; Otago Medical School in Dunedin had the only medical degree in the country. After a year of preliminaries at Victoria, Brian moved to Dunedin in 1942 and enrolled in the MB ChB at Otago. He was eighteen years old. The medical school of the war years was crowded and intense, full of accelerated courses and male students of his age who would otherwise have been overseas. He graduated in 1946, twenty-two, with an MB ChB and a settled idea that he wanted to be a surgeon.
The early house years were spent at Wellington and Palmerston North hospitals. He was a good young registrar by every account and an obviously ambitious one. He took the FRCS—the English fellowship in surgery, then the gold standard of the British surgical world—in 1952. He had also met, and on 9 November 1949 in Dunedin married, a young physiotherapist called Norma Margaret Thomson. They had begun what would, before the marriage ended, produce five sons.
The Mayo Clinic and a man called Kirklin
In 1953 Brian Barratt-Boyes flew to the United States on a fellowship to the Mayo Clinic in Rochester, Minnesota. Mayo was, in the early 1950s, the most important place in the world for what was about to be called cardiac surgery. The discipline was, at that moment, perhaps two years old. The first successful operation using a heart-lung machine had been performed in Philadelphia in 1953, by John Gibbon, on an 18-year-old college student. Mayo had begun building its own bypass machine. The young surgeon who would lead Mayo’s programme—and who, more than any other figure of the early period, defined what cardiac surgery would look like for the next forty years—was John W. Kirklin.
Kirklin was eight years older than Barratt-Boyes. He was a Minnesotan, a former neurosurgeon turned cardiac surgeon, and the most disciplined operator any of his trainees had ever seen. He worked at a metronomic pace. He kept records of everything. He believed that cardiac surgery, which at the time was killing roughly one patient in two, would only become safe through the systematic accumulation of data—by treating each operation as an experiment whose result had to be written down and learned from. He recruited Barratt-Boyes to his unit as a senior registrar. The pair worked together for two years. Kirklin saw, in the young New Zealander, a temperament very like his own—controlled, technically precise, ferociously hard-working, intolerant of error—and Barratt-Boyes saw, in Kirklin, an example of what a unit could achieve if it was run that way.
The friendship that began at Mayo lasted the rest of their lives. They wrote to each other for decades. They met at every international congress. They eventually wrote, together, a textbook called simply Cardiac Surgery, the first edition of which appeared in 1985 and which the world’s cardiac surgical residents—in Auckland, in Mumbai, in Houston, in Tokyo—treated as their basic reference work. The Mayo Clinic Proceedings tribute after Barratt-Boyes’s death described the relationship as the central professional friendship of his career.
From Mayo he moved on to a Nuffield Fellowship in Bristol from 1955 to 1956 to broaden his general thoracic surgical training. By the end of 1956 he was thirty-two years old, fully credentialled in cardiac and thoracic surgery, technically as well prepared as any cardiac surgeon then alive, and looking for a place to operate.
Auckland, Sir Douglas Robb, and a hospital with no machine
The man who recruited him home was Douglas Robb. Robb was the senior surgeon at Auckland’s Green Lane Hospital, a thoracic surgeon of the old school who had built an excellent unit doing closed-heart procedures—mitral valvotomy, patent ductus, the kind of work that could be done on a beating heart without bypass. Robb was old enough to know that the future was open-heart surgery, and old enough to know that he was not himself going to be the man to bring it to New Zealand. He had been watching the new generation. He recruited Barratt-Boyes back to Auckland in 1957 and gave him the job of starting the country’s open-heart programme.
Green Lane in 1957 had no heart-lung machine. The machine in question was a thing called a Melrose pump-oxygenator, a British design built around a stack of stainless-steel discs rotating on a spindle inside a Perspex cylinder. Blood flowing across the discs was exposed to oxygen as the discs rotated through it; gas exchange happened by direct contact, the way it does in a fish’s gills. Barratt-Boyes persuaded the Auckland Hospital Board to buy one. It arrived from England in pieces, with parts missing. He sat down with two engineers from the hospital workshops, Sid Yarrow and Alfred Melville, and over the following months they finished it.
The team practised for almost two years. They ran the machine on dogs first, then on sheep. The patient who eventually took its first human run recalled, decades later, that they had operated on seventeen sheep before they came to her. Her name was Helen Arnold. She was ten years old and from Christchurch. She had been born with a large hole between the two ventricles of her heart—the chambers that pump blood out to the body and to the lungs—and the hole was killing her slowly. Without surgery, the doctors expected she would not see forty.
On the morning of 3 September 1958, in the main theatre at Green Lane, Barratt-Boyes opened her chest, cannulated the great vessels, took her circulation onto the Melrose machine, opened her right atrium, found the defect at the top of the ventricular septum and stitched it closed. The operation took several hours. She came off the machine. Her heart restarted. She woke up. She got better. She was, last I read of her, in her mid-seventies, having outlived almost every prediction made for her in 1958. Today there is a tree at Greenlane Clinical Centre, planted in 1958 to mark the day, with a brass memorial plaque on a low stone in front of it.
The operation was the first “open heart” procedure performed in New Zealand. Barratt-Boyes was thirty-four years old. He had been at Green Lane for fifteen months. The unit, he and Robb both understood, was now in business.
What a heart-lung machine actually does, in plain English
It is worth, at this point, stopping. The phrases “cardiopulmonary bypass”, “ventricular septal defect” and “heart-lung machine” are words that doctors use comfortably and that almost nobody else does. The thing they describe is straightforward, and the reason it transformed twentieth-century medicine is straightforward too.
The heart is a pump. Its job is to push blood around two circuits—one to the lungs to pick up oxygen, one to the rest of the body to deliver it—in a continuous loop. If you stop the heart, the brain begins to die in roughly four minutes. Surgery on a beating heart is possible only for the simplest kind of repair. For anything inside the heart—a hole between chambers, a malformed valve, an artery joined to the wrong place—the surgeon needs the heart still and empty so he can see what he is doing. Stopping the heart kills the patient. Until the early 1950s, that was the bind that defined cardiac surgery. There were no operations of any consequence on the inside of the heart, because the heart could not be stopped.
The heart-lung machine breaks the bind. Plumbing connects the patient’s great veins to a machine outside the body. The machine sucks venous blood out, oxygenates it—in the Melrose design, by spinning it across discs in an oxygen atmosphere—and pumps it back into a major artery. While the machine is running, the patient is kept alive without using either heart or lungs. The surgeon can then stop the heart with a chemical solution, open the chamber he wants to fix, and work in a still and empty space. When the repair is done, the heart is restarted, the patient is taken off the machine, and the chest is closed.
The technique was, for the first decade, dangerous. Early bypass machines damaged red blood cells, kicked particles of fat or air into the brain, and produced a strange post-operative malaise that surgeons called “pump head”. Operative mortality in the late 1950s for a relatively complex repair could run at twenty per cent or more. The Green Lane unit’s mortality, by the mid-1960s, was steadily falling, because Barratt-Boyes treated each operation as Kirklin had taught him: every case was written up, every complication was discussed, every modification to the technique was recorded. The unit was, in effect, a research programme that happened to be saving lives along the way.
A homograft valve, and a race with a man called Donald Ross
The next leap came in 1962. The problem this time was the aortic valve—the one-way door between the left ventricle and the main artery of the body. When the aortic valve fails, either by failing to open properly or by failing to close, the heart cannot push blood out efficiently and the patient slowly drowns from the inside. By the early 1960s surgeons were replacing damaged aortic valves with mechanical prostheses made of metal and silicone. Mechanical valves worked, after a fashion, but they had a serious problem: blood clots formed on them, so patients had to take anticoagulant drugs for the rest of their lives, which carried their own bleeding risks.
Barratt-Boyes had a different idea. The natural aortic valve is a thin tissue structure made of three crescent-shaped leaflets. If you took a fresh aortic valve from a donor who had recently died—a homograft, in surgical Latin, a graft from the same species—and sewed it into the patient in place of the damaged one, you would have, in principle, a valve that the body recognised as biological tissue and that did not provoke clot formation. There would be no need for anticoagulants. The valve would, ideally, last for years.
The same idea had occurred to a young South African-born British surgeon called Donald Ross, working at the National Heart Hospital in London. Ross performed the first homograft aortic valve replacement on 24 July 1962. Barratt-Boyes performed his own first, in Auckland, on a 43-year-old man with calcified aortic stenosis, on 23 August 1962—about a month after Ross. The two operations are usually credited together. The technical method differed in detail, and the Auckland version—with the homograft sewn into a particular geometry below the coronary arteries—is the one that subsequent generations of surgeons mostly adopted.
Barratt-Boyes’s first homograft patient, a Mrs Wallis, was a different case. She was a woman in her thirties with rheumatic aortic disease. Her replacement valve, sewn in at Green Lane in late 1962, lasted twenty-five years. When it began to wear out, in 1987, Barratt-Boyes himself replaced it with a second homograft. She survived the second operation as well. The story is the kind of thing the homograft technique made possible: a valve that could be replaced when it failed, and a patient who could outlive the valve and outlive its successor.
Green Lane became, in the 1960s and 1970s, the world centre for homograft aortic valve surgery. The unit had a tissue bank—valves harvested from cadavers within hours of death, treated, frozen, stored, ready for use. By the early 1970s Auckland surgeons had implanted more homograft aortic valves than any other unit on the planet, and the long-term outcome data Barratt-Boyes was publishing was the data on which the rest of the field was being built. The technique was not perfect—long-term, calcification of the cusps was a problem, especially in younger patients—but for thirty years it was the best aortic valve replacement available, and for the right patient it remained competitive into the modern era.
Cooling a baby almost to a stop
The problem after homograft valves was infants. The heart-lung machines of the 1960s were built for adults. They needed a circuit volume of perhaps a litre or more of blood; an infant’s entire blood volume was less than half that. Plumbing a four-month-old onto bypass meant priming the machine with several units of donor blood and pumping that through her tiny vessels at adult flow rates, which produced its own complications. Babies with congenital heart defects—ventricular septal defects, transposition of the great arteries, tetralogy of Fallot—were therefore being kept alive with palliative procedures into early childhood and only then taken on for the curative open-heart repair, by which point the heart had been damaged by years of abnormal flow.
Barratt-Boyes solved this problem by going back to a technique that had been worked on, in less developed form, by surgeons in Japan and Toronto in the 1950s. Surface cooling. You took the infant, anaesthetised her, and immersed her in ice water for about thirty minutes until her core temperature had dropped from 37 to about 18 degrees. Tissue at 18 degrees uses a small fraction of the oxygen tissue at 37 degrees uses. With the patient that cold, you connected her to the bypass machine just long enough to cool her further to about 16 degrees, then you stopped the circulation altogether for the actual surgery. The machine was switched off. The blood was drained out of the body cavity. The heart was a still, empty, exposed organ in a still, empty chest, and the surgeon had perhaps an hour to do the repair before the brain’s reserves of oxygen ran out.
That hour was called “profound hypothermia and circulatory arrest”. Auckland began using it on infants in 1969 and Barratt-Boyes published the results in a series of papers from 1971 onward that set off a wave of adoption around the world. The neonatal cardiac surgery units that grew up at Boston Children’s Hospital, the Hospital for Sick Children in Toronto, Great Ormond Street in London, the Royal Children’s in Melbourne and a dozen other places had, in the 1970s, an Auckland-trained surgeon on staff or a member of staff who had spent six months in Auckland watching Barratt-Boyes work. The technique was not all his—the Japanese antecedents are real, and Mark Dillard at the University of Iowa was working in parallel—but the man who made it the standard method for paediatric open-heart surgery was Barratt-Boyes.
For New Zealand families this meant that the routine of paediatric cardiac care changed completely. A baby diagnosed with a hole in the heart at three months in 1962 would have been kept alive on diuretics, allowed to grow, palliated where necessary, and operated on if she made it to school age. The same baby in 1972 was being flown to Auckland and being operated on in her first year of life. By the late 1970s she was being operated on in her first weeks. The mortality of those early infant operations was high—the technique was not gentle on small bodies—but the alternative for severe defects was usually death, and a child who survived had a heart with a fighting chance of growing into a normal adult one.
Green Lane as a destination, and the diaspora
By 1970 Green Lane was, by international consensus, one of the four or five best cardiac surgical units in the world. It was the only one of those units in the southern hemisphere. Surgeons came to Auckland to learn. The trainee list, by the end of the decade, read like an atlas. There were young men from Britain, from Denmark, from Switzerland and the United States. There were trainees from Thailand, from Singapore, from Afghanistan and Iran. There were several from Japan. By far the largest contingent was from India. They came on six-month or one-year fellowships. They watched, they assisted, they did their own cases under supervision, and then they went home and built units of their own.
The diaspora of Auckland-trained heart surgeons, by the time Barratt-Boyes retired in 1989, was substantial. There were Green Lane alumni running the cardiac surgical service in Bombay, in Madras, in Bangalore, in Bangkok, in Singapore, in Auckland (obviously) and Sydney and Brisbane, and there were former trainees on staff at Stanford, at Toronto, at the Brompton in London, at Birmingham, at the Karolinska in Stockholm. Alan Kerr, his Auckland colleague, said in 2006 that Sir Brian’s greatest legacy was the young surgeons he trained. It is the kind of statement that ought to feel polite, but is in this case very nearly literal: the modern paediatric cardiac surgical world is, in part, the second-generation network of his pupils.
In 1965 he organised the first international cardiac surgical conference in Auckland; the 1987 Asian Pacific Congress that he hosted attracted a contingent of overseas surgeons that astonished people who had thought of New Zealand as a small place. Auckland was not a small place for cardiac surgery. By that decade Auckland was the place a generation of Asian-Pacific surgeons had been trained.
The man in the theatre
Barratt-Boyes was not, by any of the accounts that have come down to us, an easy man. The polite phrasing in the formal obituaries is that he was demanding. The fuller version, written candidly in the Royal College of Surgeons in-memoriam, is that his peers found him opinionated and intolerant, and that his juniors found him aloof, demanding and intimidating.
His biographer Donna Chisholm, in From the Heart, the 1987 biography that is the closest thing to an authorised account, described two qualities that everyone who watched him operate noticed. The first was the intensity of his eyes above the mask. The second was the sheer physical beauty of his hands in action. Technically, she wrote, he was flawless. Surgeons who passed through Green Lane in the 1960s and 1970s remembered the calm in the theatre when he was operating, and the absolute intolerance of carelessness or sloppiness in any of the ten people standing around the table. He raised his voice at trainees. He spoke to nurses, occasionally, in ways that no nurse anywhere would now accept. He believed that cardiac surgery was the most demanding craft known to medicine and that doing it less than perfectly killed children, which was correct, and that the only ethical response to that knowledge was to demand the most of everyone in the room, which was also defensible. The trainees who survived his theatre tended to remember it, in retrospect, as the place where they had been forced to become real surgeons.
Ken Graham, who joined the unit as a trainee in 1958, gave the most often-quoted summary in a later interview. He found Barratt-Boyes, he said, kindly but slightly demanding. You can’t achieve the things he has achieved, Graham added, by being completely relaxed.
Outside the theatre he was a slightly different man. The thank-you letters from the families of children he had saved came to Green Lane in volume, and Professor Harvey White recalled that Barratt-Boyes wrote back to all of them, by hand, in his own time, often in the evenings. He was warm with patients. He was warm with grandchildren. The contradiction between the operating-theatre martinet and the man who answered children’s thank-you letters by hand is the kind of contradiction that runs through accounts of him from people who knew him at different parts of his life. He was harder on his colleagues than on his patients, and hardest on himself.
A surgeon’s own coronary arteries
He had been a smoker, and a hard worker, and a man who took little exercise. In 1963, in a hotel room in Bangkok during an international tour, he had his first chest pain. He was thirty-nine. He suspected what it was, and he ignored it, and the pain came back. For five years he denied it. By 1974 he had developed unstable angina. The arteries supplying his own heart muscle were blocked. He needed coronary artery bypass grafting—a different operation from the homograft work, but in the same surgical universe. The operation was done at Green Lane, in November 1974, by his colleague Alan Kerr. Barratt-Boyes was fifty. He had a double bypass.
He went back to the theatre table within months. He cut down on smoking. He kept operating, kept teaching, kept publishing. Over the next thirty years he had three further cardiac operations: redo grafts, valve work, the kind of late maintenance that the survivors of bypass surgery in the 1970s ended up needing as their original grafts wore out. Each time he was operated on by colleagues. Each time he survived. He liked to say, to people who asked, that the experience of being a cardiac surgical patient on the receiving end of his own discipline had taught him things about the experience that he had only thought he understood before. He was kinder afterwards to nurses, some of his juniors thought, than he had been before.
Politics, the public health system, and the loud voice
The politics of cardiac surgery in New Zealand from 1960 onwards was the politics of the waiting list. Public funding was always a year behind what the unit could do; the unit could always have done twice the volume of cases it was funded to do; and Barratt-Boyes was, very visibly, the most prominent doctor in the country shouting about it. He shouted at the Auckland Hospital Board. He shouted at the Department of Health. He shouted at Cabinet ministers. He gave interviews to the New Zealand Herald in which he said, in 1971, that Green Lane was doing half the work that could be done if it was adequately staffed. In 1975 he warned publicly that patients needing heart surgery were dying because of the financial limits.
The line he gave in his eighties summed up the strategy. People said Greenlane got more money than it should because of his influence, he said, and there was truth in that, because you never get anything unless you go after it and shout for it. He went after it. He shouted for it. The Auckland cardiac unit, by every objective measure, did better in resource allocation than equivalent units in equivalently sized New Zealand cities, partly because of geography and partly because Brian Barratt-Boyes was running its public-relations campaign personally.
He was made a Commander of the British Empire in the 1966 New Year Honours, and a Knight Commander of the British Empire in the 1971 New Year Honours. He took the second knighthood as Sir Brian Barratt-Boyes. The tradition in New Zealand at the time was that knighthoods went to the long-retired and to the ceremonial; Barratt-Boyes was 47, in the middle of his career, and still operating. The honour in his case had nothing to do with retirement.
A divorce, a remarriage, and the farm at Waiwera
The first marriage did not survive his career. Brian and Norma had married in Dunedin in 1949 when he was twenty-five and she was a young physiotherapist who had no clear idea of the life she was being signed up for. They had five sons over the course of his establishment as a heart surgeon. The marriage was a long one in calendar terms, but the cardiac surgical years from 1957 to the late 1980s were not gentle on family life. Barratt-Boyes operated long days, ran the unit, travelled internationally several months a year, wrote textbooks at home in the evenings. He was, as one of his sons later put it tactfully, often not present.
The marriage ended in 1986. The divorce was, by the standards of New Zealand high-society divorces of the period, public. Within months he had married Sara Rose Monester, an Australian lawyer who had come into his life in the early 1980s. The second marriage took, and lasted the rest of his life. He and Sara bought a farm called Green Hills, at Waiwera, on the Hibiscus Coast forty kilometres north of Auckland, and the farm became where he spent his weekends and where, after retirement, he largely lived.
He retired from clinical surgery in 1989 at the age of sixty-five. He was not a man who stopped completely. He kept up his publications, particularly on long-term outcomes of valve replacement, well into the 1990s. He travelled to international conferences as a senior figure. He sat on committees. He read widely. He had, his sons remembered, time for them in the late years that he had never had time for them in the early years, and he was a present grandfather. His eightieth birthday in January 2004 was celebrated at the Waiwera farm with most of the grandchildren in attendance.
Cleveland, March 2006
By 2006 Brian Barratt-Boyes had been a cardiac patient for more than thirty years. The arteries that had needed bypass grafts in 1974 had been re-grafted; one of his heart valves had developed regurgitation; another was failing. The operations he had pioneered in the 1960s for valve replacement were now standard. He needed a double valve replacement, and the surgical team he chose for it was at the Cleveland Clinic in Ohio, run by Toby Cosgrove, then one of the most prominent cardiac surgeons in the United States and a man who had himself trained in part on Barratt-Boyes’s own published work.
The operation in early March 2006 went technically well. The complications afterwards did not. Cardiac surgery in an eighty-two-year-old patient who is on his fifth open-heart procedure is not, even at Cleveland, even with the best surgeons in the world, a casual undertaking. He died at the Cleveland Clinic on 8 March 2006, of complications from the surgery—not, despite some accounts that have circulated since, of cancer. He was eighty-two. Sara was with him.
The funeral was held in Auckland a fortnight later. The church was full, with senior surgeons present from London, Sydney and the United States, and several of his Indian and South-East Asian trainees flying in. The eulogy was given by colleagues who had stood across the operating table from him for thirty years. Ken Graham’s description of him as kindly but slightly demanding was quoted, and the church laughed.
What he left behind
The work, twenty years after his death, is still in the discipline. Profound hypothermia and circulatory arrest is a standard technique in paediatric cardiac surgical training around the world; modern infant cardiac surgery uses lower flows and shorter arrest times than Auckland used in 1969, and a degree of refinement that the original method did not have, but the conceptual move—cool the baby and switch off the circulation—is what came out of Green Lane. The homograft aortic valve is no longer the most-used valve in adult aortic surgery; mechanical valves and bioprosthetic valves of the modern generation, mostly bovine pericardium, have taken over much of the field. But the homograft remains the procedure of choice in particular contexts—in young patients with endocarditis, in the Ross procedure where the patient’s own pulmonary valve is moved into the aortic position and a homograft replaces the pulmonary—and the long-term Auckland outcome data underpins the modern understanding of how those valves behave over decades.
The Auckland unit continues. Green Lane Hospital was reorganised in 2003, when its inpatient cardiothoracic services moved to the new Auckland City Hospital and the old Greenlane site became Greenlane Clinical Centre, an outpatient and specialist services campus. The Green Lane Cardiothoracic Surgery unit at Auckland City Hospital still bears the name. The Cardiac Surgery Unit Trust, which Barratt-Boyes helped found, still raises philanthropic money to fund equipment and clinical research that the public system cannot or will not pay for. It has been running since 1990.
The textbook, Cardiac Surgery, has gone through five editions. The most recent, by Nicholas Kouchoukos and others working in the lineage of the original authors, runs to nearly two thousand pages and is the discipline’s standard reference. Kirklin and Barratt-Boyes are both dead now, but the cover still carries their names.
The patients are perhaps the most concrete legacy. Helen Harris, born Helen Arnold, the ten-year-old from Christchurch on the table on 3 September 1958, was in her seventies the last time the press wrote about her. There are several thousand New Zealanders walking around today who would not be alive if they had been born ten years earlier than they were, because what was wrong with them as babies was something that surgeons in 1958 could not fix and surgeons in 1968 could. They are, in a sense that is hard to make abstract, his memorial. They drive cars and raise children and have grandchildren of their own. They mostly do not know his name.
The fame in New Zealand was always a little muted. He never had Hillary’s photograph or Rutherford’s prize. The cardiac surgical world knew exactly who he was; the New Zealand public, beyond a vague recognition that he had something to do with hearts, mostly did not. He was put on a postage stamp in 1995, one of five living New Zealanders so honoured at the time, and he was knighted in 1971, but the country never really turned him into the kind of public hero that the achievements warranted. Part of that was the work itself. You cannot put paediatric cardiac surgery on a postcard. The decisive moments happen in masked silence inside a chest cavity, watched by ten people who are not allowed to talk, and the patient lying on the table at the end of it, if everything has gone well, looks much the same as the patient lying on the table at the start. The work itself was, by design, in the body of someone else.
And yet the things he left in the country are real. A working national paediatric cardiac surgical service. A homograft heart-valve bank, the first in the southern hemisphere. A textbook that the next generation of New Zealand cardiac surgeons grew up on. The Cardiac Surgery Unit Trust. A diaspora of trainees on every continent except Antarctica. A tree at Greenlane Clinical Centre, planted in 1958 to mark the day, with a small brass memorial plaque on a stone in front of it. The plaque is unobtrusive. The tree is now in middle age. It is the kind of memorial Barratt-Boyes would have wanted, which is to say, almost not a memorial at all, but a working part of the hospital where his career happened. Children still walk past it on their way out, holding their parents’ hands, with sternotomy scars healing under their shirts, on their way home.
Sources and further reading
- Te Ara Dictionary of New Zealand Biography, Barratt-Boyes, Brian Gerald. The standard scholarly entry.
- NZ History, Brian Barratt-Boyes.
- Wikipedia, Brian Barratt-Boyes.
- Mayo Clinic Proceedings, Sir Brian Gerald Barratt-Boyes—Pioneer Cardiac Surgeon.
- Texas Heart Institute Journal tribute, Sir Brian Gerald Barratt-Boyes KBE (1924–2006).
- British Heart Journal obituary, Sir Brian Barratt-Boyes KBE.
- Eyes on New Zealand profile.
- Our Health Museum, A Pioneering Heart Surgeon.
- Our Health Museum, Heart Surgery in New Zealand, Part 1.
- NZ Herald, Obituary, Sir Brian Barratt-Boyes (2006).
- NZ Herald, Heart pioneer led world from Auckland.
- NZ Herald archive, 1958, Brian Barratt-Boyes, Mender of hearts.
- RNZ Eyewitness, Changing medical history, New Zealand’s first open-heart surgery.
- Royal College of Surgeons of England, Lives of the Fellows, Barratt-Boyes.
- Milestone Operations in Heart Valve and Aortic Replacement, PMC review (2024).
- Donna Chisholm, From the Heart, A Biography of Sir Brian Barratt-Boyes, Hodder & Stoughton, 1987.
- John W. Kirklin and Brian G. Barratt-Boyes, Cardiac Surgery, John Wiley & Sons, first edition 1985.
- Brian G. Barratt-Boyes, “Profound hypothermia and circulatory arrest in cardiac surgery”, Annals of the Royal College of Surgeons of England, 1971.
- Cardiac Surgery Unit Trust, New Zealand.
Comments
Did you or someone in your family have heart surgery at Green Lane under Sir Brian Barratt-Boyes, or did you train under him? Drop a comment below — we read every one.
This article was written by AI, briefed to report the facts, hopefully without some of the bias people bring to the job 🙂
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