August 30, 2024 • 55 mins
This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He has done and seen it all and has a unique perspective. How did he achieve so much and still have a succesful 56 year marriage to his wife Carol Ann? What is Dr. Brown most proud of in a career that is as prolific as his? What advice would he have have for the next generation? Prepare to be inspired by this master surgeon and friend and colleague of many in our field.
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Episode Transcript
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Speaker 1 (00:16):
Welcome to Pedheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I'm the host of this podcast. I
am Professor of Pediatrics at the Icon School of Medicine
at Mount Sinai, where I'm also the Chief of Pediatric Cardiology.
Thank you for joining me for this three hundred and
ninth special episode of Pdheart. I hope all enjoyed last
week's episode, in which we spoke with doctor David Hogansen
(00:36):
of Boston Children's Hospital about computational fluid dynamic modeling for
patients who are undergoing single ventrical palliation. Doctor Hoganson explained
to us the myriad manner in which he and his
team are able to perform virtual surgeries to determine the
optimal way to perform a fontine, and the multiple possible
uses of this technology going into the future. For those
(00:58):
of you interested in the find tan single ventricles and
surgical modeling, as well as surgery in general, I'd recommend
you take to listen to last week's three hundred and
eighth episode. As I say most weeks, If you'd like
to get in touch with me, my email is easy
to remember. It's Ptiheart at gmail dot com. This week,
we'll be spending the entire podcast speaking with the noted
(01:19):
congeneral heart surgeon, doctor John W. Brown, who is a
renowned cardiothoracic surgeon and who helped found Indiana's first pediatric
heart transplant program. Doctor Larry Markham of Riley Hospital for
Children in Indiana reminded me recently that Riley Hospital was
celebrating its one hundredth anniversary this year, providing amazing care
(01:39):
to children in Indianapolis, Indiana. During that time period, the
pediatric heart program has grown in volume and reputation, and interestingly,
it has had only four surgical chiefs in its entire history,
and these are namely doctor Harris Schumacher, who was a
disciple of doctor Alfred Blaylock and started working there in
(01:59):
the night nineteen fifties, followed by doctor Harold King and
then doctor Brown and recently doctor Mark Turantine. Doctor Brown
worked at Indiana University Hospital and Riley Hospital for Children
for most of his attending surgical career, spanning an incredible
forty six years. He performed the first pediatric heart transplant
in the state in nineteen eighty eight and also one
(02:22):
decade later, implemented the nation's first bovine venus valve implants
in a thirteen month old child, and he did this
based upon his long time research in this arena, introducing
this valve into congenital heart surgery. And we all know
how important that concept has become for us in both
surgery and more recently trans cathar valve procedures. Doctor Brown
(02:43):
was the chief of carniothoracic surgery in Indiana for over
twenty years and it's estimated that he has completed over
fifteen thousand pediatric art operations at Riley Hospital and another
five thousand in adults at Indiana University and Methodist Hospitals.
In twenty thirteen, doctor Brown was honored by the Indiana
(03:03):
University School of Medicine with the formation of the John W. Brown,
MD Endowed Chair of Cardiothoracic Surgery. Doctor Brown has a
long list of other honors and awards, including the John B.
Hicckham Award in nineteen seventy, Corps Vite Heart of Life
Award in two thousand and eight, Distinguished Faculty Award in
twenty ten, Sagamore of the Wabash in twenty eighteen, and
(03:27):
he was recently awarded the Indiana University bi Centennial Medal
in recognition of his distinguished contributions to Indiana University in
twenty nineteen. There are so many contributions of doctor Brown,
but clearly his work in expanding pediatric open heart surgeries
in newborns and infants at Riley is one of his
most long lasting professional legacies. He retired from full time
(03:49):
practice in twenty twenty one, and he is the first
Harris B. Schumacher Professor Emeritus of Surgery, and I am
told that he continues to this day to help his
surgical colleagues intermittently in the operating room. In addition to
all of these wonderful professional achievements, doctor Brown has been
married to his high school sweetheart, Carol Ann Brighton Brown,
for fifty five years, and they have three married children
(04:13):
and seven grandchildren. We'll speak today with doctor Brown about
his life and times, about balancing his family life with
his professional one, and what he believes are the most
enduring and important contributions he's made. And so, without much
further ado, let's welcome doctor Brown to.
Speaker 2 (04:29):
P D Heart.
Speaker 3 (04:30):
Okay, I'm here now with doctor John Brown. John, thank
you so much, for joining us this week on the podcast.
Speaker 4 (04:35):
Well, it's a pleasure to be here.
Speaker 3 (04:37):
It's a great honor to have you, I have to say,
and I've been very excited a lot of buzz on
the internet about you joining us this week. And I
want to start by thanking doctor Larry Markham of Riley
Children's for being so thoughtful to offer this suggestion of
talking with you. And I'm really honored that you would
spend some time with us, So thank you very very much.
(04:59):
You know, I thought to start, I've asked. We've had
a number of different famous cardiac surgeons and cardiologists on
the podcast, and I usually start by asking, you know
something simple like where did you grow up and how
did you decide to become a doctor and then a surgeon.
Were there other doctors in your family or any other
mentors in medicine early in your life that you looked
(05:20):
up to.
Speaker 5 (05:21):
And maybe gave you an idea.
Speaker 4 (05:23):
Well, we'll start at the beginning.
Speaker 6 (05:25):
I grew up on a forty acre farm in south
central Indiana, a very nuclear family. My parents and grandparents
were farmers. My dad sharecropt and other three hundred acres,
and my brothers and I helped our dad farm as
we were growing up, and so my two older brothers
(05:48):
and my younger sister were the first in our family
to attend college. Our parents thought education was important for
us to do, and they thought farm life was great. However,
they thought that we had maybe the potential of doing
something more than farming with our lives.
Speaker 4 (06:07):
So I went to a little high school.
Speaker 6 (06:11):
There were seventeen in my graduating class from high school,
about third of the people in my class. I went
on to college, but I thought, you know, as as
I entered my junior and senior year, that I would
follow in my older brother's footsteps and probably go to
(06:33):
Purdue University and become an engineer. But as I entered
my senior year, I decided, you know, that's not what
I really wanted to do.
Speaker 4 (06:43):
My wife, Carol Anne, and I.
Speaker 6 (06:46):
Started dating when she was in the seventh grade and
I was a sophomore in high school and we've been
going steady and then been married for fifty six of
those years. And I'm very proud of her because she
wanted a college education as well well, wanted to become
a special ed teacher and all of that.
Speaker 4 (07:03):
So anyway, it sort of worked out.
Speaker 6 (07:06):
That we stayed together and became married, or we were
married when I was in a junior medical student, and
so she's been through.
Speaker 4 (07:18):
All the phases of surgical training.
Speaker 6 (07:20):
And has been dedicated and loved and supported me for
the fifty six years of our marriage.
Speaker 4 (07:31):
So it's very great.
Speaker 5 (07:32):
So that's extraordinary.
Speaker 6 (07:35):
I didn't know anybody in medicine when I my math
teacher in high school suggested that I take an aptitude test, and.
Speaker 4 (07:48):
I took that aptitude test.
Speaker 6 (07:50):
It combined my sort of desire to be a problem
solver and to work with my hands, with the faith
that we grew up with that, you know, a purpose
in life was to do something for others, not just ourselves.
So that aptitude test was strongly favoring a career in medicine.
(08:14):
And I'd never considered it before that aptitude test, So
I give a lot of credit to pointing me.
Speaker 4 (08:20):
In that direction.
Speaker 6 (08:21):
So nineteen sixty three I went to Indiana University at
Bloomington as a pre med student. However, my high school
didn't offer physics, chemistry, or a foreign language, so I
to start out with beginning courses at IU, and then
it took me a semester to catch up with my
(08:43):
pre med class, and so you know, and because I
was borrowing money for room and board and tuition, I
was able to finish undergrad and medical school in seven years,
which was allowed at that point in time, so I
wouldn't run up more educational death than I had to.
Speaker 3 (09:05):
And your girlfriend and then wife did she also go
to IU as well.
Speaker 4 (09:10):
She went to IU as well.
Speaker 6 (09:12):
She was two years younger than I, so we only
spent overlapped the one year at Indiana University in Bloomington.
And we chuckle about this now. She said, you were
so concerned about whether you'd be able to get into
medical school or not. We didn't do a lot of socializing.
We didn't have a lot of movies or dates or
ballgames to go to. We spent a lot of time
(09:34):
both studying in the library and that sort of thing.
Speaker 4 (09:36):
But anyway, get paid in the long run.
Speaker 3 (09:40):
So, John, you went to medical school, and when you
were in med school, obviously at some point you decided
you wanted to be a search And how did that
decision come about?
Speaker 4 (09:50):
Well, it was fairly easy.
Speaker 6 (09:52):
I guess the courses that I liked the most in
the first two years of medical school were anatomy and physiology,
and where some of my uh you know, classmates sort
of stood back during cadaver dissection and that sort of thing,
I wanted to be all about it. And so I
(10:14):
loved the anatomy and and I loved the physiology, and
the heart was the heart physiology was measurable, and cardiac
surgery was in its infancy at.
Speaker 4 (10:27):
That point in time, and I thought, cardiac.
Speaker 6 (10:30):
Surgery sounds like it would be a great field to pursue.
And then I had the opportunity, after my second year
of medical school to spend three months in a sort
of an off quarter with two adult cardiac surgeons at
a large private hospital in Indianapolis, the Methodist Hospital, John Pittman.
Speaker 4 (10:53):
And Harry Sedaris.
Speaker 6 (10:54):
They had one general surgery resident for the two of them,
and so when I spent those three I was first
assistant on most of their cardiac pass that where the
general surgery resident wasn't spending his day. And so they
gave me enormous responsibility as a young medical student, not
(11:15):
only in the operating room, but taking care of their
patients post operatively. And actually they hired me to babysit
the fresh pumps for the hours of about six pm
to midnight on those cases that I'd scrubbed on. So
I got a lot of experience as a medical student,
(11:37):
you know, with cardiac surgery.
Speaker 4 (11:38):
Then I went back to my junior year. I loved
all of my.
Speaker 6 (11:41):
Clinical rotations medicine as well as surgery, but I gravitated
to the surgeons because I was fascinated by what they.
Speaker 4 (11:50):
Were able to do and how they were able to.
Speaker 6 (11:52):
Change the courses of patients lives with what they did
in the operating room. And then what really sealed the
deal was as a conj geral heart surgeon, I spent
a month rotation with doctor Harold King, who was chief
of the Cardiac service at Indiana University, and he was
a congenital heart surgeon, and I was truly amazed in
(12:13):
my rotation with him about what he was able to
accomplish in the operating room with children.
Speaker 4 (12:19):
With congenital heart disease.
Speaker 6 (12:20):
And decided at that time, if I could do anything
with my career, I'd like to do.
Speaker 4 (12:25):
What Harold King did.
Speaker 6 (12:26):
And so I've sort of been living my dream in
that respect.
Speaker 3 (12:31):
So I guess then it would be fair to say you.
Speaker 5 (12:33):
Looked up to him a lot.
Speaker 3 (12:35):
I'm guessing based on that time and what kinds of
operations this is I guess must be in the late
nineteen sixties or is this the early seventies.
Speaker 4 (12:46):
Or late nineteen sixties?
Speaker 5 (12:47):
Seven?
Speaker 3 (12:47):
Right, So what kinds of surgeries were you observing? What
kind of congeneral heart surgers were you watching at that time?
Speaker 6 (12:55):
Well, I think the ones that made the biggest impression
on me were completely desemplty effect ab canals and tetrology.
And doctor King was a master surgeon, and in those
days we didn't have.
Speaker 4 (13:08):
You know, pulmary valve replacements.
Speaker 6 (13:09):
They all had, you know, all the children with pulmonary
Stenosi's got a big transangular patch and were left with
pulmonary regurgitation. But his survival rate was in the high
ninety percent, even in those early days, and so he
had excellent results. And the residents that I scrubbed, you know,
(13:31):
as all the rotation with were very impressed. He says,
you know, there's nobody in the country that I think
has better outcomes than he does with some of these
more complicated procedures.
Speaker 4 (13:42):
In those days.
Speaker 5 (13:43):
I see, I see.
Speaker 6 (13:45):
Repalliated many things, as you well, know, shunts and pa
bandings and that sort of thing were commonplace, So.
Speaker 3 (13:53):
You know, I was wondering it must have been quite
an extraordinary change over the course of your career. Starting
your career in an era of palliation and ending your
career in primary repairs. That must have been quite a
lot of change. I guess it was exciting, but probably
I guess you never stopped learning the entire forty five
(14:15):
years you were practicing exactly.
Speaker 6 (14:18):
It was a very exciting time, and I think, you know,
I learned early on in my career to I joined
an organization called the Congenital Heart Surgeon Society, and so
these were a lot of my peers from around the
country and that sort of thing, and we had an
annual meeting in Chicago and talked about the problems that
(14:39):
we had encountered with some of these early like arterial
switches and Norwood procedures and things like that, and worked
out a lot of details. And I consider that educational
opportunity to be one of the most important in my
early career.
Speaker 3 (14:56):
Sir John, I know that you did your congenital training
in Michigan. How did you come to decide to go there?
I mean, obviously we all know that Michigan is one
of the great congenital hearts centers. How did you make
that decision? There were a couple of great places at
that time.
Speaker 4 (15:12):
Sure, well.
Speaker 6 (15:13):
One of my early mentors, John Pittman, the privates cardiac surgeon,
had trained at University of Michigan, and then doctor Harold King,
my chief at Indiana University, and Herb Sloan, who was
the chief of cardiac surgery at Michigan, were close friends,
and he said, you really ought to look at the
University of Michigan for your cardiac.
Speaker 4 (15:35):
For your general surgery and cardiac surgical training.
Speaker 6 (15:38):
And although I visited other places because I wasn't sure
I could get into Michigan, Michigan was my first choice
and they accepted me, and so I spent from nineteen
seventy and finished up my cardiothoracic surgical training in nineteen
seventy eight, and then I had two years in the
midst of that to spend at the NIH with Glenn
Morrow on the cardiac surgical service, and he gave us
(16:01):
a lot of responsibility, not only in the operating room,
but also I taught us how to write manuscripts and
papers for the surgical liturgy.
Speaker 3 (16:12):
You know, it's always seemed to me that surgeons who
trained in Michigan are uniformly pretty good. And the reason
I say that is it's always seemed to me like
maybe they allowed the surgical trainees to do more there
than in other places. What did you as a fellow,
(16:37):
you know, in the nineteen seventies, what did they allow
you to do? Were you like first operating on complex
babies and how did that work? Well?
Speaker 6 (16:47):
No, obviously we were obviously did a lot of the
pali of operations, and we were first assistants on the
complicated congenital procedures. But you know, we only got to
spend a few months on the congenital service, so we
weren't allowed to do all that much. But as a
(17:07):
general surgeon, we were given tremendous responsibility at the what
we called them Wayne County General Hospital. We sort of
ran the service, operated day and night, you know, were
the staff was in the room, but not necessarily scrubbed
on the cases. So I would do complex abdominal operations
(17:28):
and bascular operations with the help of a junior resident.
And so we did get a tremendous responsibility in and
I think, you know that's as I look.
Speaker 4 (17:40):
At training now, it's not quite the same.
Speaker 6 (17:43):
We were not allowed to give our residents that much independence.
Speaker 4 (17:48):
So, you know, a lot of what I learned.
Speaker 6 (17:51):
About congenital heart surgery I learned when I came back
to Indiana at the STAFF, and what I learned at
the NIH with Doctor Morrow.
Speaker 4 (17:58):
Those two years.
Speaker 3 (17:59):
I was I'm interested to hear about how you think
about training like today. I know there are residencies where
you can basically categorically choose to do cardiac surgery right
from the start, and then there are the more traditional
path I guess is where you do general surgery followed
by a fellowship in cardiac surgery. I'm wondering it sounds
(18:22):
to me like you found your general surgical experience very,
very helpful. What do you think about the present move
to sort of turn programs more into these sort of
cardiac surgical residencies rather than the old, more traditional approach.
Speaker 6 (18:38):
Well, initially I was skeptical because I thought everybody had
to do their training the way I did, and that
I love the independence that I had as a general surgeon,
sort of gain surgical maturity, and we've learned how to
work with others and junior people and that sort of thing. However,
(18:59):
with a combined residency program that we have now, I'm
quite impressed with the people who elect to do the
integrated program, where they basically have a cardiothoracic surgery residency,
spend a good amount of time in their first two
or three years on general surgery, but the rest of
(19:20):
their time they spend on cardiothoracic surgical services. And I
have to admit our early graduates seem to be quite
competitive with what I considered.
Speaker 4 (19:32):
The traditional training in.
Speaker 6 (19:34):
The past, so I think it was an experiment, but
I think it's probably going to work out now. You know,
once you finish your residency and congenital heart surgery, you're
not a train congenital heart surgeon because you're not generally
allowed to do a lot of complex neonates.
Speaker 4 (19:53):
And that sort of thing.
Speaker 6 (19:54):
As a cardiothoracic residence, you help. However, I've helped my residence.
They do more than a fifty percent of an arterial
switch and a good portion of the norwoods and the
avy canals and the tetrologies, and you know, the whole
gamut of things. But you know, they don't do it independently.
(20:19):
We're always scrubbed and in the operating room and directing
the operation whenever our residents are with us.
Speaker 3 (20:25):
And was this always the case even when you were
in training or do you think that when you were
a resident and a fellow in congenital heart surgery that
you had more independence and were able to do more
of the surgery, allowed to do more of the searchers
or is it similar do you think today? No?
Speaker 6 (20:43):
I think definitely residents this day and age are not
allowed to do as much.
Speaker 4 (20:49):
As I was allowed to do.
Speaker 6 (20:52):
You know, I think during my residency at Michigan and
the you know, the program wasn't all.
Speaker 4 (20:57):
That big in the nineteen sixties.
Speaker 6 (21:00):
Well in the early nineteen seventies, we you know, we
probably did two hundred total cases or two hundred and
fifty total cases a year.
Speaker 4 (21:07):
Of course it's three or four times that now.
Speaker 6 (21:11):
Nflvy, who's was the long term chief there was my
junior resident, and he and I spent a lot of
our residency, both in general and cardiac surgery together and
have remained close friends ever since that time. But it's
had a great reputation, and I think they train excellent
surgeons in their residency program as I think we do
(21:33):
here at IU as well, because I think our residents
get to do generally considerably more than residents in many
other programs, at least the ones where I talk with
the residents.
Speaker 3 (21:45):
I see, Well, you know, getting back to your history, John,
you finished up your training, and then how did you
get a job back at Indiana University? I know you
had trained there, but and also at Riley. I mean
did you when you started were you doing both congenital
and regular adult cardiac surgery. I know that in the
past surgeons very routinely would do that, And if so,
(22:09):
did you at some point say I'm not doing adult
stuff anymore? How did that transition work? And how did
you start your career there?
Speaker 4 (22:17):
Well?
Speaker 6 (22:18):
I met with doctor King, the chief of the cardiac
service and who was a congenital heart surgeon, as a
senior medical student, and I said, my dream would be
to come back to Riley and to IV and.
Speaker 4 (22:34):
Practice congenital heart surgery.
Speaker 6 (22:36):
Now, you know, I don't know whether I can get
the training that that requires.
Speaker 4 (22:42):
You know, what, I was a medical student. I had
no idea.
Speaker 6 (22:45):
It was a very competitive field, and so I just
said I'd like to keep in communication. So fortunately, in
nineteen seventy seven, a year after my my general surgery training,
I took my general surgery boards in Indianapolis, and so
(23:06):
I had one more year of cardiac surgical training, which
I finished in June of nineteen seventy eight. So I
went to his office in seventy seven and I said,
I'd love to come back to Indiana University and to Riley.
And he says, give me a week or two to
do some checking around about, you know, sort of how
(23:29):
you're perceived by your Michigan people, and i'll get back
with you. Well, within a couple of weeks he said,
you're hired. You've got a job at Indiana University. So,
you know, as I was starting my chief year as
a cardiothracic residence, I knew I was going to be
able to go back to Indiana and to go back
to Riley and you know, sort of live my dream.
(23:53):
So it's just worked out them very well in that regard.
Speaker 3 (24:01):
Well, I'm guessing you did pretty well in Michigan then,
now did you? Were you always only performing congenital heart
surgery asn't attending or did you do a lot of
adult stuff in the beginning of your career.
Speaker 4 (24:14):
I did.
Speaker 6 (24:15):
The first fifteen years of my career, I did probably
about a fifty to fifty split percent. I was totally
independent as an adult cardiac surgeon. But I did general
thoracic and I did thoracic bascular work very independently with
just junior help, and so I just gained an awful
(24:35):
lot of experience. And then I would help Doctor King
with complex cases, which you know, in those days were
canals and TETs and trunkuses and.
Speaker 4 (24:45):
Things like that.
Speaker 6 (24:46):
But he really sort of shied away from newborn stuff,
and I was fascinated by meddle surgery, and so our
volume in the late nineteen eighty sort of the mid
nineteen eighties to the mid nineteen nineties sort of doubled
or tripled, and so I got so busy doing congenital
(25:09):
cardiac operations. I didn't have that much time to spend
doing adults. Now, I've always done some adults, and you know,
I've done a lot of adult congenital stuff and continue
to do that.
Speaker 4 (25:24):
I helped my partners with complex.
Speaker 6 (25:28):
Congenital and adult congenital cardiac cases to this day.
Speaker 4 (25:34):
So but anyway, starting out, I did an awful lot
of you know.
Speaker 6 (25:38):
The standard self cornery bypass surgery, bowl replacements, thoracic aortic
work of dominal aortic, lung cancer, esopagio cancer, the whole thing.
Speaker 4 (25:48):
So I kept very busy.
Speaker 6 (25:50):
But I also knew that starting a research laboratory. That
was one of my demands when I came back to Indiana,
I said I must have a research laboratory because I
had several problems that I wanted to work out in
an animal laboratory and apply those to the field of congeneral.
Speaker 5 (26:10):
Archerery Wow, well, I want to definitely get to that.
Speaker 3 (26:12):
But I was wondering, John, I mean, you started your
career really before the main era of neonatal heart surgery. Essentially,
I guess had to learn it on the fly during
your actual professional career. How did you actually do that?
Speaker 5 (26:28):
Like? How did you learn?
Speaker 3 (26:29):
I mean, these are not easy operations to learn how
to do an arterial switch or nor would I mean,
you don't just wake up one day and say I
read a book on this, I think I'm ready. How
did you learn how to do this and actually start
doing them.
Speaker 4 (26:44):
Well.
Speaker 6 (26:45):
I was fortunate enough to have a good mentor in
Harold King. However, he'd not done any of these complex
neo latal operations as well, so we worked out a
lot of our techniques together, and then he allowed me
to go back and visit my my co resident ed
Bouvet in the early days of switch surgery.
Speaker 4 (27:04):
I went to Vanderbilt and watched.
Speaker 6 (27:07):
Since we started out doing mustard operations for transposition of
the great arteries, doctor King wanted me to find out
is a sinning a better operation than a mustard, And
after spending a couple of days at Vanderbilt, I decided
they are very similar operations. I think what we really
ought to do is go to the arterial switch thing,
which started in the mid nineteen eighties. And I think
(27:29):
we started doing switches in nineteen eighty six and never
looked back. But you know, obviously the mortality was a
little higher during our learning curve.
Speaker 4 (27:41):
But because.
Speaker 6 (27:44):
I was able to visit a few other institutions and
then with the hope of my colleagues in the Congenital
Heart Surgeon Society, I could call them up and I said,
you know, I had this issue with this particular but
what's been your experience? And they would do the same
with me, and then we would meet once a year
(28:05):
and sort of air our difficulties and our successes with
each other, and we learned from each other along the way.
Speaker 4 (28:13):
So that's how it was done. But there was a
lot of self teaching during those years.
Speaker 3 (28:17):
You know, I'm wondering you've seen and done it all.
What do you think about public reporting today and how
it has affected training versus say, when you were I
assume most of the time you were in training there
was not public reporting and so and now, of course
(28:37):
everybody is very worried about their STS numbers being publicly reported,
as well as things like US News and World Report.
Do you think that this has a It seems to
me like it's had a negative impact on surgical training.
But I wonder, as someone who really is right in
the thick of it, what your thoughts are on this.
Speaker 6 (28:56):
I think it has you know, we just can't give
our residence the independence that we had early on in
our careers during our training. And also I think it
has had a deleterious effect. However, I guess I do
most of my surgery on the left side of the
(29:17):
operating table, and my resident or junior staff is almost
always on the right side of the table, and that's
sort of the way it was at Michigan. So, you know,
I feel very confident in the abilities of the residents
that are going through our program to be able to,
you know, to cut and sew and do some of
(29:39):
the very complicated aspects of the operation, as long as
I'm there to guide every movement. And so I think
our outcomes reflect the fact that the outcomes are not
affected by letting residents do a good portion of most
of the operations.
Speaker 4 (29:56):
That we do.
Speaker 3 (29:57):
But I do think there's probably a great skille else
of being able to be on the left side of
the table and conduct such a complicated operation with someone
who isn't you know, very experienced to that you make
it get sad like it's very straightforward, but I'm sure
it's very nerve wracking. As the quote unquote assistance when
you're really sort of directing the operation.
Speaker 6 (30:18):
Well, you can direct from the left hand side of
the table as well as you can from the right
hand side of the table, and you really want your
trainees or your residents to be able to see it
as they are likely to see it if they decide
to become congenital heart surgeons. And so I've trained one
hundred cardiothoracic residents in my career, and you know, there's
(30:39):
probably a dozen of them that are congenital heart surgeons.
Speaker 4 (30:42):
And I'm proud of every one of them.
Speaker 6 (30:44):
And I'm proud to have had at least contributed a
bit to their to their training and how to do it,
and they got to see it from the surgeon's perspective
during their training.
Speaker 3 (30:56):
I see, Well, John, you know, you're known for so
many different things. I'm going to only touch on two
of them. The first I wanted to talk about was
the bovine jugular vein. I know that you pretty much
were the person who came up with this idea. I
did not know that until I started reading about you.
Tell me how you even had this idea to potentially
(31:19):
use a cow vein and a child. How did you
study this? Was there a lot of resistance when you
first started thinking about this. I'm fascinated to know the
story of that.
Speaker 6 (31:31):
Well, it goes back to my residency, and you know,
in the or mid nineteen seventies, late nineteen seventies. You know,
we'd been replacing the pulmonary valve with xenographs, usually a
Pouresen aortic valve and a day ron two and we
(31:51):
were taking a good number of those out of small
children that they just were not durable, and so I
I was very.
Speaker 4 (32:02):
Interested in problem solving.
Speaker 6 (32:04):
That started at the NIH with the epical aortic conduit
to treat tunnel sub aortic stenosis and Doctor Morrows it
fixed this problem, and so I worked long and hard
on that, on that project. But like that, when I
was finishing my residency, I decided we needed to come
up with something better than a xenographed inside a dacron too,
(32:29):
and felt that maybe the dacron was the big problem
and not necessarily the xenograph.
Speaker 3 (32:34):
So is that like a handcock you're talking about like
a handcock conduct conduct.
Speaker 6 (32:40):
So one of the first things that I did when
I came back to IU and Doctor King, my boss
allowed me to have an animal research laboratory that the
department paid for.
Speaker 4 (32:54):
The trouble of it, there was.
Speaker 6 (32:55):
No chronic animal care facility for large animals that so
that was a problem because in order to study RVPA
conduits and pulmonary valves.
Speaker 4 (33:06):
You had to follow these animals over a number of
months to gears.
Speaker 6 (33:11):
To solve that problem, My wife Carolina and I bought
a large home about twenty miles south of Indianapolis that
had a big dog cannel on it, and so I
gave my lab technician, Randy Bill's free rent. If he
would transport the animals from the kennel to my animal laboratory,
(33:32):
we'd operate on him and then he would take them
back and care for them in the kennel until they
needed a next hardcat or till.
Speaker 4 (33:40):
They needed to be brought back up where we.
Speaker 6 (33:44):
Looked at the conduits that we'd explanted or that we
put in months or years before.
Speaker 4 (33:49):
And that was.
Speaker 6 (33:50):
During that period of time that you know, we were
able to do that.
Speaker 4 (33:55):
Now, we were.
Speaker 6 (33:58):
The ones that bought the farm and supported it, but
doctor King took care of my other research needs. Now,
the trouble of it is that I was shown the
Boving juguter vein at a surgical meeting in nineteen eighty eight,
and a company called Venpro was using Boving juguter veins
to treat vericos veins in adults in Europe and I
(34:22):
met this biomedical engineer at a previous meeting and he
showed this to me in a little jar gluter aldehyde.
He says, do you think you could use this in
congenital heart surgery.
Speaker 4 (34:34):
Well, he allowed me to look at it and examine it.
Speaker 6 (34:37):
And it had all of the features that I thought
would be an ideal RVPA.
Speaker 4 (34:42):
Conduit for a baby or a child.
Speaker 6 (34:45):
And so he gave me the first two that he
gave me the only two that he had at that
period of time, and he'd gotten those from a slaughterhouse somewhere.
Speaker 4 (34:56):
And had treated the valves with gluter aldehye.
Speaker 6 (34:59):
Well, he couldn't provide more for me, so I decided
we can solve that problem. So there was a slaughterhouse
just south of Indianapolis, and I went and talked with
the owner and told them what I wanted to do,
and I wanted to study this problem and children.
Speaker 4 (35:14):
And he allowed my.
Speaker 6 (35:16):
Lab technician, Randy Bills, and my resident who was in
my laboratory at the time, Vincetavo, to come down once
a week or once every other week and harvest the
jugular vein from cows that he was slaughtering for meat
and so we got very proficient and so in an
hour in the morning, so we couldn't slow down their process.
(35:39):
We would harvest both jugular veins from a cow's neck
and you know obtain there's three valves in each side
of that vein. So we had six conduits in one
trip to the slaughterhouse and we glued a ount I
preserve them and then put them in animals, and we
did that over a number of years.
Speaker 3 (35:58):
I didn't understand that the jugular vein and account has
three valves in it.
Speaker 6 (36:02):
Actually it's alternating between tricuspid and bicuspent valves, and on
one side it may be different than the other.
Speaker 4 (36:10):
We decided that the tried leaflet.
Speaker 6 (36:13):
Valves were probably UH going to be most acceptable to
the FDA.
Speaker 4 (36:18):
Well.
Speaker 6 (36:19):
Venpro also was showing this valve to congenital heart surgeonsine
Europe and so U. But Venpro used all of the
data that we obtained in my research laboratory at Indiana
to satisfy UH Europeans UH for the CEE mark, and
(36:40):
so they got a cee E mark and Europe to
use it in children about a year before we were
able to use it in the United States.
Speaker 3 (36:48):
Using your data using data, so they got to.
Speaker 4 (36:54):
See e mark.
Speaker 6 (36:55):
However, I had a child with trump is archiosis that
I read that I operated on as a newborn, and
his plmonary homograph became very regurgit in about six months. Yeah,
So I contacted the FDA and I said, you know,
this valve has ce mark in UH in Europe. I've
(37:15):
done all the animal research for it. Can I use
one of their.
Speaker 4 (37:19):
Valves in a in a child at Riley Hospital?
Speaker 6 (37:23):
And lo and behold I did, and that child did
very well and the valve lasted him for a decade
or more. And then that started a long series of
both and juguter vein conduits for the right right heart reconstruction.
Speaker 3 (37:39):
John, Why why does a both find jugular vein graft
have better longevity than a homograft?
Speaker 5 (37:47):
I wasn't aware that that was the case.
Speaker 6 (37:50):
Well, I think there's an immune response to any homograft,
you know, I thought that from the very beginning, and
and and in our laboratory studies and our histology studies
indicate that.
Speaker 4 (38:01):
Now.
Speaker 6 (38:02):
I think the decellularized pullmenty of homographs that we're using today,
the ones that are furnished by a company called pryo
life are more durable than the ones that were not decellularized.
So that's that's why I thought the nice thing about
a juguter vein. It's used to venus pressure. The leaflets
are delicate, they open easily, they close nicely, and all
(38:24):
of that, and so like a homograph which is used
to venus pressure, for the most part, they should be
the same. But the boving juguar vein outperformed pull many
homographs in my experience, until the day that they became
a decellularized, which was about two thousand and eight two
thousand and nine, So now we use them both.
Speaker 4 (38:46):
We had small children.
Speaker 6 (38:48):
We use bovine juguar veins today for most of the
complex repair, but when I'm doing a ross procedure, which
we do quite commonly in Indiana, we use pullmenty homographs
that are decellularized. So I haven't given up totally on
so many homographs, but we used the contager for.
Speaker 5 (39:08):
Now.
Speaker 3 (39:09):
I'm wondering, I'm sure you were aware that Philip Bonhoeffer
was taking your valve and putting it in a stent
and creating the melody valve. Did you have anything at
all to do with that did he contact you or
speak with you about it as he was developing that.
Speaker 6 (39:25):
I spoke with him, I think on one occasion, and
I sort of communicated through the company my experience and
that sort of thing, and so I keep I tried
to get Metroni to do a comparative study with a
percutaneously placed boba and jugiter vain with a surgical implanted,
(39:48):
but nobody would ever do it. I sort of thought
that maybe the surgical implant with valves would last a
little bit longer because of some of the early stint issues,
but I think they're probably quite comfortable today.
Speaker 3 (40:02):
I actually think the opposite, John, I think that when
they're putting on a stent, they last longer because the
stent usually protects it. Now, initially you probably aware that
we didn't realize you had to put a lot of
protective metal spare metal stents around it. But now that
we sort of routinely put one or two or even
(40:23):
three bare metal stents before placing the melody, it seems
to have pretty good longevity. Although, as I'm sure you're
also aware, people are slowly moving away from it and
moving more towards the edwards valve than Sapien valves, but
still a very popular valve used all the time, and
a lot of really great aspects to it. Now, the
(40:44):
other aspect of your career, which we haven't even talked about,
just shows you how doctor Brown has just been polymeth
and it's just involved in so many different things. You
were the first person to perform a pediatric heart transplant
in Indiana. Now, how did you get involved in that?
And were you the lead transplant surgeon for a long
(41:04):
time there?
Speaker 4 (41:06):
Well, I did start the program. Yes, I was the
lead surgeon for both adults and children. But I had
to help. I had some great pediatric cardiologist Randy.
Speaker 6 (41:18):
Colwell and Bob Dara, and then Jackie O'Donnell on the
adult side. And then we hired Mark Turntine as our
first transplant fellow, and before he finished, before he'd even
started a cardiothoracic residence, he finished general surgery and he
came to us as a transplant fellow and fell in
love with general art surgery as well as transplantation, and
(41:41):
he was technically excellent, and so as soon as he
finished his residence, we hired him and he very quickly
became the leader of our pediatric art transplant program, and
he and I probably did you know, one hundred and
fifty to two hundred and fifty adult and pediatric art
transplants together. So anyway, we've had a great team to start.
(42:07):
You know, we were fortunate enough early in the career,
and I think it still holds that we did the
one and only twin to twin heart transplant that's ever
been done in the world.
Speaker 4 (42:17):
Turned out, the.
Speaker 6 (42:20):
Little boy of the twins had hypoplastic left heart syndrome
and the little girl had well, the little boy was
born with a new cord and was brain dead, and
the little girl had hypoplastic left heart syndrome. So we
took brother's heart and put it in the little girl.
(42:40):
She's now thirty four years old and has not had
a documented significant rejection episode in the thirty four years
she's been alive.
Speaker 4 (42:51):
She's still on suppression.
Speaker 6 (42:52):
We've been afraid to stop it, but she's done extraordinarily well.
Speaker 4 (42:56):
Wow, but we you.
Speaker 6 (42:58):
Know, in the early eighties, our results with a Norwood
procedure left quite a bit to be desired, so we
offered heart transplantation to babies born with hypoplastic left arts
syndrome right, and the family participate in the decision making
(43:18):
and so and then later even did the study comparing
the outcomes.
Speaker 4 (43:23):
Of the two approaches. So any you know, we.
Speaker 6 (43:25):
Got started early on in the mid nineteen eighties and
have continued today and still have a strong congenital heart
transplant program.
Speaker 3 (43:36):
Well, for those in the audience, it's so late on
Monday evening. Doctor Brown has really been so kind to
speak with us about his extraordinary career. But I think
I would be remiss without asking you to speak a
little bit about your family. I mean, we've already heard
that your poor wife, Caroline allowed you to buy a
farm with a kennel to contunct your research. If that's
(43:58):
not love, I don't know what it is. But I'm wondering.
You know you were married, You're married over fifty years.
I know that you have three kids and multiple grandchildren.
How were you able to have such an extraordinarily productive
professional career and still have a very meaningful personal life
(44:20):
and a family life.
Speaker 4 (44:23):
Well, I have to give most credit to Carolyn.
Speaker 6 (44:27):
She knew that I was passionate about what I was doing,
and she knew the importance of what I was doing,
and so she was just able to shoulder a lot
of the responsibility when our kids were young and that
sort of thing.
Speaker 4 (44:42):
She was just there.
Speaker 6 (44:45):
You know, she interrupted her teaching career so that she
could raise our children when they were young, and then
as they got to be teenagers, I tried to you know,
I had to make rounds with me at the hospital,
and I took to each one of them on a
heart transplant, harvest and implantation and that sort of thing.
Speaker 4 (45:06):
So they had a little bit of inkling about what's
going on.
Speaker 6 (45:08):
But you know, Caroline made it all possible for me
to pursue this kind of a life, of a life
that I've loved to do.
Speaker 4 (45:17):
It.
Speaker 6 (45:17):
It's been grueling. You know, we talk about work life balance.
That term wasn't even invented during my you know, that's
that's a that's a that's a term that four didn't
didn't exist in the seventies, eighties, and nineties and even in.
Speaker 4 (45:35):
The early two thousands. So you know, the training was grueling.
Speaker 6 (45:41):
The responsibility that you had for your patients, you know,
it just it was one of those situations where you know,
you couldn't promise a family the outcome that you both
wanted for their child. But I guess I would promise
each family that I would treat their child as if
a child were my own.
Speaker 4 (46:01):
And you know, that served me very.
Speaker 6 (46:04):
Well because but it required a lot of phone calls
at night, a lot of interrupted meals and things like that.
Speaker 4 (46:12):
But I guess if.
Speaker 6 (46:14):
I had to say in a you know, Carol Anne
deserves a major amount of crendit. But our kids were understanding.
They all turned out to be great kids. I think
they understood what I was doing and appreciated what I
was doing. And then family gave vacations were one of
(46:34):
those things where we all got together, you know, for
a couple of weeks in the summertime when they were off,
and then Carol Anne and I always attended a ski
meeting with other congenital cardiologists and cardiac surgeons, which gave
us sort of a yearly honeymoon, so we could have,
you know, a week to spend with each other and
(46:55):
without kids, and both of our sets of parents made
that possible to look after our kids while we were going.
Speaker 4 (47:01):
So there are many many facets of people.
Speaker 3 (47:05):
That have John, did any of your kids or your
grandchildren go into medicine or any area related to medicine.
Speaker 6 (47:13):
Well only proof related. My oldest son Jason works for
Eli Lilly and Company, and so he's related there. But
you know, he used to come to the operating room
and videotape complex and genital operations, so all of that.
You know, we had a great time together and still do.
Speaker 4 (47:32):
My daughter runs a AI company that.
Speaker 6 (47:37):
Deals with hospitals and pharmaceutical companies looking at customer feedback
and so she has a startup company and so she's
all into medical.
Speaker 4 (47:46):
Stuff as well. And then my youngest son, Peter, is a.
Speaker 6 (47:49):
Physical therapist out in Colorado and he's married to a
nurse practitioner.
Speaker 4 (47:53):
So there's a lot of medicine in.
Speaker 5 (47:55):
Our family, no question.
Speaker 6 (47:57):
But none wanted to be art surgeons were paying attention.
Speaker 4 (48:03):
You didn't want the lifestyle that you that you have
had all these years. Right.
Speaker 3 (48:08):
Well, you know you've achieved so much, been honored by
so many, so many times in your career. I'm wondering,
is there one thing that you're most proud of in
your professional and personal life as you think back on
your entire the entirety of your massive career. I mean,
really have two extraordinary achievements. A surgeon for over forty
(48:30):
five years and married for did you say fifty five
years or fifty six years?
Speaker 4 (48:35):
Fifty six our fifty six anniversion.
Speaker 3 (48:38):
Wow, So those are those are two pretty amazing accomplishments.
I'm wondering are what do you view as your biggest
accomplishments when you look back upon your very extraordinary life.
Speaker 6 (48:51):
Well, again, I have to give pan to Carol and
who's sort of supported me and made a whole for
me and our kids and that sort of thing along
the way. And I've had some great mentors along the
way and colleagues, you know, I've had pediatric cardiologists that
were just superb and you know partners, you know, Mark Turntine,
(49:15):
Mark Rodefel, Jeremy Herman, you know, wonderful people who sort
of bought into the same philosophy that I had about
patient care, it particularly as it.
Speaker 4 (49:25):
Applies to children.
Speaker 7 (49:27):
And so we've had at a great team and we've
worked very hard and we've i think accomplished a fair
amount during that forty six years or shore that I've
been doing it.
Speaker 3 (49:39):
So John, I'm going to finish up now. You're I
know you're still working a little bit, but you're like
I guess. I guess you're like sort of semi retired.
What do you do? What do you do in your
free time? I mean, you've spent the last half century
operating continuously. What is a certain of your magnitude?
Speaker 4 (49:57):
What do you do?
Speaker 5 (49:58):
Would you have some free time?
Speaker 4 (50:00):
Well, you know, I'm busier now that I think that
I have ever been.
Speaker 6 (50:04):
Taryland and I have about a six hundred acre farm
in southern Indiana that we manage. We don't do any
of the farm work, although I love to get on
a tractor and do bush hogging and things like that
for week control. I love to hunt, I love to fish,
and I love to spend time with my grandkids. They're
all in various sports and musical sort of things, and
(50:24):
so Karlane and I three or four times a week
are in one performance or in sporting event or another.
So we spend an awful lot of time with our grandkids.
And my mother, who's one hundred and two, it's still alive,
is still very sharp, and so we try to get
down there weekly to see her. All my siblings are
(50:44):
still alive, and my two older brothers are in their
mid eighties and that sort of thing, and all you know,
very active people, so I'm very fortunate in their regard.
So I'm proud of I guess my parents who taught
us how to work hard.
Speaker 4 (51:02):
I'm proud of Caroline.
Speaker 6 (51:03):
I'm proud of our kids, and I'm proud of sort
of the legacy of patient care that we've left behind.
It's not what you do, it's what you leave behind
that sort of counts. And I'm very proud of the
kind of program that we have at Indiana University and
what we do for kids.
Speaker 3 (51:19):
Well, that's a wonderful summary. Well, doctor Brown, I just
can't thank you enough. What an inspiring story. I think
I don't know what I want to do now. I
think I have to go to the gym and workout
or if it's so inspired by the story of your life.
Thank you so very much for all that you've done
in your career, of course, but most importantly tonight, thank
(51:42):
you for spending a little bit of time with us
in what sounds like a very busy, semi retired life
to speak about your life. And I'm sure everybody listening
to the podcast is going to be very excited to
hear from you and hear about you.
Speaker 6 (51:54):
Well, thanks very much, Rob, It's been my pleasure. Thanks
for the opportunity.
Speaker 5 (51:58):
Thank you very much.
Speaker 1 (51:59):
Well, I'm sure sure that, like me, you are inspired
by doctor Brown's story. He made so many interesting points
and certainly has lived a wonderful life helping so many
and I don't mean just patience, but also family and colleagues.
I think his dedication to training the next generation has
been unparalleled. And if I were to take just one
(52:20):
quote of his many from this wonderful conversation, it would
be when he stated that quote, it's not what you do,
it's what you have left behind that counts. I think
we can all use that in thinking about our own
lives and what each of us can leave behind to
make this place a better one. I'm most appreciative to
doctor Brown for taking time out of a very busy
(52:41):
semi retirement to speak with us this week on Petiheart.
To conclude this three hundred and ninth episode of PETI
Heart Pediatric Cardiology, Today honoring doctor John Brown, we hear
the wonderful Italian baritone Ettrre Bastianini singing the lovely nineteen
eleven Neapolitan love song corn Grato by Cardillo. And this
(53:03):
song was actually written in the United States, though was
perhaps the only such Neapolitan love song not penned in Italy.
Bascionini was known as one of the greatest baritones of
his day, singing throughout the world, and he sadly and
tragically died in nineteen sixty seven at the young age
of only forty five, after battling throat cancer for a
(53:24):
number of years. Thank you very much for joining me
for this three hundred and ninth episode, and once again
I'd like to thank doctor Brown for spending time with
us and sharing his life with us. I hope all
have a good week.
Speaker 8 (53:35):
Aheit coaryary comi am i mavorimmieni no taste for the.
Speaker 2 (54:03):
Carta your doty for a.
Speaker 4 (54:06):
County, not.
Speaker 8 (54:10):
For cottery cattery, carrying the auditionary stopper locking aspousan little
japi in sa.
Speaker 2 (54:29):
Forts totical.
Speaker 8 (54:41):
Call called grat tapingary on me.
Speaker 4 (55:00):
The passa.
Speaker 2 (55:04):
And tabbier sackti pussletle and no taper
Speaker 8 (55:42):
Sack
Welcome to Pedheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I'm the host of this podcast. I
am Professor of Pediatrics at the Icon School of Medicine
at Mount Sinai, where I'm also the Chief of Pediatric Cardiology.
Thank you for joining me for this three hundred and
ninth special episode of Pdheart. I hope all enjoyed last
week's episode, in which we spoke with doctor David Hogansen
(00:36):
of Boston Children's Hospital about computational fluid dynamic modeling for
patients who are undergoing single ventrical palliation. Doctor Hoganson explained
to us the myriad manner in which he and his
team are able to perform virtual surgeries to determine the
optimal way to perform a fontine, and the multiple possible
uses of this technology going into the future. For those
(00:58):
of you interested in the find tan single ventricles and
surgical modeling, as well as surgery in general, I'd recommend
you take to listen to last week's three hundred and
eighth episode. As I say most weeks, If you'd like
to get in touch with me, my email is easy
to remember. It's Ptiheart at gmail dot com. This week,
we'll be spending the entire podcast speaking with the noted
(01:19):
congeneral heart surgeon, doctor John W. Brown, who is a
renowned cardiothoracic surgeon and who helped found Indiana's first pediatric
heart transplant program. Doctor Larry Markham of Riley Hospital for
Children in Indiana reminded me recently that Riley Hospital was
celebrating its one hundredth anniversary this year, providing amazing care
(01:39):
to children in Indianapolis, Indiana. During that time period, the
pediatric heart program has grown in volume and reputation, and interestingly,
it has had only four surgical chiefs in its entire history,
and these are namely doctor Harris Schumacher, who was a
disciple of doctor Alfred Blaylock and started working there in
(01:59):
the night nineteen fifties, followed by doctor Harold King and
then doctor Brown and recently doctor Mark Turantine. Doctor Brown
worked at Indiana University Hospital and Riley Hospital for Children
for most of his attending surgical career, spanning an incredible
forty six years. He performed the first pediatric heart transplant
in the state in nineteen eighty eight and also one
(02:22):
decade later, implemented the nation's first bovine venus valve implants
in a thirteen month old child, and he did this
based upon his long time research in this arena, introducing
this valve into congenital heart surgery. And we all know
how important that concept has become for us in both
surgery and more recently trans cathar valve procedures. Doctor Brown
(02:43):
was the chief of carniothoracic surgery in Indiana for over
twenty years and it's estimated that he has completed over
fifteen thousand pediatric art operations at Riley Hospital and another
five thousand in adults at Indiana University and Methodist Hospitals.
In twenty thirteen, doctor Brown was honored by the Indiana
(03:03):
University School of Medicine with the formation of the John W. Brown,
MD Endowed Chair of Cardiothoracic Surgery. Doctor Brown has a
long list of other honors and awards, including the John B.
Hicckham Award in nineteen seventy, Corps Vite Heart of Life
Award in two thousand and eight, Distinguished Faculty Award in
twenty ten, Sagamore of the Wabash in twenty eighteen, and
(03:27):
he was recently awarded the Indiana University bi Centennial Medal
in recognition of his distinguished contributions to Indiana University in
twenty nineteen. There are so many contributions of doctor Brown,
but clearly his work in expanding pediatric open heart surgeries
in newborns and infants at Riley is one of his
most long lasting professional legacies. He retired from full time
(03:49):
practice in twenty twenty one, and he is the first
Harris B. Schumacher Professor Emeritus of Surgery, and I am
told that he continues to this day to help his
surgical colleagues intermittently in the operating room. In addition to
all of these wonderful professional achievements, doctor Brown has been
married to his high school sweetheart, Carol Ann Brighton Brown,
for fifty five years, and they have three married children
(04:13):
and seven grandchildren. We'll speak today with doctor Brown about
his life and times, about balancing his family life with
his professional one, and what he believes are the most
enduring and important contributions he's made. And so, without much
further ado, let's welcome doctor Brown to.
Speaker 2 (04:29):
P D Heart.
Speaker 3 (04:30):
Okay, I'm here now with doctor John Brown. John, thank
you so much, for joining us this week on the podcast.
Speaker 4 (04:35):
Well, it's a pleasure to be here.
Speaker 3 (04:37):
It's a great honor to have you, I have to say,
and I've been very excited a lot of buzz on
the internet about you joining us this week. And I
want to start by thanking doctor Larry Markham of Riley
Children's for being so thoughtful to offer this suggestion of
talking with you. And I'm really honored that you would
spend some time with us, So thank you very very much.
(04:59):
You know, I thought to start, I've asked. We've had
a number of different famous cardiac surgeons and cardiologists on
the podcast, and I usually start by asking, you know
something simple like where did you grow up and how
did you decide to become a doctor and then a surgeon.
Were there other doctors in your family or any other
mentors in medicine early in your life that you looked
(05:20):
up to.
Speaker 5 (05:21):
And maybe gave you an idea.
Speaker 4 (05:23):
Well, we'll start at the beginning.
Speaker 6 (05:25):
I grew up on a forty acre farm in south
central Indiana, a very nuclear family. My parents and grandparents
were farmers. My dad sharecropt and other three hundred acres,
and my brothers and I helped our dad farm as
we were growing up, and so my two older brothers
(05:48):
and my younger sister were the first in our family
to attend college. Our parents thought education was important for
us to do, and they thought farm life was great. However,
they thought that we had maybe the potential of doing
something more than farming with our lives.
Speaker 4 (06:07):
So I went to a little high school.
Speaker 6 (06:11):
There were seventeen in my graduating class from high school,
about third of the people in my class. I went
on to college, but I thought, you know, as as
I entered my junior and senior year, that I would
follow in my older brother's footsteps and probably go to
(06:33):
Purdue University and become an engineer. But as I entered
my senior year, I decided, you know, that's not what
I really wanted to do.
Speaker 4 (06:43):
My wife, Carol Anne, and I.
Speaker 6 (06:46):
Started dating when she was in the seventh grade and
I was a sophomore in high school and we've been
going steady and then been married for fifty six of
those years. And I'm very proud of her because she
wanted a college education as well well, wanted to become
a special ed teacher and all of that.
Speaker 4 (07:03):
So anyway, it sort of worked out.
Speaker 6 (07:06):
That we stayed together and became married, or we were
married when I was in a junior medical student, and
so she's been through.
Speaker 4 (07:18):
All the phases of surgical training.
Speaker 6 (07:20):
And has been dedicated and loved and supported me for
the fifty six years of our marriage.
Speaker 4 (07:31):
So it's very great.
Speaker 5 (07:32):
So that's extraordinary.
Speaker 6 (07:35):
I didn't know anybody in medicine when I my math
teacher in high school suggested that I take an aptitude test, and.
Speaker 4 (07:48):
I took that aptitude test.
Speaker 6 (07:50):
It combined my sort of desire to be a problem
solver and to work with my hands, with the faith
that we grew up with that, you know, a purpose
in life was to do something for others, not just ourselves.
So that aptitude test was strongly favoring a career in medicine.
(08:14):
And I'd never considered it before that aptitude test, So
I give a lot of credit to pointing me.
Speaker 4 (08:20):
In that direction.
Speaker 6 (08:21):
So nineteen sixty three I went to Indiana University at
Bloomington as a pre med student. However, my high school
didn't offer physics, chemistry, or a foreign language, so I
to start out with beginning courses at IU, and then
it took me a semester to catch up with my
(08:43):
pre med class, and so you know, and because I
was borrowing money for room and board and tuition, I
was able to finish undergrad and medical school in seven years,
which was allowed at that point in time, so I
wouldn't run up more educational death than I had to.
Speaker 3 (09:05):
And your girlfriend and then wife did she also go
to IU as well.
Speaker 4 (09:10):
She went to IU as well.
Speaker 6 (09:12):
She was two years younger than I, so we only
spent overlapped the one year at Indiana University in Bloomington.
And we chuckle about this now. She said, you were
so concerned about whether you'd be able to get into
medical school or not. We didn't do a lot of socializing.
We didn't have a lot of movies or dates or
ballgames to go to. We spent a lot of time
(09:34):
both studying in the library and that sort of thing.
Speaker 4 (09:36):
But anyway, get paid in the long run.
Speaker 3 (09:40):
So, John, you went to medical school, and when you
were in med school, obviously at some point you decided
you wanted to be a search And how did that
decision come about?
Speaker 4 (09:50):
Well, it was fairly easy.
Speaker 6 (09:52):
I guess the courses that I liked the most in
the first two years of medical school were anatomy and physiology,
and where some of my uh you know, classmates sort
of stood back during cadaver dissection and that sort of thing,
I wanted to be all about it. And so I
(10:14):
loved the anatomy and and I loved the physiology, and
the heart was the heart physiology was measurable, and cardiac
surgery was in its infancy at.
Speaker 4 (10:27):
That point in time, and I thought, cardiac.
Speaker 6 (10:30):
Surgery sounds like it would be a great field to pursue.
And then I had the opportunity, after my second year
of medical school to spend three months in a sort
of an off quarter with two adult cardiac surgeons at
a large private hospital in Indianapolis, the Methodist Hospital, John Pittman.
Speaker 4 (10:53):
And Harry Sedaris.
Speaker 6 (10:54):
They had one general surgery resident for the two of them,
and so when I spent those three I was first
assistant on most of their cardiac pass that where the
general surgery resident wasn't spending his day. And so they
gave me enormous responsibility as a young medical student, not
(11:15):
only in the operating room, but taking care of their
patients post operatively. And actually they hired me to babysit
the fresh pumps for the hours of about six pm
to midnight on those cases that I'd scrubbed on. So
I got a lot of experience as a medical student,
(11:37):
you know, with cardiac surgery.
Speaker 4 (11:38):
Then I went back to my junior year. I loved
all of my.
Speaker 6 (11:41):
Clinical rotations medicine as well as surgery, but I gravitated
to the surgeons because I was fascinated by what they.
Speaker 4 (11:50):
Were able to do and how they were able to.
Speaker 6 (11:52):
Change the courses of patients lives with what they did
in the operating room. And then what really sealed the
deal was as a conj geral heart surgeon, I spent
a month rotation with doctor Harold King, who was chief
of the Cardiac service at Indiana University, and he was
a congenital heart surgeon, and I was truly amazed in
(12:13):
my rotation with him about what he was able to
accomplish in the operating room with children.
Speaker 4 (12:19):
With congenital heart disease.
Speaker 6 (12:20):
And decided at that time, if I could do anything
with my career, I'd like to do.
Speaker 4 (12:25):
What Harold King did.
Speaker 6 (12:26):
And so I've sort of been living my dream in
that respect.
Speaker 3 (12:31):
So I guess then it would be fair to say you.
Speaker 5 (12:33):
Looked up to him a lot.
Speaker 3 (12:35):
I'm guessing based on that time and what kinds of
operations this is I guess must be in the late
nineteen sixties or is this the early seventies.
Speaker 4 (12:46):
Or late nineteen sixties?
Speaker 5 (12:47):
Seven?
Speaker 3 (12:47):
Right, So what kinds of surgeries were you observing? What
kind of congeneral heart surgers were you watching at that time?
Speaker 6 (12:55):
Well, I think the ones that made the biggest impression
on me were completely desemplty effect ab canals and tetrology.
And doctor King was a master surgeon, and in those
days we didn't have.
Speaker 4 (13:08):
You know, pulmary valve replacements.
Speaker 6 (13:09):
They all had, you know, all the children with pulmonary
Stenosi's got a big transangular patch and were left with
pulmonary regurgitation. But his survival rate was in the high
ninety percent, even in those early days, and so he
had excellent results. And the residents that I scrubbed, you know,
(13:31):
as all the rotation with were very impressed. He says,
you know, there's nobody in the country that I think
has better outcomes than he does with some of these
more complicated procedures.
Speaker 4 (13:42):
In those days.
Speaker 5 (13:43):
I see, I see.
Speaker 6 (13:45):
Repalliated many things, as you well, know, shunts and pa
bandings and that sort of thing were commonplace, So.
Speaker 3 (13:53):
You know, I was wondering it must have been quite
an extraordinary change over the course of your career. Starting
your career in an era of palliation and ending your
career in primary repairs. That must have been quite a
lot of change. I guess it was exciting, but probably
I guess you never stopped learning the entire forty five
(14:15):
years you were practicing exactly.
Speaker 6 (14:18):
It was a very exciting time, and I think, you know,
I learned early on in my career to I joined
an organization called the Congenital Heart Surgeon Society, and so
these were a lot of my peers from around the
country and that sort of thing, and we had an
annual meeting in Chicago and talked about the problems that
(14:39):
we had encountered with some of these early like arterial
switches and Norwood procedures and things like that, and worked
out a lot of details. And I consider that educational
opportunity to be one of the most important in my
early career.
Speaker 3 (14:56):
Sir John, I know that you did your congenital training
in Michigan. How did you come to decide to go there?
I mean, obviously we all know that Michigan is one
of the great congenital hearts centers. How did you make
that decision? There were a couple of great places at
that time.
Speaker 4 (15:12):
Sure, well.
Speaker 6 (15:13):
One of my early mentors, John Pittman, the privates cardiac surgeon,
had trained at University of Michigan, and then doctor Harold King,
my chief at Indiana University, and Herb Sloan, who was
the chief of cardiac surgery at Michigan, were close friends,
and he said, you really ought to look at the
University of Michigan for your cardiac.
Speaker 4 (15:35):
For your general surgery and cardiac surgical training.
Speaker 6 (15:38):
And although I visited other places because I wasn't sure
I could get into Michigan, Michigan was my first choice
and they accepted me, and so I spent from nineteen
seventy and finished up my cardiothoracic surgical training in nineteen
seventy eight, and then I had two years in the
midst of that to spend at the NIH with Glenn
Morrow on the cardiac surgical service, and he gave us
(16:01):
a lot of responsibility, not only in the operating room,
but also I taught us how to write manuscripts and
papers for the surgical liturgy.
Speaker 3 (16:12):
You know, it's always seemed to me that surgeons who
trained in Michigan are uniformly pretty good. And the reason
I say that is it's always seemed to me like
maybe they allowed the surgical trainees to do more there
than in other places. What did you as a fellow,
(16:37):
you know, in the nineteen seventies, what did they allow
you to do? Were you like first operating on complex
babies and how did that work? Well?
Speaker 6 (16:47):
No, obviously we were obviously did a lot of the
pali of operations, and we were first assistants on the
complicated congenital procedures. But you know, we only got to
spend a few months on the congenital service, so we
weren't allowed to do all that much. But as a
(17:07):
general surgeon, we were given tremendous responsibility at the what
we called them Wayne County General Hospital. We sort of
ran the service, operated day and night, you know, were
the staff was in the room, but not necessarily scrubbed
on the cases. So I would do complex abdominal operations
(17:28):
and bascular operations with the help of a junior resident.
And so we did get a tremendous responsibility in and
I think, you know that's as I look.
Speaker 4 (17:40):
At training now, it's not quite the same.
Speaker 6 (17:43):
We were not allowed to give our residents that much independence.
Speaker 4 (17:48):
So, you know, a lot of what I learned.
Speaker 6 (17:51):
About congenital heart surgery I learned when I came back
to Indiana at the STAFF, and what I learned at
the NIH with Doctor Morrow.
Speaker 4 (17:58):
Those two years.
Speaker 3 (17:59):
I was I'm interested to hear about how you think
about training like today. I know there are residencies where
you can basically categorically choose to do cardiac surgery right
from the start, and then there are the more traditional
path I guess is where you do general surgery followed
by a fellowship in cardiac surgery. I'm wondering it sounds
(18:22):
to me like you found your general surgical experience very,
very helpful. What do you think about the present move
to sort of turn programs more into these sort of
cardiac surgical residencies rather than the old, more traditional approach.
Speaker 6 (18:38):
Well, initially I was skeptical because I thought everybody had
to do their training the way I did, and that
I love the independence that I had as a general surgeon,
sort of gain surgical maturity, and we've learned how to
work with others and junior people and that sort of thing. However,
(18:59):
with a combined residency program that we have now, I'm
quite impressed with the people who elect to do the
integrated program, where they basically have a cardiothoracic surgery residency,
spend a good amount of time in their first two
or three years on general surgery, but the rest of
(19:20):
their time they spend on cardiothoracic surgical services. And I
have to admit our early graduates seem to be quite
competitive with what I considered.
Speaker 4 (19:32):
The traditional training in.
Speaker 6 (19:34):
The past, so I think it was an experiment, but
I think it's probably going to work out now. You know,
once you finish your residency and congenital heart surgery, you're
not a train congenital heart surgeon because you're not generally
allowed to do a lot of complex neonates.
Speaker 4 (19:53):
And that sort of thing.
Speaker 6 (19:54):
As a cardiothoracic residence, you help. However, I've helped my residence.
They do more than a fifty percent of an arterial
switch and a good portion of the norwoods and the
avy canals and the tetrologies, and you know, the whole
gamut of things. But you know, they don't do it independently.
(20:19):
We're always scrubbed and in the operating room and directing
the operation whenever our residents are with us.
Speaker 3 (20:25):
And was this always the case even when you were
in training or do you think that when you were
a resident and a fellow in congenital heart surgery that
you had more independence and were able to do more
of the surgery, allowed to do more of the searchers
or is it similar do you think today? No?
Speaker 6 (20:43):
I think definitely residents this day and age are not
allowed to do as much.
Speaker 4 (20:49):
As I was allowed to do.
Speaker 6 (20:52):
You know, I think during my residency at Michigan and
the you know, the program wasn't all.
Speaker 4 (20:57):
That big in the nineteen sixties.
Speaker 6 (21:00):
Well in the early nineteen seventies, we you know, we
probably did two hundred total cases or two hundred and
fifty total cases a year.
Speaker 4 (21:07):
Of course it's three or four times that now.
Speaker 6 (21:11):
Nflvy, who's was the long term chief there was my
junior resident, and he and I spent a lot of
our residency, both in general and cardiac surgery together and
have remained close friends ever since that time. But it's
had a great reputation, and I think they train excellent
surgeons in their residency program as I think we do
(21:33):
here at IU as well, because I think our residents
get to do generally considerably more than residents in many
other programs, at least the ones where I talk with
the residents.
Speaker 3 (21:45):
I see, Well, you know, getting back to your history, John,
you finished up your training, and then how did you
get a job back at Indiana University? I know you
had trained there, but and also at Riley. I mean
did you when you started were you doing both congenital
and regular adult cardiac surgery. I know that in the
past surgeons very routinely would do that, And if so,
(22:09):
did you at some point say I'm not doing adult
stuff anymore? How did that transition work? And how did
you start your career there?
Speaker 4 (22:17):
Well?
Speaker 6 (22:18):
I met with doctor King, the chief of the cardiac
service and who was a congenital heart surgeon, as a
senior medical student, and I said, my dream would be
to come back to Riley and to IV and.
Speaker 4 (22:34):
Practice congenital heart surgery.
Speaker 6 (22:36):
Now, you know, I don't know whether I can get
the training that that requires.
Speaker 4 (22:42):
You know, what, I was a medical student. I had
no idea.
Speaker 6 (22:45):
It was a very competitive field, and so I just
said I'd like to keep in communication. So fortunately, in
nineteen seventy seven, a year after my my general surgery training,
I took my general surgery boards in Indianapolis, and so
(23:06):
I had one more year of cardiac surgical training, which
I finished in June of nineteen seventy eight. So I
went to his office in seventy seven and I said,
I'd love to come back to Indiana University and to Riley.
And he says, give me a week or two to
do some checking around about, you know, sort of how
(23:29):
you're perceived by your Michigan people, and i'll get back
with you. Well, within a couple of weeks he said,
you're hired. You've got a job at Indiana University. So,
you know, as I was starting my chief year as
a cardiothracic residence, I knew I was going to be
able to go back to Indiana and to go back
to Riley and you know, sort of live my dream.
(23:53):
So it's just worked out them very well in that regard.
Speaker 3 (24:01):
Well, I'm guessing you did pretty well in Michigan then,
now did you? Were you always only performing congenital heart
surgery asn't attending or did you do a lot of
adult stuff in the beginning of your career.
Speaker 4 (24:14):
I did.
Speaker 6 (24:15):
The first fifteen years of my career, I did probably
about a fifty to fifty split percent. I was totally
independent as an adult cardiac surgeon. But I did general
thoracic and I did thoracic bascular work very independently with
just junior help, and so I just gained an awful
(24:35):
lot of experience. And then I would help Doctor King
with complex cases, which you know, in those days were
canals and TETs and trunkuses and.
Speaker 4 (24:45):
Things like that.
Speaker 6 (24:46):
But he really sort of shied away from newborn stuff,
and I was fascinated by meddle surgery, and so our
volume in the late nineteen eighty sort of the mid
nineteen eighties to the mid nineteen nineties sort of doubled
or tripled, and so I got so busy doing congenital
(25:09):
cardiac operations. I didn't have that much time to spend
doing adults. Now, I've always done some adults, and you know,
I've done a lot of adult congenital stuff and continue
to do that.
Speaker 4 (25:24):
I helped my partners with complex.
Speaker 6 (25:28):
Congenital and adult congenital cardiac cases to this day.
Speaker 4 (25:34):
So but anyway, starting out, I did an awful lot
of you know.
Speaker 6 (25:38):
The standard self cornery bypass surgery, bowl replacements, thoracic aortic
work of dominal aortic, lung cancer, esopagio cancer, the whole thing.
Speaker 4 (25:48):
So I kept very busy.
Speaker 6 (25:50):
But I also knew that starting a research laboratory. That
was one of my demands when I came back to Indiana,
I said I must have a research laboratory because I
had several problems that I wanted to work out in
an animal laboratory and apply those to the field of congeneral.
Speaker 5 (26:10):
Archerery Wow, well, I want to definitely get to that.
Speaker 3 (26:12):
But I was wondering, John, I mean, you started your
career really before the main era of neonatal heart surgery. Essentially,
I guess had to learn it on the fly during
your actual professional career. How did you actually do that?
Speaker 5 (26:28):
Like? How did you learn?
Speaker 3 (26:29):
I mean, these are not easy operations to learn how
to do an arterial switch or nor would I mean,
you don't just wake up one day and say I
read a book on this, I think I'm ready. How
did you learn how to do this and actually start
doing them.
Speaker 4 (26:44):
Well.
Speaker 6 (26:45):
I was fortunate enough to have a good mentor in
Harold King. However, he'd not done any of these complex
neo latal operations as well, so we worked out a
lot of our techniques together, and then he allowed me
to go back and visit my my co resident ed
Bouvet in the early days of switch surgery.
Speaker 4 (27:04):
I went to Vanderbilt and watched.
Speaker 6 (27:07):
Since we started out doing mustard operations for transposition of
the great arteries, doctor King wanted me to find out
is a sinning a better operation than a mustard, And
after spending a couple of days at Vanderbilt, I decided
they are very similar operations. I think what we really
ought to do is go to the arterial switch thing,
which started in the mid nineteen eighties. And I think
(27:29):
we started doing switches in nineteen eighty six and never
looked back. But you know, obviously the mortality was a
little higher during our learning curve.
Speaker 4 (27:41):
But because.
Speaker 6 (27:44):
I was able to visit a few other institutions and
then with the hope of my colleagues in the Congenital
Heart Surgeon Society, I could call them up and I said,
you know, I had this issue with this particular but
what's been your experience? And they would do the same
with me, and then we would meet once a year
(28:05):
and sort of air our difficulties and our successes with
each other, and we learned from each other along the way.
Speaker 4 (28:13):
So that's how it was done. But there was a
lot of self teaching during those years.
Speaker 3 (28:17):
You know, I'm wondering you've seen and done it all.
What do you think about public reporting today and how
it has affected training versus say, when you were I
assume most of the time you were in training there
was not public reporting and so and now, of course
(28:37):
everybody is very worried about their STS numbers being publicly reported,
as well as things like US News and World Report.
Do you think that this has a It seems to
me like it's had a negative impact on surgical training.
But I wonder, as someone who really is right in
the thick of it, what your thoughts are on this.
Speaker 6 (28:56):
I think it has you know, we just can't give
our residence the independence that we had early on in
our careers during our training. And also I think it
has had a deleterious effect. However, I guess I do
most of my surgery on the left side of the
(29:17):
operating table, and my resident or junior staff is almost
always on the right side of the table, and that's
sort of the way it was at Michigan. So, you know,
I feel very confident in the abilities of the residents
that are going through our program to be able to,
you know, to cut and sew and do some of
(29:39):
the very complicated aspects of the operation, as long as
I'm there to guide every movement. And so I think
our outcomes reflect the fact that the outcomes are not
affected by letting residents do a good portion of most
of the operations.
Speaker 4 (29:56):
That we do.
Speaker 3 (29:57):
But I do think there's probably a great skille else
of being able to be on the left side of
the table and conduct such a complicated operation with someone
who isn't you know, very experienced to that you make
it get sad like it's very straightforward, but I'm sure
it's very nerve wracking. As the quote unquote assistance when
you're really sort of directing the operation.
Speaker 6 (30:18):
Well, you can direct from the left hand side of
the table as well as you can from the right
hand side of the table, and you really want your
trainees or your residents to be able to see it
as they are likely to see it if they decide
to become congenital heart surgeons. And so I've trained one
hundred cardiothoracic residents in my career, and you know, there's
(30:39):
probably a dozen of them that are congenital heart surgeons.
Speaker 4 (30:42):
And I'm proud of every one of them.
Speaker 6 (30:44):
And I'm proud to have had at least contributed a
bit to their to their training and how to do it,
and they got to see it from the surgeon's perspective
during their training.
Speaker 3 (30:56):
I see, Well, John, you know, you're known for so
many different things. I'm going to only touch on two
of them. The first I wanted to talk about was
the bovine jugular vein. I know that you pretty much
were the person who came up with this idea. I
did not know that until I started reading about you.
Tell me how you even had this idea to potentially
(31:19):
use a cow vein and a child. How did you
study this? Was there a lot of resistance when you
first started thinking about this. I'm fascinated to know the
story of that.
Speaker 6 (31:31):
Well, it goes back to my residency, and you know,
in the or mid nineteen seventies, late nineteen seventies. You know,
we'd been replacing the pulmonary valve with xenographs, usually a
Pouresen aortic valve and a day ron two and we
(31:51):
were taking a good number of those out of small
children that they just were not durable, and so I
I was very.
Speaker 4 (32:02):
Interested in problem solving.
Speaker 6 (32:04):
That started at the NIH with the epical aortic conduit
to treat tunnel sub aortic stenosis and Doctor Morrows it
fixed this problem, and so I worked long and hard
on that, on that project. But like that, when I
was finishing my residency, I decided we needed to come
up with something better than a xenographed inside a dacron too,
(32:29):
and felt that maybe the dacron was the big problem
and not necessarily the xenograph.
Speaker 3 (32:34):
So is that like a handcock you're talking about like
a handcock conduct conduct.
Speaker 6 (32:40):
So one of the first things that I did when
I came back to IU and Doctor King, my boss
allowed me to have an animal research laboratory that the
department paid for.
Speaker 4 (32:54):
The trouble of it, there was.
Speaker 6 (32:55):
No chronic animal care facility for large animals that so
that was a problem because in order to study RVPA
conduits and pulmonary valves.
Speaker 4 (33:06):
You had to follow these animals over a number of
months to gears.
Speaker 6 (33:11):
To solve that problem, My wife Carolina and I bought
a large home about twenty miles south of Indianapolis that
had a big dog cannel on it, and so I
gave my lab technician, Randy Bill's free rent. If he
would transport the animals from the kennel to my animal laboratory,
(33:32):
we'd operate on him and then he would take them
back and care for them in the kennel until they
needed a next hardcat or till.
Speaker 4 (33:40):
They needed to be brought back up where we.
Speaker 6 (33:44):
Looked at the conduits that we'd explanted or that we
put in months or years before.
Speaker 4 (33:49):
And that was.
Speaker 6 (33:50):
During that period of time that you know, we were
able to do that.
Speaker 4 (33:55):
Now, we were.
Speaker 6 (33:58):
The ones that bought the farm and supported it, but
doctor King took care of my other research needs. Now,
the trouble of it is that I was shown the
Boving juguter vein at a surgical meeting in nineteen eighty eight,
and a company called Venpro was using Boving juguter veins
to treat vericos veins in adults in Europe and I
(34:22):
met this biomedical engineer at a previous meeting and he
showed this to me in a little jar gluter aldehyde.
He says, do you think you could use this in
congenital heart surgery.
Speaker 4 (34:34):
Well, he allowed me to look at it and examine it.
Speaker 6 (34:37):
And it had all of the features that I thought
would be an ideal RVPA.
Speaker 4 (34:42):
Conduit for a baby or a child.
Speaker 6 (34:45):
And so he gave me the first two that he
gave me the only two that he had at that
period of time, and he'd gotten those from a slaughterhouse somewhere.
Speaker 4 (34:56):
And had treated the valves with gluter aldehye.
Speaker 6 (34:59):
Well, he couldn't provide more for me, so I decided
we can solve that problem. So there was a slaughterhouse
just south of Indianapolis, and I went and talked with
the owner and told them what I wanted to do,
and I wanted to study this problem and children.
Speaker 4 (35:14):
And he allowed my.
Speaker 6 (35:16):
Lab technician, Randy Bills, and my resident who was in
my laboratory at the time, Vincetavo, to come down once
a week or once every other week and harvest the
jugular vein from cows that he was slaughtering for meat
and so we got very proficient and so in an
hour in the morning, so we couldn't slow down their process.
(35:39):
We would harvest both jugular veins from a cow's neck
and you know obtain there's three valves in each side
of that vein. So we had six conduits in one
trip to the slaughterhouse and we glued a ount I
preserve them and then put them in animals, and we
did that over a number of years.
Speaker 3 (35:58):
I didn't understand that the jugular vein and account has
three valves in it.
Speaker 6 (36:02):
Actually it's alternating between tricuspid and bicuspent valves, and on
one side it may be different than the other.
Speaker 4 (36:10):
We decided that the tried leaflet.
Speaker 6 (36:13):
Valves were probably UH going to be most acceptable to
the FDA.
Speaker 4 (36:18):
Well.
Speaker 6 (36:19):
Venpro also was showing this valve to congenital heart surgeonsine
Europe and so U. But Venpro used all of the
data that we obtained in my research laboratory at Indiana
to satisfy UH Europeans UH for the CEE mark, and
(36:40):
so they got a cee E mark and Europe to
use it in children about a year before we were
able to use it in the United States.
Speaker 3 (36:48):
Using your data using data, so they got to.
Speaker 4 (36:54):
See e mark.
Speaker 6 (36:55):
However, I had a child with trump is archiosis that
I read that I operated on as a newborn, and
his plmonary homograph became very regurgit in about six months. Yeah,
So I contacted the FDA and I said, you know,
this valve has ce mark in UH in Europe. I've
(37:15):
done all the animal research for it. Can I use
one of their.
Speaker 4 (37:19):
Valves in a in a child at Riley Hospital?
Speaker 6 (37:23):
And lo and behold I did, and that child did
very well and the valve lasted him for a decade
or more. And then that started a long series of
both and juguter vein conduits for the right right heart reconstruction.
Speaker 3 (37:39):
John, Why why does a both find jugular vein graft
have better longevity than a homograft?
Speaker 5 (37:47):
I wasn't aware that that was the case.
Speaker 6 (37:50):
Well, I think there's an immune response to any homograft,
you know, I thought that from the very beginning, and
and and in our laboratory studies and our histology studies
indicate that.
Speaker 4 (38:01):
Now.
Speaker 6 (38:02):
I think the decellularized pullmenty of homographs that we're using today,
the ones that are furnished by a company called pryo
life are more durable than the ones that were not decellularized.
So that's that's why I thought the nice thing about
a juguter vein. It's used to venus pressure. The leaflets
are delicate, they open easily, they close nicely, and all
(38:24):
of that, and so like a homograph which is used
to venus pressure, for the most part, they should be
the same. But the boving juguar vein outperformed pull many
homographs in my experience, until the day that they became
a decellularized, which was about two thousand and eight two
thousand and nine, So now we use them both.
Speaker 4 (38:46):
We had small children.
Speaker 6 (38:48):
We use bovine juguar veins today for most of the
complex repair, but when I'm doing a ross procedure, which
we do quite commonly in Indiana, we use pullmenty homographs
that are decellularized. So I haven't given up totally on
so many homographs, but we used the contager for.
Speaker 5 (39:08):
Now.
Speaker 3 (39:09):
I'm wondering, I'm sure you were aware that Philip Bonhoeffer
was taking your valve and putting it in a stent
and creating the melody valve. Did you have anything at
all to do with that did he contact you or
speak with you about it as he was developing that.
Speaker 6 (39:25):
I spoke with him, I think on one occasion, and
I sort of communicated through the company my experience and
that sort of thing, and so I keep I tried
to get Metroni to do a comparative study with a
percutaneously placed boba and jugiter vain with a surgical implanted,
(39:48):
but nobody would ever do it. I sort of thought
that maybe the surgical implant with valves would last a
little bit longer because of some of the early stint issues,
but I think they're probably quite comfortable today.
Speaker 3 (40:02):
I actually think the opposite, John, I think that when
they're putting on a stent, they last longer because the
stent usually protects it. Now, initially you probably aware that
we didn't realize you had to put a lot of
protective metal spare metal stents around it. But now that
we sort of routinely put one or two or even
(40:23):
three bare metal stents before placing the melody, it seems
to have pretty good longevity. Although, as I'm sure you're
also aware, people are slowly moving away from it and
moving more towards the edwards valve than Sapien valves, but
still a very popular valve used all the time, and
a lot of really great aspects to it. Now, the
(40:44):
other aspect of your career, which we haven't even talked about,
just shows you how doctor Brown has just been polymeth
and it's just involved in so many different things. You
were the first person to perform a pediatric heart transplant
in Indiana. Now, how did you get involved in that?
And were you the lead transplant surgeon for a long
(41:04):
time there?
Speaker 4 (41:06):
Well, I did start the program. Yes, I was the
lead surgeon for both adults and children. But I had
to help. I had some great pediatric cardiologist Randy.
Speaker 6 (41:18):
Colwell and Bob Dara, and then Jackie O'Donnell on the
adult side. And then we hired Mark Turntine as our
first transplant fellow, and before he finished, before he'd even
started a cardiothoracic residence, he finished general surgery and he
came to us as a transplant fellow and fell in
love with general art surgery as well as transplantation, and
(41:41):
he was technically excellent, and so as soon as he
finished his residence, we hired him and he very quickly
became the leader of our pediatric art transplant program, and
he and I probably did you know, one hundred and
fifty to two hundred and fifty adult and pediatric art
transplants together. So anyway, we've had a great team to start.
(42:07):
You know, we were fortunate enough early in the career,
and I think it still holds that we did the
one and only twin to twin heart transplant that's ever
been done in the world.
Speaker 4 (42:17):
Turned out, the.
Speaker 6 (42:20):
Little boy of the twins had hypoplastic left heart syndrome
and the little girl had well, the little boy was
born with a new cord and was brain dead, and
the little girl had hypoplastic left heart syndrome. So we
took brother's heart and put it in the little girl.
(42:40):
She's now thirty four years old and has not had
a documented significant rejection episode in the thirty four years
she's been alive.
Speaker 4 (42:51):
She's still on suppression.
Speaker 6 (42:52):
We've been afraid to stop it, but she's done extraordinarily well.
Speaker 4 (42:56):
Wow, but we you.
Speaker 6 (42:58):
Know, in the early eighties, our results with a Norwood
procedure left quite a bit to be desired, so we
offered heart transplantation to babies born with hypoplastic left arts
syndrome right, and the family participate in the decision making
(43:18):
and so and then later even did the study comparing
the outcomes.
Speaker 4 (43:23):
Of the two approaches. So any you know, we.
Speaker 6 (43:25):
Got started early on in the mid nineteen eighties and
have continued today and still have a strong congenital heart
transplant program.
Speaker 3 (43:36):
Well, for those in the audience, it's so late on
Monday evening. Doctor Brown has really been so kind to
speak with us about his extraordinary career. But I think
I would be remiss without asking you to speak a
little bit about your family. I mean, we've already heard
that your poor wife, Caroline allowed you to buy a
farm with a kennel to contunct your research. If that's
(43:58):
not love, I don't know what it is. But I'm wondering.
You know you were married, You're married over fifty years.
I know that you have three kids and multiple grandchildren.
How were you able to have such an extraordinarily productive
professional career and still have a very meaningful personal life
(44:20):
and a family life.
Speaker 4 (44:23):
Well, I have to give most credit to Carolyn.
Speaker 6 (44:27):
She knew that I was passionate about what I was doing,
and she knew the importance of what I was doing,
and so she was just able to shoulder a lot
of the responsibility when our kids were young and that
sort of thing.
Speaker 4 (44:42):
She was just there.
Speaker 6 (44:45):
You know, she interrupted her teaching career so that she
could raise our children when they were young, and then
as they got to be teenagers, I tried to you know,
I had to make rounds with me at the hospital,
and I took to each one of them on a
heart transplant, harvest and implantation and that sort of thing.
Speaker 4 (45:06):
So they had a little bit of inkling about what's
going on.
Speaker 6 (45:08):
But you know, Caroline made it all possible for me
to pursue this kind of a life, of a life
that I've loved to do.
Speaker 4 (45:17):
It.
Speaker 6 (45:17):
It's been grueling. You know, we talk about work life balance.
That term wasn't even invented during my you know, that's
that's a that's a that's a term that four didn't
didn't exist in the seventies, eighties, and nineties and even in.
Speaker 4 (45:35):
The early two thousands. So you know, the training was grueling.
Speaker 6 (45:41):
The responsibility that you had for your patients, you know,
it just it was one of those situations where you know,
you couldn't promise a family the outcome that you both
wanted for their child. But I guess I would promise
each family that I would treat their child as if
a child were my own.
Speaker 4 (46:01):
And you know, that served me very.
Speaker 6 (46:04):
Well because but it required a lot of phone calls
at night, a lot of interrupted meals and things like that.
Speaker 4 (46:12):
But I guess if.
Speaker 6 (46:14):
I had to say in a you know, Carol Anne
deserves a major amount of crendit. But our kids were understanding.
They all turned out to be great kids. I think
they understood what I was doing and appreciated what I
was doing. And then family gave vacations were one of
(46:34):
those things where we all got together, you know, for
a couple of weeks in the summertime when they were off,
and then Carol Anne and I always attended a ski
meeting with other congenital cardiologists and cardiac surgeons, which gave
us sort of a yearly honeymoon, so we could have,
you know, a week to spend with each other and
(46:55):
without kids, and both of our sets of parents made
that possible to look after our kids while we were going.
Speaker 4 (47:01):
So there are many many facets of people.
Speaker 3 (47:05):
That have John, did any of your kids or your
grandchildren go into medicine or any area related to medicine.
Speaker 6 (47:13):
Well only proof related. My oldest son Jason works for
Eli Lilly and Company, and so he's related there. But
you know, he used to come to the operating room
and videotape complex and genital operations, so all of that.
You know, we had a great time together and still do.
Speaker 4 (47:32):
My daughter runs a AI company that.
Speaker 6 (47:37):
Deals with hospitals and pharmaceutical companies looking at customer feedback
and so she has a startup company and so she's
all into medical.
Speaker 4 (47:46):
Stuff as well. And then my youngest son, Peter, is a.
Speaker 6 (47:49):
Physical therapist out in Colorado and he's married to a
nurse practitioner.
Speaker 4 (47:53):
So there's a lot of medicine in.
Speaker 5 (47:55):
Our family, no question.
Speaker 6 (47:57):
But none wanted to be art surgeons were paying attention.
Speaker 4 (48:03):
You didn't want the lifestyle that you that you have
had all these years. Right.
Speaker 3 (48:08):
Well, you know you've achieved so much, been honored by
so many, so many times in your career. I'm wondering,
is there one thing that you're most proud of in
your professional and personal life as you think back on
your entire the entirety of your massive career. I mean,
really have two extraordinary achievements. A surgeon for over forty
(48:30):
five years and married for did you say fifty five
years or fifty six years?
Speaker 4 (48:35):
Fifty six our fifty six anniversion.
Speaker 3 (48:38):
Wow, So those are those are two pretty amazing accomplishments.
I'm wondering are what do you view as your biggest
accomplishments when you look back upon your very extraordinary life.
Speaker 6 (48:51):
Well, again, I have to give pan to Carol and
who's sort of supported me and made a whole for
me and our kids and that sort of thing along
the way. And I've had some great mentors along the
way and colleagues, you know, I've had pediatric cardiologists that
were just superb and you know partners, you know, Mark Turntine,
(49:15):
Mark Rodefel, Jeremy Herman, you know, wonderful people who sort
of bought into the same philosophy that I had about
patient care, it particularly as it.
Speaker 4 (49:25):
Applies to children.
Speaker 7 (49:27):
And so we've had at a great team and we've
worked very hard and we've i think accomplished a fair
amount during that forty six years or shore that I've
been doing it.
Speaker 3 (49:39):
So John, I'm going to finish up now. You're I
know you're still working a little bit, but you're like
I guess. I guess you're like sort of semi retired.
What do you do? What do you do in your
free time? I mean, you've spent the last half century
operating continuously. What is a certain of your magnitude?
Speaker 4 (49:57):
What do you do?
Speaker 5 (49:58):
Would you have some free time?
Speaker 4 (50:00):
Well, you know, I'm busier now that I think that
I have ever been.
Speaker 6 (50:04):
Taryland and I have about a six hundred acre farm
in southern Indiana that we manage. We don't do any
of the farm work, although I love to get on
a tractor and do bush hogging and things like that
for week control. I love to hunt, I love to fish,
and I love to spend time with my grandkids. They're
all in various sports and musical sort of things, and
(50:24):
so Karlane and I three or four times a week
are in one performance or in sporting event or another.
So we spend an awful lot of time with our grandkids.
And my mother, who's one hundred and two, it's still alive,
is still very sharp, and so we try to get
down there weekly to see her. All my siblings are
(50:44):
still alive, and my two older brothers are in their
mid eighties and that sort of thing, and all you know,
very active people, so I'm very fortunate in their regard.
So I'm proud of I guess my parents who taught
us how to work hard.
Speaker 4 (51:02):
I'm proud of Caroline.
Speaker 6 (51:03):
I'm proud of our kids, and I'm proud of sort
of the legacy of patient care that we've left behind.
It's not what you do, it's what you leave behind
that sort of counts. And I'm very proud of the
kind of program that we have at Indiana University and
what we do for kids.
Speaker 3 (51:19):
Well, that's a wonderful summary. Well, doctor Brown, I just
can't thank you enough. What an inspiring story. I think
I don't know what I want to do now. I
think I have to go to the gym and workout
or if it's so inspired by the story of your life.
Thank you so very much for all that you've done
in your career, of course, but most importantly tonight, thank
(51:42):
you for spending a little bit of time with us
in what sounds like a very busy, semi retired life
to speak about your life. And I'm sure everybody listening
to the podcast is going to be very excited to
hear from you and hear about you.
Speaker 6 (51:54):
Well, thanks very much, Rob, It's been my pleasure. Thanks
for the opportunity.
Speaker 5 (51:58):
Thank you very much.
Speaker 1 (51:59):
Well, I'm sure sure that, like me, you are inspired
by doctor Brown's story. He made so many interesting points
and certainly has lived a wonderful life helping so many
and I don't mean just patience, but also family and colleagues.
I think his dedication to training the next generation has
been unparalleled. And if I were to take just one
(52:20):
quote of his many from this wonderful conversation, it would
be when he stated that quote, it's not what you do,
it's what you have left behind that counts. I think
we can all use that in thinking about our own
lives and what each of us can leave behind to
make this place a better one. I'm most appreciative to
doctor Brown for taking time out of a very busy
(52:41):
semi retirement to speak with us this week on Petiheart.
To conclude this three hundred and ninth episode of PETI
Heart Pediatric Cardiology, Today honoring doctor John Brown, we hear
the wonderful Italian baritone Ettrre Bastianini singing the lovely nineteen
eleven Neapolitan love song corn Grato by Cardillo. And this
(53:03):
song was actually written in the United States, though was
perhaps the only such Neapolitan love song not penned in Italy.
Bascionini was known as one of the greatest baritones of
his day, singing throughout the world, and he sadly and
tragically died in nineteen sixty seven at the young age
of only forty five, after battling throat cancer for a
(53:24):
number of years. Thank you very much for joining me
for this three hundred and ninth episode, and once again
I'd like to thank doctor Brown for spending time with
us and sharing his life with us. I hope all
have a good week.
Speaker 8 (53:35):
Aheit coaryary comi am i mavorimmieni no taste for the.
Speaker 2 (54:03):
Carta your doty for a.
Speaker 4 (54:06):
County, not.
Speaker 8 (54:10):
For cottery cattery, carrying the auditionary stopper locking aspousan little
japi in sa.
Speaker 2 (54:29):
Forts totical.
Speaker 8 (54:41):
Call called grat tapingary on me.
Speaker 4 (55:00):
The passa.
Speaker 2 (55:04):
And tabbier sackti pussletle and no taper
Speaker 8 (55:42):
Sack
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