Southern California Physician - http://www.socalphys.com/article
Artist of the Heart
http://www.socalphys.com/article/articles/564/1/Artist-of-the-Heart/Page1.html
By Chris Womack
Published on 10/1/2007
 
Chris Womack

 

A creative side has propelled Los Angeles surgeon and researcher Hillel Laks, MD, to the heights of cardiothoracic surgery.


A creative side has propelled Los Angeles surgeon and researcher Hillel Laks, MD.

As an artistically inclined child in Johannesburg, South Africa, Hillel Laks, MD, could not have known that his creative inclinations would lead him to implant some of the first artificial hearts in human patients or to train doctors from the third world in the finer points of cardiothoracic surgery.

A fondness for science and a drive to help people steered Dr. Laks toward medicine, but one skill remained untapped until fairly late. "I always used to paint when I was in high school and college, and once I rotated onto surgery and found something that I could do with my hands, it appealed to me," he says.

That appeal was matched by a great aptitude. A professor of cardiothoracic surgery at the David Geffen School of Medicine at UCLA, Dr. Laks was awarded the UCLA Chancellor's Professorship in April. Acting Chancellor Norman Abrams cited him specifically for "creative and pioneering approaches to complex heart disease."

Asked for an example of new surgical techniques that he helped develop, Dr. Laks mentions correcting a problem with the Fontaine procedure, which diverts venous return through the lungs, and often ends with patients having very high venous pressure that damages survival. He and colleagues dreamed up a way to open and control a small hole between the heart's chambers, giving them the ability to externally divert blood to the lower-pressure side of the organ when necessary.

In another example, Dr. Laks and colleagues fashioned a way to repair children whose pulmonary arteries stem from the aorta, rather than from the heart. "We came up with the solution of connecting all of those blood vessels into a single system using the patient's own tissues, and then connecting that to the front of the chest where one could reach it and do a complete correction," he explains.

In the research arena, Dr. Laks has spent much of his professional career involved with artificial hearts and heart-assist devices, beginning with an introduction to the field during his early 1970s residency at Boston Children's Hospital, where investigators tested a left-ventricular assist device. By the mid-1970s, "I did experimental work on the left-ventricular assist device in my first faculty position at St. Louis University [School of Medicine]," he says. "I've been involved with it ever since."

In the early 1980s, UCLA was one of the first five centers to install the small, easy-to-work-with Jarvik heart. By his own count, Dr. Laks has been involved in four artificial heart clinical trials. "We probably could have been many years ahead, if there had been heavier funding of research in this area [over the past 15 years]," he laments.

But things have picked up. Led by Drs. Robert Dowling and Laman Gray at the University of Louisville School of Medicine and Jewish Hospital, Dr. Laks' team and researchers at three other U.S. medical centers tested the AbioCor artificial heart, and reported their results beginning in 2004. In 2006, the U.S. Food and Drug Administration approved the device under a Humanitarian Device Exemption. "The manufacturer has now come up with an improved model, and we're planning to be in that trial as well," Dr. Laks says enthusiastically.

Along the way, Dr. Laks has been busy with other projects to bolster cardiothoracic surgery in the United States and abroad. For example, in 1984, he founded UCLA's Heart Transplant Program, and two years later, he started the medical center's pediatric mechanical-assist device program.

Dr. Laks also had a hand in developing UCLA's alternate-recipient heart transplant program in 1992. "Originally, it was the suggestion of the mother of a young boy who was at very, very high risk for a transplant," he says. The boy had been turned down by several centers, including UCLA, because the philosophy governing transplants dictated a match between the best recipients and the best organs. "That means that large numbers of people were never selected for a transplant and died without being offered that opportunity," he says. Now the medical center can make use of slightly more risky hearts and recipients. "For example, someone who's 67, but in top shape, would be on the regular list, but somebody who's 67 and had certain risk factors would only be on the alternate list," Dr. Laks says. "For the first five to seven years, there's really no statistical difference between the [survival of the] two groups of patients."

Believing that patients in underdeveloped countries can benefit more from trained, local cardiothoracic surgery teams, Dr. Laks has taken part in about 10 missions to educate doctors in Russia, Peru, Thailand and Saudi Arabia, among other countries. He has also helped foreign doctors get training at UCLA. "We found that that was a better way of trying to advance, and it really did make a difference in terms of what [foreign teams] were doing."

When he's not satisfying his creative side in surgery, Dr. Laks enjoys outdoor activities and studying history and philosophy--especially that of a famous Jewish rabbi and physician. "I've given some lectures on the providence of God and philosophy of [Moses] Maimonides, who was a great Jewish philosophical teacher," he says. In addition, Dr. Laks has three children, each of which appears to share with him a primary drive. "My daughter runs an animal rescue foundation, which she has combined with education for teaching compassion, and my older son is in environmental science, and my younger son is an artist, a painter."