Much loved pioneering heart surgeon

CARDIOTHORACIC SURGEON

10-7-1927 27-6-2012

GEORGE Westlake, a pioneer in heart surgery in Australia as well as a superb technical surgeon and innovator who was responsible for training many cardiothoracic surgeons, died at his home in Rye of pneumonia that complicated a long illness. He was 84.

He was head of cardiothoracic surgery at Royal Melbourne Hospital (1977-88) , and director of Melbourne University's open heart surgery unit (1978-82).

A gifted surgeon, ambidextrous, quick and decisive, Westlake was able to effortlessly perform complex surgery that others often found difficult. He operated with grace under pressure and achieved excellent results performing more than 10,000 major lung and heart operations in his career.

Enthusiastic and inquisitive, he constantly improved surgical techniques, and helped introduce new procedures such as the repair and replacement of heart valves and the thoracic aorta, and challenged procedures to correct complex congenital heart defects and coronary artery bypass surgery.

The enormity of these tasks should be seen in the context of developing these procedures step by step with colleagues, as they were being performed for the first time. Echocardiography, CT scanning and MRI were not yet invented, and heart-lung machine technology was rudimentary.

In 1977, after a visit to St Thomas' Hospital in London, he introduced "cardioplegia" for heart protection during surgery, and it is still used today, albeit with some modifications. And, in August 1978 he was the first to implant the St Jude Medical bileaflet pyrolytic carbon mechanical heart valve in Australasia. This valve has provided excellent results, with more than 2 million implants worldwide.

Westlake also supported the establishment of heart surgery at Epworth Private Hospital in September 1981, despite significant opposition from within the profession. This became an outstanding venture, and the large database that was generated has formed the basis of multiple publications, pivotal in establishing Melbourne's international reputation for coronary surgery, particularly with arterial grafting.

Westlake was born in Perth, where he attended the selective entry Perth Modern School from 1939 to 1945. Bob Hawke and Rolf Harris were fellow students.

After first year science at Western Australia University, he moved east to study medicine at Melbourne University, from where he graduated in 1950.

In 1952, he married Barbara Brumley, a nursing sister at the Alfred Hospital, where he spent his early medical years, then trained in thoracic surgery at the Repatriation General, and Royal Melbourne hospitals, completing his FRACS in 1956.

That year he took his family by ship to Britain and worked at the Royal Brompton Hospital in London, under the mentorship of Lord Russell Brock, thoracic surgeon to King George VI. Those were pioneering days of heart surgery Dr John Gibbon had just invented the heart-lung machine in Philadelphia in 1955. So in 1958, Westlake travelled to the United States to study the critical developments that were taking place there.

He returned to Australia as cardiothoracic surgeon at the RMH in 1958, and, was also appointed director of heart surgery at the Royal Children's Hospital, from 1958 to 1966. At the time, cardiac surgery encompassed repair of congenital "holes in the heart", and "opening up" heart valves narrowed at birth or by rheumatic fever, usually in children and young adults.

In 1970, following a review of cardiac surgery in Melbourne, two cardiac surgery units were established: at the Alfred Hospital (Monash University), and Melbourne University's open heart surgery unit at St Vincent's Hospital, where patients from Royal Melbourne, Austin and St Vincent's hospitals were operated, and later sent back on the second post operative day for continuing management. This rationalised system allowed pooling of resources, efficiencies, and concentration of expertise, and despite logistic problems, generally served the patients well.

In 1982, with successful heart valve replacement surgery and the growing need for coronary bypass, RMH re-established its own cardiac surgery unit.

Westlake and his colleagues progressively improved and refined heart operations, incorporating the latest advances. Operative risk was reduced from 20 per cent in the 1960s, to 5-10 per cent in the '70s, and further reduced to 1-5 per cent in the '80s. Operations that took 6-12 hours and used up to 18 units (6 litres) of blood were transformed to 3-4 hours and frequently performed without blood.

Westlake was also a key member of a number of philanthropic surgical teams that travelled to Burma and Thailand in the 1960s and '70s, repairing heart defects and mentoring young surgeons, experiences he found fulfilling. In 1977, following a number of difficult years and divorce, Westlake married Maureen Thorp.

Socially, he had many friends from a wide spectrum of society medicine, media, as well as entertainment and charity groups. He developed a passion for jazz, and became a keen exponent of the trombone.

Westlake was adventurous and irrepressible, with a daredevil approach to new experiences. He was especially captivated by scuba diving. Unfortunately, in 1985, his career was dramatically disrupted by a parasailing accident while holidaying in Queensland. He fractured both forearms and both hips, requiring many orthopaedic operations and significant rehabilitation.

With great tenacity and spirit he returned to surgery for another five years before he retired at 65 in 1992. One can only imagine the degree of pain and discomfort that dogged him through those final years.

Westlake always made an impression on people, with his good looks, intellect, disarming directness, and warmth. He had a great sense of humour, disliked political correctness, and was fiercely loyal to staff, who, in turn, adored and respected him. He was also admired by his colleagues at RMH and Epworth.

His generosity to his colleagues and staff was legendary as evidenced by the many social events, including Christmas functions for more than 100 people on many occasions which he and Maureen hosted. There was always a gift for every person.

Westlake's great love remained clinical cardiac surgery which he performed with exquisite skill for which his patients and their families were eternally grateful.

In 1988, Australia's Bicentenary, he was honoured with an Order of Australia Award for "services to medicine, particularly as a cardiothoracic surgeon". He spent his 20 years in retirement travelling, fishing, deep sea diving, playing golf, enjoying friends, and simply enjoying time with his family.

He is survived by his wife, Maureen, daughters Jenny, Anna and Lisa from his first marriage, 8 grandchildren, and his brother, Donald.

Professor James Tatoulis, who was mentored by George Westlake, succeeded him as director of cardiothoracic surgery, Royal Melbourne Hospital. He is also professor of cardiothoracic surgery at Melbourne University.