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Master of the scalpel

Adib Jatene was responsible for landmark achievements in experimental medicine and victories for public health

Marisa Cauduro/FolhapressThe biography of cardiovascular surgeon Adib Jatene, 85, who suffered a fatal heart attack on November 14, 2014, represents a collection of landmark achievements in Brazilian experimental medicine and victories in the field of public health. Author of more than 700 scientific works, Jatene directed or performed with his own hands about 20,000 cardiac surgeries—and left behind a number of contributions in the field of myocardial revascularization and surgical correction of congenital heart disease. In the 1950s, he established a laboratory at the Hospital das Clínicas of the University of São Paulo School of Medicine (FM-USP), precursor of the current Bioengineering Division of the Heart Institute (InCor), where he developed the world’s first artificial heart-lung machine. In 1968, he was the first surgeon in Brazil to perform bypass surgery. In 1985, he created a method for correcting congenital cardiopathy in infants, transposition of the great arteries, which became known as the Jatene Procedure. Also in the1980s, by then as full professor at FM-USP and scientific director of InCor, Jatene was one of the leaders in performing heart transplants in Brazil, having resumed experiments that had been conducted by Professor Euryclides de Jesus Zerbini (1912-1993) in the late 1960s.

Jatene became a prominent public figure in 1979, while secretary of health for the State of São Paulo under Governor Paulo Maluf. That was when he laid out a health care plan for the São Paulo metropolitan area that was intended to ensure a minimum level of care for low-income people in all parts of the city. Many of the hospitals built on the outskirts of São Paulo in recent years resulted from that plan. Jatene served as minister of health under two presidents. He held the post for eight months in the Fernando Collor administration and in 1995, under Fernando Henrique Cardoso, gained publicity because of his battle in favor of the assessment of a tax that would fund health care. One year later, the Provisional Contribution on Financial Transactions (CPMF) was enacted for the purpose, but abolished in 2007. He never tired of repeating that health care, more than any other area, needs earmarked budget support. “When you build a hydroelectric plant, you have to wait until it’s finished before you begin to see revenue. But when you deliver a public hospital, you spend twice as much every year on maintenance as was appropriated for the project. That is why you need earmarked funding,” Jatene said in 2006, when he accepted the Conrad Wessel Foundation Award in the category of Medicine.

A General Store
Adib Domingos Jatene was born in Xapuri, in the northeast Brazilian state of Acre. When only two years old, he lost his father, a Lebanese merchant, to yellow fever. He spent his adolescence in Uberlândia, in the state of Minas Gerais, where his widowed mother had gone to live and open a small general store. He swapped Uberlândia for São Paulo during his high school years and graduated, at age 23, from the USP School of Medicine. He also did his graduate work there, with Zerbini as his advisor and with whom he began to work in 1951. In 1955, he returned to Minas Gerais to assume a professorship at a medical school in Uberaba, but went back to São Paulo two years later to perform surgery at the Hospital das Clínicas and the Dante Pazzanese Institute. In 1983, he succeeded Zerbini as full professor of cardiovascular surgery at FM-USP and helped found InCor, which gained international renown as a standard for care and research. It introduced a hospital management model in which the care of private patients and those covered by insurance helped finance the beds designated for Unified Health System (SUS) patients.

Jatene retired from USP and InCor in 1999 but continued to operate at the Heart Hospital (Hcor), a private institute that he also headed. Although he was no longer sought after as much as before, he thought that was just fine. “All my life I fought to have teams of excellence available all over Brazil. Now that is not only a reality, but many of those teams include talented surgeons whom I helped train,” he said, also in the 2006 interview. Jatene continued to pursue a variety activities. He continued to head the Family Health Program, coordinated by the Zerbini Foundation and responsible for management of InCor, which has built health care modules in the São Paulo districts of Sapopemba and Vila Nova Cachoeirinha. At the Dante Pazzanese Cardiology Institute in São Paulo, he continued his work in bioengineering, developing prostheses and surgical and diagnostic equipment used in support of heart surgery, such as an implantable electromechanical heart ventricle for use in patients who are on the waiting list for a heart transplant. He still found time to supervise his cattle ranches and, until recently, serve as president of the Board of Trustees of the São Paulo Museum of Art (MASP), an institution of which he had become president emeritus. In 2012, when Jatene suffered his first heart attack, he diagnosed the problem himself and asked a trusted colleague to implant a stent. But he kept working. In 2013, he presided over a commission of experts who helped the federal government formulate recommendations for changes in medical education in Brazil. He leaves his wife of 60 years, Aurice, and four children—physicians Ieda, Marcelo, and Fabio and architect Iara—and ten grandchildren.