In Memoriam

Donald B. Effler

Donald Brian Effler, a pioneer cardiac surgeon, died recently at age 89.  He was born on Blackwell's Island (now Roosevelt Island) in the middle of the East River in New York City.  His father, an ENT surgeon, soon moved his family to Toledo, Ohio.  After receiving an M.D. at the University of Michigan in 1941, he joined the Army Medical Corps and served through 1947, a period that included a general surgery residency at Walter Reed Hospital.  There, he was influenced by the Chief of Thoracic Surgery Brian Blades to become a chest surgeon.  Dr. Effler trained under Brian Blades at George Washington University and later with John C. Jones in Los Angeles.  Dr. Effler became a diplomat of the American Board of Thoracic Surgery in 1949.

In 1948, Dr. Effler joined the staff of The Cleveland Clinic, where he spent his most productive years.  He was quickly appointed head of a new department of thoracic surgery, and served in that post until 1975.  The Cleveland Clinic provided a fertile environment for the development of cardiac surgery.  The staff boasted a number of remarkable innovators, including artificial organ pioneer Willem Johan Kolff, cardiologist F. Mason Sones, and scientist Irvine Page.

Dr. Effler's first open heart surgery in 1956 repaired a post-infarction interventricular septal defect in a 17-month-old boy, with the aid of a unique heart-lung machine invented by Dr. Kolff.  By 1964, Dr. Effler's team had completed 1,000 cases of open heart surgery.

Between 1954 and 1956, F. Mason Sones developed the technique of selective cine coronary angiography.  This was the necessary first step in the evolution of surgery for coronary atherosclerosis.  Dr. Effler became an expert in all of the approaches to myocardial revascularization available at the time.  He was scrupulous about reporting results, and working with Dr. Sones, improved outcomes by refining the patient selection process.  Dr. Effler tried endarterectomy in both the left main and right coronary arteries.  Between 1962 and 67, he performed coronary patch graft reconstruction in 147 patients, with a hospital mortality of 11 percent for right coronary patch grafts and 65 percent when applied to the left coronary artery.

As an individual, Dr. Effler cut a striking figure.  A tall, handsome man, with sharply chiseled features, he might have been sent over from central casting to play the role of the charismatic surgeon.  He was athletic, articulate and sartorially elegant.  Dr. Kolff, now 93 years old, recalls that "Don Effler was a good speaker and a marvelous raconteur.  One of his favorite stories was that of a Parson who had a male cat that was much loved and it brought happiness to the evenings.  At a certain moment, it did not want to stay home at night and caused much noise in the parsonage.  The cat was sent to a veterinarian, and, for a short time, stayed home at night and peace returned to the parsonage.  But then the cat started traveling again.  The Parson followed the cat through the alleys and small streets until he found the cat in a circle of other cats.  The cat had become a senior consultant."

For those of us who worked with Dr. Effler, his greatest achievement was to create a department environment where discovery and development could proliferate.  The most famous early product of this environment was Rene Favaloro, an Argentine-born surgeon.  After experimenting with the Vineberg implant, Dr. Favaloro popularized aortocoronary bypass grafting in 1967, and published widely about new techniques and late results.

An adept surgeon, Dr. Effler also became a skilled administrator.  He organized a team of experienced nurses, nurse clinicians, residents, fellows and carefully selected staff physicians.  He integrated the process of surgery with anesthesiology and cardiology.  He gave strong support for the development of cardiothoracic anesthesiology as a distinct specialty.  He was a consistent advocate of nursing.  He understood the responsibility of the physician to the nurse, and insisted on having the best possible nursing throughout the process of thoracic and cardiovascular surgery.  A prolific contributor to the literature, Effler also was known for his droll and entertaining memoranda to administrators and colleagues: "The Anatomy of Delay," "Never-ending Frustrations," and "Prohibition in the Cleveland Clinic," as well as topics such as inadequate remuneration, reduction in personal incentives, reactionary and inflexible policies of the Board of Governors, personal appearance, and his ever favorite, corpulence.

Throughout the formative years of coronary artery surgery, Effler argued forcefully in favor of making both medical and surgical therapy available at the local level.  He advocated coronary angiography in community hospitals, and spoke and wrote frequently about the need to provide access to modern heart care throughout America.

Dr. Effler was a fellow of the American College of Surgeons, and a member of many prestigious professional organizations.  He received international honors as a pioneer of cardiac surgery, and participated in the State Department's Education and Cultural Exchange Program.  He was a founding member of The Society of Thoracic Surgeons and became president in 1969.  In 1973, he was one of the first physicians to visit China by invitation after the cultural revolution . He recounted this experience in a book, which described barefoot doctors, acupuncture anesthesia for major procedures, and Marxist medical education.

Dr. Effler enjoyed a remarkable career in the heroic age of cardiac surgery.  By his character, leadership and example he inspired and instructed the first generation of coronary artery surgeons.  He established a foundation of excellence that has gone on to enable the Department of Thoracic and Cardiovascular Surgery at The Cleveland Clinic to become one of the best in the world.

Floyd L. Loop, MD
Chief Executive Officer
The Cleveland Clinic Foundation
Cleveland, Ohio