The Life Scientific: Sir Magdi Yacoub

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1:04My guest today is quite simply one of the world's best known and most prolific heart surgeons, a man who pioneered high profile and often controversial procedures, but who's helped drive huge medical progress. Sir Magdi Yaqub is Emeritus Professor of Cardiothoracic Surgery, so that's heart and lungs, at Imperial College London and Director of Research at Harefield Hospital's Magdy Yaqub Institute. Inspired by a surgeon father and impacted by the tragic early death of his aunt from a heart condition, Sir Magdy's medical career has deeply personal roots. And alongside surgery, he's led numerous research projects to further our understanding of and ability to treat heart disease.

1:47Over a career spanning more than six decades, Magdy's carried out around 2 ,000 heart transplants, earning him the moniker the Leonardo da Vinci of heart surgery. But at times, his work, such as early unsuccessful transplant attempts, attracted serious public criticism, not an easy thing for anyone to weather. Today, of course, the transplant landscape is very different, thanks in no small part to Magdy himself. And, as he puts it, science progresses by imaginative leaps. the only way is to keep pushing forward. Professor Simagdiakou, welcome to The Life Scientific. Thank you very much. I alluded there to the controversy around heart transplants when they were first trialled.

2:29What was it, do you think, that made this such a controversial issue for some when others, including you, saw it as the future? The idea of transplantation matured because there was a massive need for treating patients with so-called terminal heart failure. And the public was amazed that this can happen, but also was critical because they said, you are experimenting on human beings and there is a lot of suffering of the operation and this and that, and it's not going to last. But time has shown that actually it did last. Some of my own patients have survived 37 years and they're the picture of health.

3:23Yeah, that's a long journey, of course, from those very early days. I also mentioned that nickname, the Leonardo da Vinci of heart surgery. In fact, many of your colleagues talk about your precision in theatre combined with this total sense of calm. have you had to perfect that over time or do you just need a very specific type of personality do you think to be a successful surgeon i think you do need to have a specific personality calm as as you have just said more calculated and do proper research if you are not calm the rest of the team because it's a team effort if you're not calm yourself and start shouting everybody...

4:07Everyone else feels stressed. Yes. It produces chaos. I gather you also play classical music in the theatre. Yes, I love classical music, particularly Johann Sebastian Bach, where the music is almost mathematical. Yes. And so exact. And presumably that was part of your personality growing up as well. I have always been calm, but that didn't serve me when I was a child at school, I used to sit in the back of the class saying nothing. At one stage, some people said, he's mentally defective. Why is he not speaking enough? And then at the end of the year, I come to the top of the class and people say, this cannot be, you must be cheating.

4:57And they proved that I was not cheating. It was my ideas and they listened very carefully. So why didn't you talk? I said, excuse me, I have nothing to say at this stage. Well, Sir Magdi, let's hear a bit more about your childhood. You were born in 1935 in Sharia, in northern Egypt. Tell me about your family. My dad was a general surgeon, and he came from Upper Egypt. My mother came from Alexandria, from the north, and she was interested in art, particularly she was throwing mainly landscapes but also she played the piano one piece repeatedly which stuck in my mind and that was Moonlight Sonata by Beethoven so that's the love of classical music and so I admired my dad very much he was a role model for me but when I said I'm going to be a heart surgeon at the age of four or five he said nonsense you haven't got it in you to be a heart surgeon.

6:09How can he make that judgment to a four or five year old? Whether he was doing it to just to tease me or he actually believed that. Well as you mentioned you did decide at a very young age that you wanted to go into medicine as well heart surgery in particular. How did that come about? I admired my father because he was involved in saving lives and I thought, wow, that's impressive. But then he lost his sister, his younger sister, my aunt, at a very early age, 22, from a narrow heart valve. And he had almost a nervous breakdown. and he didn't want to talk for a period of time. And he declared that she didn't need to die because there are now surgeons starting to open the narrow heart valve.

7:10And so I declared, I'm going to be a heart surgeon, which said you're not going to be a heart surgeon. Well, you did turn out to be an exceptionally precocious student. You got a scholarship to study at the University of Cairo College of Medicine when you were just 15. You qualified as a doctor in 1957. Then after a couple of years of surgical residencies, you moved to the UK to train at London's Royal Brompton Hospital. And in 1964, you started at the National Heart and Chest Hospital, working with a surgeon, Donald Ross, repairing heart valves, using a system that he developed, the Ross procedure.

7:51can you explain just in a nutshell what that involves? The ROS procedure consists of taking the patient's own pulmonary valve the valve going to the lung and putting it in the aorta in the aortic position where there is a high pressure and the valve is abnormal and then putting a human valve on the right side where there is low pressure. So the aortic valve sends the blood from one side of the heart through the aorta that sends this oxygen-rich blood around the rest of the body. So that's the high-pressure valve that presumably gets a lot more use than the pulmonary valve, which just takes the blood to the lungs.

8:31Yes, indeed. The pulmonary valve takes blood from the right ventricle to the lung at a very low pressure. Right. Whereas the aortic valve pumps blood to the entire body and therefore is exposed to a very high pressure to allow the blood to go. So it gets more wear and tear. And so it gets more and tear. This really was pretty groundbreaking stuff for the time, wasn't it? I mean, you were performing the procedure on people who were expected to die within days and they were surviving. Yes, and 30 to 40 years without any re-operation, without any anticoagulants. This was unknown in any other type of life.

9:17Quite remarkable. It was also around this time, Magdi, that you met your late wife, Marianne. Tell me about her. Marianne was a remarkable person who taught me a whole lot of things. She came initially from East Germany, but her family were in Hamburg, so she escaped across the wall. Then she came to the UK and worked as an auxiliary nurse at the Brompton Hospital. That's where we met. And we got married in the US because I went to the US later and she followed me. And we got married in one of the quadrangles of the University of Chicago. So you were offered an assistant professorship there at the University of Chicago.

10:09Exactly. How did you enjoy that time? I enjoyed that tremendously. And that was the year where I was doing a lot of research, as well as clinical work, as well as teaching, and I got married. A busy time. Busy time. We're going to get into the nitty-gritty of transplant surgery now, Magdi. So in 1967, the South African surgeon Christian Bernard performed the first heart transplant. The following year, when you were in Chicago, in fact, your mentor, Donald Ross, conducted the first transplant in the UK. This was still a hugely experimental procedure. Neither of those two patients survived more than a few weeks.

10:52Now, in 1973, Magdi, you returned to the UK to take up the role of consultant cardiothoracic surgeon at Harefield Hospital in West London. At this point, quite a small facility, but I gather you had big ambitions when you went there. Yes, indeed. Heart surgery was being performed, but once every two weeks. And when I arrived, I said, we're going to do 10 to 20 patients per week. And people thought this was impossible. and I proved that it was possible and I proved to my colleagues that I was not megalomaniac because I will help them do the operation, help them on the table or run the heart-lung machine or clean the floor and they were very impressed by that and then Airfield Hospital became a major cardiac centre, including transplantation later on.

11:52Well, before that, there were certainly some challenges to be overcome. Following Donald Ross's unsuccessful heart transplant at the end of the 60s, the British government had declared a voluntary moratorium on any further attempts because of the risks. But you decided to go against that and attempt a transplant anyway. Tell me about that. That was a mistake, and I admit it freely. I had a patient who was dying, and then I learned that there was a potential donor in a nearby hospital. So I went ahead and did that, but the patient died. And I admit we were not prepared for it at that time because we didn't have the drug and we didn't have the experience and so on.

12:42So that was a mistake. What was the response like from your colleagues and more broadly from the media or the wider public? Quite rightly, they were very critical. Why did he do that? Well, of course, experimentation in many of these procedures of medicine come with successes and indeed failures. In fact, you hit the headlines again in 1975 when you linked a baby's circulatory system to that of a baboon to provide the baby with life support. On the face of it, it sounds almost incredible, but it's a method that was trialled before mechanical, artificial hearts were in use. Can you talk me through the science behind this?

13:23This cross-circulation, joining a baboon to a human, was used already for multi-organ support for liver failure in particular by a group in the United States. And the idea is that if you join an animal to a human, particularly baboon, it will reject immediately because the blood of the baboon is different from that of the human. But if you bleed the baboon and replace with blood compatible with the human, cross-circulation goes on and the baboon can survive for months or years because it replaces the human blood by baboon blood over the next several months. so why did I apply it? because I had this baby who had multi-organ failure following a new operation for single ventricle he had only one chamber of the heart so I wanted to support all the other organs and we didn't have an artificial heart at that time so the only way I could think of to save that baby is to use this cross-circulation with a baboon.

14:42The baby improved immediately and all the organs started to recover. But the baboon died a few days later. And when he died, the child also died. There was a lot of criticism from the animal right people. How dare you sacrifice an animal for a human? I didn't want to sacrifice the animal. Actually, I hoped that we can save both the baby and the baboon. Pop quiz. What's in your kid's lunchbox? At Whole Foods Market, they've already done the studying. Over 300 food ingredients are banned from their shelves. No hydronated fats in the peanut butter and no high fructose corn syrup in the cookies. And for sandwiches, there are no synthetic nitrates or nitrites in any of their deli meat, so you can pack lunch boxes with peace of mind.

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16:15You've spoken before about what a difficult decision it is, embarking on risky surgery. And of course, sometimes it's the only chance of saving them. But every loss must be incredibly hard. How do you handle that and ultimately keep going forward? When you're doing something new, you're doing it like you have just said, because there is nothing else which can help that baby except this new procedure. You are all on your own. Anything can happen. And this is a very difficult thing. You feel very lonely. But how do I get over that? I concentrate on the baby, but also on the procedure. I need put all my effort to make the procedure successful but I am not a machine afterwards I am very emotional switch on all the emotions well as I said when you're trying new things there are happily also the successes and it was in the 1970s that you pioneered the arterial switch operation to save babies born with their pulmonary and aortic arteries the wrong way around How does that actually work?

17:26When babies are born with transposition of the great arteries, what happens is the right side of the heart gives the aorta and the left side of the heart gives the pulmonary artery. So these babies cannot survive unless there is mixing of blood between the two sides. Initially, people tried performing operations immediately after birth, But then you had a lot of babies die because if you switch the arteries, you also have to anastomose the coronary arteries, the arteries supplying the heart muscle. And they are less than one millimeter in diameter. So they are tiny. And they have to develop techniques to switch the arteries as well as the coronary arteries.

18:19We were starting to do that. But the problem with that is that following birth, the pressure in the pulmonary artery, which is coming from the left side of the heart, drops. And with it, the heart muscle becomes unsuitable for the switch operation. So we had to do it in the first month of life. And we devised an operation to prepare the left ventricle by banding of the pulmonary artery before the switch operation. And initially people say it will never happen. But now the neonatal switch operation, this is a standard operation around the world. Incredible. Meanwhile, there was movement in the world of transplants.

19:07In 1980, as these new anti-rejection drugs became available, the government moratorium was lifted. You performed three heart transplants in fairly quick succession. and although the first two patients didn't survive for long, the third, Derek Morris, lived for another 25 years. A couple of years later, you performed the surgery on John McCafferty, who survived for more than 33 years. Then in 1983, you handled the UK's first combined heart and lung transplant. I'm guessing that must be much more complicated than just a heart transplant by itself. yes and no the heart is suited for the lungs and if you replace both of them you have a perfect match and it works very well so you take both the heart and the lungs and the chest is empty but you preserve the nerves supplying the diaphragm which you have to preserve to be able to breathe afterwards.

20:08To keep the patient alive. To keep the patient alive. And so I did the first heart-lung transplantation in this country, in Europe, as a matter of fact. And then we had the biggest heart-lung transplantation program in the world at Herfield. In these early days of transplants, I gather you were also responsible for harvesting the donor organs yourself prior to operations. Yes, indeed. So I used to go out in the middle of the night, fly out into Europe or to different parts of the UK. But later on, teams could go because we standardised out-of-hospital procurement. My producer Lucy tells me that when you were collecting and transporting a donor heart, you'd often be driven back to Harefield by a police car at very high speed.

21:01I imagine it's quite difficult to keep your cool in that sort of high-stakes situation. Yes, the police force used to take us to help us procure their organs from out of hospital. And they used to drive at 100 or 120 miles an hour. And that's very frightening. And on one occasion, the senior police officer was driving and the younger police officer was sitting next to him. the senior officer was driving at a terrific speed and the younger one became motion sick and was violently sick out of the window and the senior police officer would ask him are you all right son to which he would ask yes sarge yes sarge and it was frightening and you're sitting in the back just with your eyes closed and then just closing my eyes but I was impressed by how the police tried to help the public.

22:04Well Magdi, in the mid-80s you were made a professor of cardiothoracic surgery at Imperial College London. Meanwhile, by the end of the first decade of the Harefield's transplant programme, there'd been around a thousand heart operations. By that point, Harefield had gathered a few celebrity supporters. You treated comedian Eric Morecambe, former Greek prime minister Andreas Popandreou, the Egyptian actor Omar Sharif. Of course, they were in the news. It just raises the profile of the surgery that they'd been through. One of your most high-profile admirers was Princess Diana, who became a big supporter of your charity, Chain of Hope, which you set up in 1995.

22:47First of all, tell me about the organisation Chain of Hope. The Chain of Hope was established because I felt strongly that what we have learned was being applied to a minority of the world population, less than 20%. So initially we used to go on missions, but we wanted to establish sustainable units around the world. And that is why the Chain of Hope was established. Now, Princess Diana was very supportive of this. She really cared about people with terminal heart failure and was a great supporter of the programme. Chain of Hope is still going strong today. And in 2008, you co-founded the Magdi Yaqub Heart Foundation in Egypt, which offers free cardiac services for children, including via the Aswan Heart Centre.

23:47I gather you also got another heart centre opening this year in Cairo, is that right? Yes, there are two other large heart centres being built. One in Cairo, which is nearing completion, and another one in Rwanda, in Kigali. Well, Magdi, back to the science. You've helped develop numerous cardio procedures during your career, including one in the early 2000s that can actually reverse heart failure. So, interestingly, with doing heterotopic heart transplantation, whereby we put the donor heart as an auxiliary pump and keep the patient's own heart, some of these patients recover. Tell me about Hannah Clark.

24:32Hannah Clark had severe cardiomyopathy, enlarged heart, as an infant, and she was going to die. We couldn't find a heart for her except a small heart. So we used a small heart as an auxiliary pump to help her own heart. And we linked them that they could counter pulse each other, help each other. So she had two hearts? Yes, for a while. And her heart, to our astonishment, actually recovered almost completely. But the donor heart started to give trouble, to reject. and she started to have lymphoproliferative disease, malignant disease affecting the lymphatic system. Cancer. Yes, which blocked her respiratory system and so we decided the only way is to stop immunosuppression.

25:28But when we stopped immunosuppression, the donor heart started to clot and throw bits of clots around the body. So we took that heart out and behold her own heart became completely normal and she is now an adult married and has several children with no heart disease and her own heart is completely normal. So we've learned so much about reversing lymphoproliferative disease about recovery of severe heart failure. So that's Hannah Clarke. A real success story, absolutely. Well, you stepped back from your role with the NHS in 2001, Magdi, but it'll come as no surprise to listeners that this was in no way, shape or form retirement.

26:20You continued as a professor and the Harefield Heart Science Centre evolved into the Magdi Yaqub Institute to support research into the causes and treatments of heart disease, of which you became the founding director. here you also led the team in 2007 that for the first time successfully grew part of a human heart valve from stem cells heart valve disease affects children and adults and causes a lot of death and suffering and learning from the ross operation we know that a living heart is the only answer So we started experimenting initially with stem cells obtained from different people or from animals.

27:04But we learned more recently that you can have a synthetic scaffold made in the lab. Right. A simple synthetic scaffold of specific shape as well as pores, which attracts the patient's own stem cells, and they line up and produce a living valve, which performs all the very sophisticated functions of a living valve, like a Ross operation. And that was just like we didn't expect it to happen. We tested it in animal model, and it works like magic and performs all the functions of a living valve. Quite incredible. Well, it's hard to believe, but this year, Magda, you turned 90. Given your experience over the past 60-odd years, what advice would you give to the next generation of heart surgeons and cardio researchers?

28:03I would give them advice I call PPH. The first P is to have passion for your work. The second is persistence, keep at it. And the third is humility. It is essential for success. Well, here's to passion, persistence and humility into the next 60 years of innovative surgical progress. Professor Magdi Aqub, thank you very much for sharing your life scientific. Thank you. And thank you for listening. I'm Jamal Khalili and my producer is Lucy Taylor.

28:39Hello, Greg Jenner here. I'm the host of You're Dead to Me, the BBC comedy show that takes history seriously. Every episode, I pair up a top historian with a fantastic comedian, and we have a lovely, funny, fascinating chat about a different subject from world history. And in this new series, we're beginning with an epic voyage through the story of Homer, the Iliad and the Odyssey. And that's with Kyle Smith-Bino joining us. And then we'll be learning about Francis Galton and the racist, discredited pseudoscience of eugenics with Desiree Birch. We'll meet many medieval saints in their bone boxes with Rachel Parrott.

29:12So if that sounds like your sort of thing, listen to You're Dead to Me wherever you get your podcasts. Thank you. Bye.