René Favaloro: The story of the coronary bypass

Argentine history has names that carry weight. Names that one pronounces slowly, because behind them there is more than just a biography: there is a way of understanding the world, of understanding science, of understanding what it means to be a doctor. Today it is the turn of one of those names. Dr. René Favaloro.

There are discoveries that shake medicine from top to bottom. Those that last do not always come from the best-equipped laboratories or the most prestigious universities. Sometimes they come from someone who has something difficult to define and easy to recognize: a different way of looking. Favaloro had that. A gaze that saw where others did not see, and the quiet courage to act when he saw it.

This is his story.

Favaloro's origins

René Gerónimo Favaloro was born on July 12, 1923, in the El Mondongo neighborhood of La Plata. The neighborhood's name came from the workers of nearby meatpacking plants, who received tripe as part of their salary.

His father, Juan Bautista Favaloro, was a carpenter. His mother, Geni Ida Raffaelli, a seamstress. Two trades that involve working with one's hands, with patience, with the body bent over wood or fabric. Favaloro himself helped out in his father's workshop during holidays as a child, becoming just another worker. This manual skill, learned among wood shavings and tools, would eventually become one of his hallmarks as a surgeon.

His maternal grandmother taught him to love nature. He would dedicate his doctoral thesis to her:

"To my grandmother Cesárea, who taught me to see beauty even in a poor dry branch."

There is something in that phrase that summarizes him quite well. Favaloro always knew how to find the essential where others saw nothing.

At just four years old, he already said he wanted to be a doctor. The reason, perhaps, was his doctor uncle, whom he accompanied in his office and on house calls. He lived a block from the Policlínico Hospital of La Plata, which would be key to his training years later.

After passing a rigorous exam, he entered the Colegio Nacional de La Plata, where he received a humanistic education from teachers like Ezequiel Martínez Estrada and Pedro Henríquez Ureña. It was the kind of institution that shaped people before professionals.

In 1941, he began his medical studies at the National University of La Plata.

From the beginning, he was the kind of student who made conformists uncomfortable. While taking his own subjects, he mingled with sixth-year students and snuck in to observe operations performed by Professor Federico E. B. Christmann, from whom he learned something he would apply throughout his life: simplification and standardization in surgery. It was Christmann who rightly said that to be a good surgeon, one first had to be a good carpenter. The curious thing is that Favaloro already was, literally.

His fundamental training took place during his residency at the Policlínico Hospital. For two years, he practically lived there, learning to treat all pathologies, but above all, he learned to respect the sick, most of whom came from humble backgrounds.

Then came the first controversy.

In 1949, newly graduated, a vacancy opened for an auxiliary doctor at the Policlínico. He was called to confirm the position, but in the last line of the form, he had to declare that he accepted the government's doctrine. This was Perón's Argentina. Favaloro refused. He resigned from the position for which his merits more than qualified him. It was not a gesture of capricious rebellion. It was, simply, a matter of principle, of not allowing medicine to deviate from caring for people.

In May 1950, he left for Jacinto Aráuz, a small town in La Pampa, to replace the local doctor for a few months. He thought it would be a brief stop. He stayed for twelve years. There, with his brother Juan José, also a doctor, they built a health center from scratch. An old house was converted into a clinic with twenty-three beds and an operating room. They organized a living blood bank, taking samples from the local inhabitants and classifying them for emergencies. They managed to reduce infant mortality, childbirth infections, and malnutrition.

It was on that Pampa plain, far from any medical conference or spotlight, where Favaloro forever understood what medicine was. Little by little, he read publications on thoracic and cardiovascular surgery, a discipline that was just beginning to develop at the time. His curiosity grew.

In 1962, after twelve years as a rural doctor, he decided to emigrate to the United States. The chosen place was the Cleveland Clinic, on the advice of his former professor Mainetti. He arrived in Cleveland with just enough English to survive, ready to start from scratch.

Cleveland, the coronaries and a leg vein

He was thirty-nine years old. Behind him, he left twelve years of rural medicine in La Pampa, a clinic built almost with his own hands, and the certainty that there was something more he needed to learn. Ahead, the Cleveland Clinic: one of the most advanced medical centers in the world, where the best cardiovascular surgeons of the time were rewriting the limits of what was possible.

He wasn't fluent enough in English. His degree wasn't validated. Yet, a year after arriving, he managed to be accepted as a resident in the service of Donald Effler, head of cardiovascular surgery. Effler was a groundbreaking surgeon: methodical, demanding, brilliant. Working alongside him was Dr. Mason Sones, the cardiologist who had developed coronary arteriography, the technique that for the first time allowed precise visualization of the inside of the heart's arteries. Sones's lab had the largest collection of cinecoronary angiograms in the United States. In practice, it was the most detailed map of the geography of the human heart that existed.

Favaloro settled there. Every afternoon, after finishing his duties in the operating room, he went down to the laboratory and spent hours reviewing those images. One after another. Looking for patterns, studying obstructions, learning to read the coronary vessels as one learns to read an unknown city, street by street. It was obscure work, without applause, that no one asked him to do. He did it because he needed to understand.

To understand what Favaloro discovered, one must first understand the problem that no one could solve. Coronary arteries are the vessels that supply blood to the heart muscle itself: without them, the heart does not receive oxygen and dies. When atherosclerosis obstructs them, blocking the flow of blood, angina pectoris, heart attack, and death ensue. In the 1960s, this process was largely irreversible. Doctors could treat the symptoms, but there was no way to restore the missing blood to the heart.

Favaloro had spent years looking at those angiograms, clearly seeing where the obstructions were, and thinking about something that perhaps others had also thought of but had not followed through to its logical conclusion: if the diseased artery cannot be cleaned, why not bypass it? Why not build an alternative pathway to carry blood from the aorta to the healthy part of the artery, skipping the damaged section?

The idea was not entirely new. In peripheral vascular surgery, venous grafts were already being used to bypass obstructed arteries in the legs. But no one had systematized it in the coronaries. The reason was technical: coronary arteries are small, delicate vessels, in constant motion with the beating of the heart. Operating on them required almost impossible precision, and the slightest mistake could be fatal.

In early 1967, Favaloro began to give concrete shape to the idea. The vessel he would use as a bridge would be the great saphenous vein, a long vein that runs along the inner side of the leg. A portion of it can be extracted without affecting circulation in the limb. It is resistant. And its diameter is compatible with that of the coronary arteries. The operation would consist of taking that segment of vein, connecting one end to the aorta and the other to the coronary artery below the obstruction, creating a bypass through which blood could flow freely.

In May 1967, he proposed it. The patient was a man with a nearly completely occluded right coronary artery, incapacitated by angina that appeared with the slightest effort. He agreed to undergo what no one had done before. Favaloro operated. Nine days later, Sones repeated the angiography to check the result. Blood was flowing again.

May 9, 1967, is the official date. That day, in Cleveland, Favaloro operated on a 51-year-old woman, applying the technique of aortocoronary bypass with saphenous vein systematically and documented for the first time. The operation was a success. What followed was, in time, one of the most performed surgical procedures in medical history.

What is most striking about Favaloro, and what distinguishes him from many other scientists who have made great discoveries, is what he did next.

He did not hoard the technique. He did not patent it. He did not turn it into a competitive advantage. He documented it with surgical precision, presented the results at conferences, and disseminated it throughout the world with the same generosity with which a village teacher shares what he knows.

In 1970, he published the book Surgical Treatment on Coronary Arteriosclerosis, where he described the technique in detail so that any surgeon in the world could learn and apply it.

"Many times I had to tell my story in the first person, as I actively participated with new ideas in the development of coronary surgery. Not doing so would have been an excess of modesty. But it must be clear that for me, the individual does not count. It is time to understand that the 'I' has been replaced by the 'we'."

Since then, coronary bypass has saved over 55 million lives worldwide. Today, around 800,000 such operations are performed each year in countries with available data alone. It is one of the 400 most important inventions in human history according to Google's cultural platform. And it was born in the mind of an Argentine rural doctor who arrived in Cleveland not knowing English, who stayed late in a laboratory looking at images that no one asked him to look at, and who thought that if blood couldn't pass where it always had, perhaps another path simply needed to be opened.

In 1971, Favaloro resigned from the Cleveland Clinic and returned to Argentina. In his farewell letter to Dr. Effler, he wrote that he wanted to dedicate the last third of his life to building something in his own country. Something that combined surgery, research, and education. Something that would train the surgeons of the future. This obsession would accompany him until the end.

The return, the dream, and the price of being honest

In 1971, Favaloro rejected all the offers that the Cleveland Clinic and other American institutions had put on the table. These were offers that any doctor in the world would have accepted without thinking. He rejected them one by one and returned to Buenos Aires with a fixed idea: to build something similar to what he had seen in Ohio in his own country. A center that united surgery, research, and training. A place where technical excellence would not be the privilege of those who could afford it. He returned, as he himself would say years later, because he believed that the homeland was also built from the operating room.

The first years were pure work. He operated at the Sanatorio Güemes alongside cardiologist Luis de la Fuente, who had been key in convincing him to return and who would be his intellectual partner for decades. The duo functioned with almost mathematical logic: De la Fuente made the diagnoses and performed the catheterizations; Favaloro would not enter the operating room unless the other had given his approval. It was a matter of rigor. Of shared responsibility. Favaloro did not conceive of surgery as an individual act.

In 1975, he formally founded the Favaloro Foundation, although the idea had been maturing for some time. The story goes that one night in the 1970s, Favaloro and De la Fuente were having dinner at the home of a grateful patient. In the early hours of the morning, with wine doing its work, the idea of creating a foundation arose. Favaloro initially did not want it to bear his name. They convinced him. Over time, that nocturnal conversation would become one of the most important cardiovascular centers in Latin America.

The Foundation grew. In 1980, it created the Basic Research Laboratory, which he funded for years with his own money. In 1992, the Institute of Cardiology and Cardiovascular Surgery was inaugurated in Buenos Aires, with the motto Favaloro never tired of repeating: advanced technology at the service of medical humanism. In 1998, Favaloro University was born. It trained more than four hundred resident doctors. It handled hundreds of thousands of consultations. It performed more than twenty thousand surgeries. The numbers are impressive, but what really mattered to him was something else: that no patient be turned away for lack of resources. The Foundation never did.

That, which was his greatest pride, would also be his ruin.

Because Favaloro was not just a surgeon. He was a man with opinions, and he expressed them. He described the Argentine health system as chaotic, unjust, and dehumanized. He publicly denounced the corruption of medical unions, social welfare organizations, and officials who viewed public health as a source of private business. He wrote books, hosted television programs, and gave speeches at universities around the world.

In 1984, President Alfonsín appointed him a member of CONADEP, the National Commission on the Disappearance of Persons created to document the crimes of the dictatorship. Favaloro accepted. But he resigned shortly after, in a gesture that defines him: he refused to be part of a commission that, as he understood it, did not have the authority to also investigate the crimes of the Triple A, the parapolice group that had operated under the government of Isabel Perón. For Favaloro, ethics did not allow for half-measures. Crimes were crimes, regardless of who committed them.

This attitude earned him respect and admiration. And also enemies. As he himself would write with bitter lucidity, he bothered people. A doctor who said out loud what others thought in silence was not comfortable. A doctor who refused to play by the rules of the system was a problem.

The 1990s were the decade in which the system began to hit back. The Foundation treated patients from social welfare organizations and PAMI, the medical care program for retirees and pensioners. It provided services, issued invoices, and waited for payment. Payment did not arrive. Invoices piled up. Between 1993 and 1995, during Víctor Alderete's tenure as head of PAMI, the agency directly refused to accept invoices from the Foundation. There was no accounting record of the debt because PAMI had refused to record it. It was an elegant way of making it disappear.

By 2000, the situation was untenable. The Foundation had accumulated its own debts of more than forty million dollars. At the same time, the State and various social welfare organizations owed it more than eighteen million for services already rendered. The main debtor was IOMA, the social welfare organization of the province of Buenos Aires. PAMI followed, with close to three million pending for those 195 invoices that no one had wanted to receive years earlier. There were also pending payments from other social welfare organizations, private health insurance companies, and official agencies. It was not an internal management problem. It was the accumulated result of years in which the system had learned that Favaloro could be left unpaid.

Favaloro wrote letters. Many letters. To officials, to businessmen, to banks, to foundations. He wrote them with the same precision with which he described a surgical technique: he explained the problem, documented the facts, proposed concrete solutions. No one responded. The country that applauded him at international conferences, that put his name on hospitals and in laws, that considered him one of the great Argentinians of the century, could not find even six million dollars to support the institution he had built with decades of work.

"I am going through one of the most difficult moments of my life. The Foundation has serious financial problems. Lately, I have become a beggar. My job is to call, call and knock on doors to raise some money that will allow us to continue."

He wrote it. With those words. A man who had operated on thirteen thousand hearts, who had trained four hundred doctors, who had invented one of the most widely used surgical procedures in the history of medicine, describing his situation as that of a beggar in his own country.

Those close to him began to notice the deterioration. The sadness that settled in his eyes when he spoke of the Foundation. The weariness of continuing to fight against an unyielding current. But he did not stop working. He taught classes, operated, wrote scientific articles, presented at conferences. Until the end, he maintained that rural doctor's discipline he had learned in La Pampa, when there was no one else and the patient was waiting. What was breaking inside was something else: the conviction that the country he had chosen over all other options could live up to what he was offering it.

On Friday, July 28, 2000, the Foundation's board asked him to make a drastic staff reduction the following Monday. To dismiss the team of doctors he himself had trained. That same Friday, he wrote a letter to President Fernando de la Rúa asking him to intercede to secure a loan of six million pesos. The letter ended with three words: I am desperate. De la Rúa did not read it until Monday.

Saturday, July 29, 2000

That morning he got up early, as always. He had breakfast with Diana Truden, his girlfriend, thirty-one years old, whom he planned to marry in August. He went down to the garage, got into his more than fifteen-year-old Peugeot 505 and drove to the Foundation on Belgrano Avenue. He arrived on time, greeted every employee he met in the hallways, stopped when a doctor consulted him about a case, asked for the X-ray, held it up to the light, gave his opinion. Then he locked himself in his office, reviewed clinical studies, evaluated images. He worked until noon.

No one noticed anything out of the ordinary. Or perhaps they did, and had been noticing it for months, and had grown accustomed to seeing that unyielding burden in him. At 1:30 PM, he returned to the apartment on Dardo Rocha street for lunch with Diana. They ate something frugal. They talked about the wedding, the guest list, the dress she had tried on. Then the intercom rang. Diana's brother was coming to pick her up. Favaloro told her he would go to La Plata in the afternoon.

He lied. He waited until he was alone.

What he did next says everything about who he was. He bathed. He shaved. He put on his pajamas and slippers. He went to the bedroom, took seven letters he had written in the previous days and a gun from a drawer. He left the envelopes on the dining room table, in a prominent place. He went back to the bathroom. He taped a note addressed to the competent authorities on the mirror. Then he looked at himself. He faced his own eyes for the last time. He placed the revolver against the left side of his chest. There, he knew better than anyone, he could not miss.

The autopsy was performed by forensic doctor Osvaldo Raffo. The time of death was determined to be 4:45 PM that Saturday. The report indicated the precision of the shot: only a medical specialist in cardiology, someone who knew exactly that the injury caused by the bullet in that place would be, precisely, the bursting of the heart, could have achieved such an effect.

He had operated on thirteen thousand hearts. He knew that organ better than anything else in the world. And he chose that place, and no other, to end it.

The seven letters he left on the table were not sentimental farewells. They were documents. There was one for Diana, another for his family, others for colleagues and friends, and at least one addressed to the authorities of the country, which was in reality a stark testimony of the system that had destroyed his work. In it, he explained the debts, named those responsible, and described with surgical precision the mechanism of corruption that had emptied social welfare funds for years. He signed it at 2:30 PM that same Saturday.

"We had to fight continuously with the prevailing corruption in medicine, part of the tremendous corruption that has contaminated our country at all levels without any limits whatsoever. We have systematically refused to break ethical guidelines. As a consequence, we never paid a single peso in return."

And later, in that same text, which is one of the most painful documents produced by Argentine science:

"It is undoubtedly true that being honest in this corrupt society has its price. Sooner or later, they make you pay for it. Most of the time I feel alone. I'm tired of fighting and fighting, galloping against the wind as Don Ata used to say. I can't change, I prefer to disappear."

He had asked for no ceremony. Neither religious nor civil. That he be cremated and his ashes scattered in Jacinto Aráuz, that small town in La Pampa where he had spent twelve years being everyone's doctor. In May 2001, his family fulfilled his request. His ashes returned to the plain where he had learned, as he himself once said, the profound social meaning of life.

After the scandal of his death, the debts that had suffocated the Foundation were in the process of regularization. The sixteen million that PAMI, social welfare organizations, unions, and the Ministry of Health owed him began to move as soon as Favaloro was no longer alive to claim them. The system that had ignored him for years suddenly found a way to function when there was no one left to hold accountable.

There is something in Favaloro's story that goes beyond medicine, beyond Argentina, beyond the bypass and corruption and the eighteen million unpaid. There is something in it that speaks of a type of person who exists in all cultures and in all eras: the one who refuses to bend. The one who has a code and maintains it even if it costs him dearly. The one who understands that there are things that cannot be changed without ceasing to be who one is.

Favaloro could have been rich. He could have stayed in Cleveland, where they offered him everything. He could have collected the kickbacks that the Argentine medical system considered part of the landscape. He could have accepted that the Foundation be downsized, that he play an honorary role, that things function more or less. He had plenty of reasons to carry on.

He couldn't. Not because he was weak, but precisely because he was too much himself. He had spent his whole life not yielding an inch on what he considered fundamental, and when the system demanded that he yield on the biggest thing, on the dream for which he had returned to Argentina, he found that there was no way to do it without betraying something that was deeper than the will to live.

There are scientists who change the world with a discovery. There are doctors who change the world with a technique. Favaloro did both.

Every year, around eight hundred thousand coronary bypass surgeries are performed worldwide. Each one of them carries within it, in some way, the hands of that carpenter's son who grew up a block from a hospital in an immigrant neighborhood, who stayed twelve years in a town in La Pampa when he could have left, who arrived in Cleveland not knowing English and stayed late in a laboratory looking at images that no one had asked him to look at.

Fifty-five million lives, according to available estimates. Fifty-five million people who continued to breathe because a man thought that if blood couldn't pass where it always had, another path had to be opened.

His ashes are in Jacinto Aráuz. The world's heart continues to beat thanks to him.

FAQs. Frequently Asked Questions about René Favaloro

Who was René Favaloro and why does he hold such an important place in the history of medicine?

René Favaloro was an Argentine cardiac surgeon who systematically developed and disseminated the aortocoronary bypass with saphenous vein, a technique that transformed the treatment of coronary heart disease. His importance is not only due to the surgical impact of this advancement, but also to his vision of medicine linked to research, teaching, and social commitment.

What exactly is the coronary bypass that Favaloro developed?

Coronary bypass is an operation in which a blood vessel from the patient's own body, often the saphenous vein from the leg, is used to create a new route to carry blood to an area of the heart beyond an obstructed artery. Instead of removing the plaque, the surgery creates a detour to restore blood flow to the heart muscle.

What medical problem was this technique trying to solve?

The technique aimed to treat reduced blood flow in the coronary arteries caused by atherosclerosis. When these arteries narrow or become blocked, the heart receives less oxygen, which can lead to angina pectoris, myocardial infarction, and irreversible damage to heart tissue.

Why was the idea of using a leg vein in the heart so revolutionary?

It was revolutionary because it allowed the application of a principle already known in peripheral vascular surgery to a much more delicate and complex area. Coronary arteries are small, move with every heartbeat, and require extreme precision, so demonstrating that a vein could function as a safe bridge in that context changed cardiac surgery forever.

When did Favaloro perform the first successful coronary bypass and what happened next?

The first systematic and documented intervention took place in May 1967 at the Cleveland Clinic. After angiographic confirmation that blood was flowing again through the new pathway, the technique began to spread internationally and eventually became one of the most practiced procedures in modern cardiovascular surgery.

Why did Favaloro decide to return to Argentina after his success in the United States?

Favaloro returned because he wanted to build an institution in his country that integrated highly complex care, biomedical research, and the training of new professionals. His goal was not just to operate, but to create a model of medical excellence that also had a public vocation and a strong humanist sense.

What was the relationship between the Favaloro Foundation's economic crisis and the surgeon's death?

The crisis was marked by millions of dollars in debts accumulated by organizations and social welfare providers that did not pay for services already rendered, which put the Foundation in a critical situation. This financial deterioration, coupled with emotional exhaustion and his constant clash with the corruption of the health system, was part of the context of immense despair that preceded his death in 2000.

Is coronary bypass still used today or has it been completely replaced by stents?

Coronary bypass remains a fundamental surgery and has not disappeared with the advent of stents. In patients with extensive coronary artery disease, multi-vessel lesions, or left main coronary artery involvement, surgery can offer better long-term results in survival, need for re-intervention, and symptom control.

What vessels besides the saphenous vein can be used in a coronary bypass?

In addition to the saphenous vein, arteries such as the internal mammary artery and the radial artery are very frequently used today. In many cases, arterial grafts offer greater durability than venous grafts because they better withstand pressure and tend to remain patent for longer.

What global impact does coronary artery disease, which Favaloro helped treat better, have?

Coronary artery disease remains one of the leading causes of death worldwide and is part of the large group of cardiovascular diseases that cause millions of deaths each year. Therefore, a technique capable of improving blood flow to the heart in severe cases has had an enormous effect on survival, quality of life, and the development of modern cardiology.