George Westlake was a pioneer and a force in heart surgery in Melbourne and Australia. He was a superb technical cardiothoracic surgeon. He was forward‐thinking, an innovator and was responsible for the training of many of the young cardiothoracic surgeons in the generation that followed.
George Westlake was born in Perth on the 10th of July 1927. He attended Perth Modern School, a selective secondary school (Bob Hawke and Rolf Harris being fellow contemporary students) during the war years from 1939 to 1945.
He undertook first year science at the University of Western Australia but had his sights set on medicine and travelled east to the University of Melbourne to study Medicine, graduating MBBS from the University of Melbourne in December 1950.
George undertook his internship, residency and early registrar years at the Alfred Hospital, became interested in and commenced training in thoracic surgery, which was further supplemented by registrar posts at the Repatriation and General Hospital, and at the Royal Melbourne Hospital, and completed his FRACS in 1956.
In 1957, he travelled with his family to London and worked as a registrar in cardiothoracic surgery at the Royal Brompton Hospital under the mentorship of Lord Russell Brock, who at that time was one of the big names in thoracic surgery not only in the UK but the world (Denton Cooley, from Texas had gone to study with Brock some years previously). Westlake spent 18 months in London during the truly early days of heart surgery, as Dr. John Gibbon had just invented the heart lung machine in 1955, with clinical success at the University of Pennsylvania. Similar advances were being made at the University of Minnesota by C.W. Lillehi. The mainstay of cardiac surgery at this time was repair of straight forward atrial and ventricular septal defects, and aortic and pulmonary valvotomies for aortic valve and pulmonary valve stenosis respectively.
In 1958, Westlake travelled to the USA for 3 months (Cleveland and Minneapolis) to gain insight into the critical developments that were taking place there, particularly in cardiovascular perfusion.
Westlake returned to a position as Cardiothoracic Surgeon at the Royal Melbourne Hospital in 1958. The position was both clinical and had a significant research development component in the dog lab. However, West lake was relatively underemployed and also took up a position as a Director of Heart Surgery at the Royal Children’s Hospital, which he held from 1958 to 1966.
Most cardiac surgery at that time was on paediatric and young adult patients, as usually congenital cardiac lesions were the only ones that could be readily dealt with. Also, there was limitation by the size and function of the oxygenators.
At the Royal Melbourne Hospital, George Westlake was part of the cardiothoracic team together with Mr. John Hayward (who retired in 1966) and Mr. Ian McConchie (who retired in 1977). In 1970, following a review of cardiac surgery services in Melbourne, by Professor John Loewenthal, two separate cardiac surgery units were established, the Monash University Unit at the Alfred Hospital and the combined University of Melbourne Open Heart Surgery Unit at St. Vincent’s Hospital in Fitzroy, where the patients from the Royal Melbourne Hospital, Austin Hospital and St. Vincent’s Hospital were operated and subsequently sent back usually on the second or third postoperative day for the rest of the postoperative management. This rationalized system allowed for the pooling of resources, efficiencies and the concentration of expertise and, despite logistic problems, generally served the patients well. During the 70s, Westlake (Royal Melbourne), John Clareborough (St. Vincent’s), George Stirling (Alfred), Eric Cooper (Prince Henry’s) and Brian Buxton (Austin) were able to consolidate and extend cardiac surgery in Melbourne, complimented by excellent results.
However, with the advent of successful heart valve replacement surgery (early in the 1960s in Australia) and the ever‐expanding need for coronary bypass surgery in the 70s, the Royal Melbourne Hospital re‐established its own cardiac surgery unit on its own campus in 1982. Westlake was the Head of Cardiothoracic Surgery at the Royal Melbourne Hospital from 1977 until 1988 and the Director of the combined University of Melbourne Open Heart Surgery Unit from 1978 to 1982.
Westlake was not yet 60 when his career was dramatically disrupted by an accident while holidaying in Queensland, where he fractured both forearms and both hips requiring many orthopaedic operations and a significant degree of convalescence and rehabilitation. However, with great tenacity and spirit, Westlake was able to return to the operating room for another 5 years and perform quality surgery until his retirement from clinical surgery at the age of 65 in 1992. We can only imagine the degree of personal pain and discomfort that dogged him through those final years.
Westlake was ahead of his time, a true pioneer and innovator. His mind was perennially open to new ideas coupled with irrepressible enthusiasm. He was inquisitive and restless in his constant search for discovery and improving surgical technique.
Westlake was a gifted surgeon, ambidextrous, quick and decisive, and able to perform complex surgery effortlessly (that others often found difficult) with ease and elegance, and he operated with grace under pressure and achieved excellent results. In his professional lifetime, he performed over 10 000 major lung and heart operations.
He was at the forefront of cardiac surgery in Melbourne and in Australia, helping constantly to introduce new procedures: heart valve repair and replacement, replacement of the thoracic aorta, challenging procedures in congenital heart surgery such as the correction of Fallot’s Tetralogy, and repair of atrioventricular canal, followed by the progressive refinement of coronary artery bypass surgery during the 70s.
The enormity of these tasks should be seen in the context of having to work out these procedures step by step with fellow colleagues, as they were being performed in the major hospitals around Australia for the first time, and it must be remembered that echocardiography, computed tomography scanning and magnetic resonance imaging were not yet invented and that cardiovascular perfusion was in its infancy and quite rudimentary.
Two of the great advances (and legacies) in heart surgery in Australia that can be directly attributed to George Westlake and that have endured include:
The use of cardioplegia for myocardial protection. George introduced this in 1977 after a visit to St. Thomas’ Hospital in London, and cardioplegia protection is still used today – albeit with some modifications.
Second, George was the first surgeon to implant the St. Jude Medical bileaflet pyrolytic carbon mechanical heart valve prosthesis in Australasia in August 1978. This valve has turned out to have excellent haemodynamics and clinical results, and is still used today. There have been a staggering almost 3 million implants over the past 35 years.
Westlake also supported Peter Wilson (Manager), Graeme Sloman (Director of Cardiology) and Brian Buxton (Cardiothoracic Surgeon) to set up cardiac surgery at Epworth Private Hospital in September 1981 in the face of significant opposition from within the profession. This has turned out to be a most outstanding and successful venture not only from the excellent service provided to patients, with superb results, but also the large database that has been generated, has been the basis of multiple publications, particularly in coronary artery surgery, and has been pivotal in establishing Melbourne’s international reputation for coronary surgery, particularly with arterial grafting.
Westlake was also either responsible for, or instrumental in the training of a number of young cardiothoracic surgeons, including James Tatoulis, Ian Nixon, Jacob Goldstein, Alex Rosalion, Peter Tesar and Andrew Cochrane.
Westlake always made an impression on people. His good looks, intellect, disarming directness, approachability and warm nature were hallmarks. He had a great sense of humour, disliked political correctness, spoke to everyone, and was incredibly loyal and supportive to the staff who in turn adored him and held in great esteem. He was also admired by his colleagues on the Senior Medical Staff at the Royal Melbourne and Epworth Hospitals. His generosity to all his colleagues and staff was legendary as evidenced by the many social events including a huge Christmas function for over a 100 people that George and his wife Maureen hosted. They ensured that not only everybody had a great time, but there was a gift for every person.
Despite these many facets, George Westlake’s great love was for clinical cardiac surgery that he performed with exquisite skill and with absolutely outstanding results for which his patients and their families were eternally grateful.
In 1988 (Australian Bicentenary), he was honoured with an Order of Australia Award for ‘Services to Medicine, particularly as a cardiothoracic surgeon’.
George spent the 20 years post‐retirement having a great time travelling, fishing, deep‐sea diving, playing golf, enjoying friends, but mostly spending time with his loving family. He died on the 27th of June, 2012, just 2 weeks short of his 85th birthday.
Richard J Mulhearn
Medical Journal of Australia
PROFESSOR NOEL WILLIAM GEORGE MACINTOSH MB, BS, DipAnthrop(Syd.), FRACS(Hon.), FRACDS(Hon.)
- D. MCCARTHY – Mankind