Albert Lasker
Clinical Medical Research Award

Acceptance Remarks by Albert Starr

I feel honored to accept this prestigious award and recognition by the Lasker committee. This occasion brings to mind three stories about our work. The first concerns Lowell Edwards, my engineer partner; the second, a dilemma in going from animal to man; and the third, a call from a grateful patient 43 years later.

Edwards and I began work in 1958 and early on he was interested in obtaining a unit of human blood. I supplied it with some difficulty and wondered why he needed it. The next day I visited his laboratory in a wood shed at his home on the Sandy River and he had the blood in a device that I had never seen.

He was measuring its lubricity; The S.A.E. of blood! No one had ever done so to his knowledge and this could be an important element in valve durability. This consideration would drive valve design so as not to extend the capabilities of blood as a lubricant. This was a stunning moment as I realized the importance of the interface between medicine and engineering. This interface would grow enormously in the next few years with multiple technology companies devoted to cardiac surgery. Edwards Laboratories, now Edwards Lifesciences, became the prototype for a massive industrial complex supporting medicine.

The second story involved the problem of animal to man in medical research. After implanting many valve types in dogs, all of which thrombosed in a few days, we eventually used a ball and cage device. Unfortunately, all animals died of valve thrombosis at about 30 days after implantation, except for one beautiful black Labrador retriever. We then developed a complex mechanism to shield the zone of implantation, with 80 percent long-term survivors beyond 6 months. As a result of the success of the shielded valve we were urged by our chief of Cardiology in General surgery to initiate clinical trials, but which valve should we use—the simple unshielded valve with our one survivor, or the shielded valve that was truly successful in the experimental animal? We chose the unshielded valve—it was the right choice, and successful in man. If we had chosen the complex shielded device, and if it was successful, how would we know if the unshielded and simpler device would also have been successful? On the other hand, if the unshielded valve failed, we could always move to the shielded valve. This decision was a good one and I owe a debt of gratitude to a beautiful dog who was adopted as a mascot by our laboratory team.

Finally, the third story involves a patient I operated on in Salonika, Greece in 1964. The chest was opened, the patient was on bypass, her own destroyed valve was removed, and I asked the nurse for a 30mm ball valve. The valves had been delivered to her in little plastic containers to be autoclaved. There was hesitation, then tears as she told me in broken English that the valves we brought to the operating room were destroyed in the autoclave. Apparently she had sterilized the valves in their little plastic bags, the plastic melted and was adherent to the valve. It looked as if the valve had melted. In fact, it was only the plastic bag, and it was possible to peel this off the device and implant it successfully. Two months ago on a visit to Athens, Greece I got a thank you call from Salonika, and it was this patient who was alive and well with the same device 43 years later. As we spoke I had vivid recall of her operation. This was but one of hundreds of calls and letters received from grateful patients, providing much positive feedback for our work. Recognition by the Lasker Foundation has added a meaningful new dimension for what has been a very happy story.