For three years Dr. William DeVries has been practicing implanting an aluminum-and-plastic heart in calves or sheep. Periodically he has also perfected his technique on human cadavers, checking how the man-made pump fits, making adjustments in its tubing and attachments.
Although artificial hearts have twice before been implanted for brief periods in people awaiting heart transplants (both patients died within a week after the transplants), DeVries, 38, chief of cardiothoracic surgery at the University of Utah Medical Center in Salt Lake City, will for the first time provide a patient with a device designed to run indefinitely. This month he hopes to begin considering whom to recommend as the first recipient. The operation could take place anytime. “I’m anxious to get going,” he says.
The artificial heart, known as Jarvik-7 after its inventor, Dr. Robert Jarvik, 36, was originally approved by the Food and Drug Administration in 1981 for testing in patients whose hearts had stopped and could not be restarted on the operating table. However, perhaps due in part to a campaign spearheaded by Dale Lott (see box), the FDA has broadened eligibility to include victims of cardiomyopathy, a progessive deterioration of the heart muscle. (The two previous artificial heart implants were done by Houston surgeon Denton Cooley. The first, in 1969, came before FDA rules were established; the second, last year, ignored them.)
DeVries now anticipates that his first patient will be a heart disease sufferer with a life expectancy of less than two months. The artificial heart will not provide miracles. “We’re putting in a mechanical device that doesn’t work as well as the real thing,” he explains. “Sooner or later the patient is going to die of a complication of that device.”
To be even considered by the six-person Medical Center evaluation committee, a patient must satisfy a roster of requirements. Along with incurable cardiomyopathy and the absence of other severe ailments, the candidate must demonstrate a stable home situation to provide optimum physical and emotional postoperative care. To allow for follow-up medical attention, the patient must live within a 45-minute drive of Salt Lake City. The patient chosen will be coached on limitations imposed by the implant and will probably visit animals currently being kept alive by artificial hearts.
The animal device, like the human, centers on two drive lines leading from the heart through the abdomen to an external air compressor. Although portable systems should permit the patient to go outside, perhaps for as long as two and a half hours, the cumbersome power unit does not allow much mobility. Infections caused by the implanted tubes may be a constant danger. To assure that the dangers are understood, the successful applicant for the surgery will be required to wait 24 hours after signing a consent form and then sign it again.
Unlike a human heart transplant, however, an inorganic heart does not present the problem of foreign tissue rejection. And while the operation will last about four hours and is expensive ($20,000 for the equipment alone), it might someday be performed on a wider scale than human heart transplants. An estimated third of the patients now waiting for a heart transplant die before a donor can be found.
DeVries began performing experimental surgery as a medical student at the University of Utah, studying under Dr. Willem Kolff, who implanted the first artificial heart in a dog in 1957 and, at 72, still heads the Utah team. DeVries was named chief surgeon of the project three years ago.
Despite the heart project and his regular surgery schedule (he does coronary bypass, valve replacement and full cardiothoracic operations), DeVries still finds time for Karen, his wife of 17 years, and their seven children, 2 to 16. A succesful artificial heart implant would make everything worthwhile. DeVries believes, “I do the best surgery anybody can do. It would be very, very satisfying to have done the implant after all these years of preparation. You’re taking a person who feels rotten, who is at death’s doorstep, and you’re giving him life. What could be more satisfying?”