Surgeons who implanted the first permanent artificial left ventricle in a patient are confident that the tiny device will eventually be used in most heart transplantations around the world. The 64 year old patient was terminally ill when he received the implant, having experienced severe heart problems for several months, and he died five days later on 1 August of multiple organ failure. His own heart had been working at only 10% capacity at the time of the implant.
Dr Jacob Lavee, head of the department of cardiothoracic surgery at the Sheba Hospital, near Tel Aviv, performed the 12 hour operation with the help of colleagues. He said that guidelines allowed implantation of the HeartMate II device only in a patient with no other treatment options. The man would have died “within six hours” if he had not received it, Dr Lavee said. The device was “functioning perfectly” when he died of multiple organ failure last week, and doctors said that the device was “not responsible” for his death.
The patient, a father of four from a town near Haifa, had the artificial ventricle inserted into his abdomen. It was powered by a lithium battery outside his body via thin wires. The device weighs only 350 g and measures 803100 mm.
The metallic device, designed at the Centre for Development of Artificial Organs in Pittsburgh, Pennsylvania, and manufactured by Thermo Cardiosystems, pumps smoothly flowing, oxygenated blood into the patient's damaged left ventricle and on to the rest of the body. The patient's own heart is not removed, and the other chambers function in coordination with the artificial device.
Fortunately, most patients who need heart transplants have only a diseased left ventricle, thus making the new procedure ideal as an alternative for human heart transplant surgery. Previous use in animals showed that the device, which lacks valves, offers long term, trouble-free service. If the patient recovers, a long term battery (such as that in a pacemaker) can be implanted permanently inside his or her body.
Asked why US surgeons were not the first to perform the implant, Dr Lavee explained that the US Food and Drug Administration does not approve the use of such devices in the US before they are proved successful in patients abroad. He added that the administration would probably want to see “20 or 30 successful implants before beginning the approval process in the United States.”
Since the Israeli cardiac surgeon worked with the Pittsburgh team from 1989 to 1990, he and his Israeli colleagues were chosen to be the first to do the implant—even though many European medical centres had been keen on being first. He expects that the next recipient will be in better condition when the operation is performed.
Figure.
THERMO CARDIOSYSTEMS INC.
When implanted alongside the heart, the metallic device takes over the function of the damaged left ventricle and pumps oxygenated blood around the body