Wireless artificial heart beats into medical history

A patient implanted with the world's first self-contained mechanical heart is resting comfortably after the groundbreaking operation, a Louisville hospital spokesman said yesterday.

The plastic-and-metal motorised hydraulic pump - which weighs 1kg and is about the size of a grapefruit - is the first to be free of wires connecting it to the outside.

"This is the first time this has ever been done," said Kathy Keadle, a spokeswoman at Jewish Hospital, where the seven-hour procedure was performed by University of Louisville surgeons Laman Gray and Robert Dowling.

"The heart is totally internal."

The permanent replacement heart, built by Abiomed, was designed for patients whose own hearts have been damaged by heart disease or heart attacks. Federal regulators have given doctors the go-ahead to implant five AbioCor mechanical hearts in patients who are too ill to qualify for a live organ transplants.

The 40,000 patients awaiting heart transplants far outnumber the number of hearts available, and a successful mechanical heart could fill a huge need.

The hospital would not identify the critically ill patient.

Earlier versions of the artificial heart were bulky and provided limited benefit to patients.

The Jarvik 7 model, implanted in the 1980s in Utah and Louisville by surgeon William DeVries, had a large, wheeled machine to power it. That and other "bridge" devices allow patients to survive, but the outside connectors left them exposed to an increased risk of infection.

The AbioCor contains a small electric motor attached to an implanted battery and is designed to last for years. Patients could wear a battery pack or plug into an electrical outlet to recharge the heart's battery.

Doctors have been quick to emphasise that implanting the Abiomed heart does not mean that replacement hearts will be ready immediately to take off the shelf and install in dying patients.

They forecast it will take at least five years before the new device is widely available - and then only if it proves itself in long-term use among several dozen experimental patients.

"Some of the established cardiac surgeons will have to grow comfortable with the reliability of this device," said Dr Robert S Higgins, chairman of cardiology at the Medical College of Virginia.

"People are dying for lack of donor organs," said Dr Timothy J. Gardner, head of heart surgery at the University of Pennsylvania medical centre in Philadelphia. "We have yet to come up with a device that gives the quality of life that makes it all worthwhile. This may be the one, but that's yet to be proven."

Dr O.H. Frazier, chief of cardiopulmonary transplant at the Texas Heart Institute in Houston, said he was ready to use the device now to save lives.

"People who would receive the devices really have no other options," he said. "It could rescue them from certain death."

He expects about 10 of the devices will be installed and the cardiac surgery community will then examine the results before widening the circle of surgeons who use them.

Dr Frazier, who has put the Abiocor heart in calves, said that for surgeons,"it is technically not that tough. It does require some training, but it is not that tough."

Dr Clyde W. Yancy jun, head of the St Paul's Medical Center transplant programme, which is affiliated with the University of Texas Southwest Medical Centre, said that the emotional-mental-social elements of a mechanical heart "may be the biggest problem."

"How does a patient respond to having a totally artificial system in place?" asked Dr Yancy. "How are the patient and the family members going to respond?"

These questions must be answered, he said, before a mechanical heart could assume an essential role in medicine.

About 46,000 Americans die annually of heart failure. About half of these die suddenly and can never benefit from heart surgery or replacement. Last year, there were more than 4200 patients on lists waiting for donor hearts, but only about half ever receive an organ. The rest die waiting.

"A transplantation requires intensive compliance," said Dr Gardner. This meant that to be successful, a patient must have a dedicated determination to take the required medicines, get the required blood tests and stick to the diet and exercise regimen ordered by the doctor.

- REUTERS