We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.
P ROLONGED OPERATIONS in the open heart at normal body temperature require heart-lung machines as a substitute for cardiopulmonary function. The principle of all these is the same: they withdraw blood from the venae cavae, oxygenate it, and return it into the aorta. Thus the patient's heart is completely bypassed (Fig. 1). It was believed for a long time that the machine would have to pump and oxygenate blood in amounts equal to the normal resting cardiac output-at least 100 ml. per kg. of body weight per minute. Accordingly, several elaborate machines have been devised to pump and oxygenate 5 liters of blood per minute, for example by Dennis, 1 Jongbloed, 2 and Kolffand Dubbelman. 3 ' 4 The most successful design was that of Miller, Gibbon, and Gibbon. 5 A similar machine is in use at the Mayo Clinic 6-7 with outstanding success; its complexity and cost have prevented its wider use.
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