Clinical Use of the Total Artificial Heart

Abstract

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.

Saving Lives, Not Sacrificing Them: The Inevitable Clash Between Medical Research and the Protection of Medical Subjects

“…In 1984 a total artifi cial heart was permanently implanted in a patient, Barney Clark, by William DeVries at the University of Utah in Salt Lake City (24). Working closely with him on this eff ort was Willem S. Kolff , who had been working on this problem for decades, and Robert K. Jarvik, designer of the artifi cial heart employed.…”

Mechanical Circulatory Support for Advanced Heart Failure

“…This was the first device intended for permanent circulatory support and allowed the recipient to survive 112 days before dying of sepsis. 6 TAH development eventually stalled because of high rates of infection, pump thrombosis, and stroke. Meanwhile, the MCS community redoubled efforts to design simpler, single-chamber pumps that could act as assist devices in series with the native ventricle.…”

The Implantable Left Ventricular Assist Device: A Bridge to a Destination

“…The idea of a pump assist-as opposed to total heart replacement-was certainly advantageous at several levels: less parts to break down and the human heart is still in place as a "backup" in case of pump failure. In the 1980's, the Jarvik-7™ TAH was introduced by Dr. DeVries as a permanent therapy in Barney Clark [3]. Although initial excitement was broadcasted worldwide, the frequent thrombo-embolic and hemorrhagic complications during this period lead to a serious setback in this technology.…”