Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
 15 February 2006

AN ARTIFICIAL HEART COMES TO CENTRAL SOUTH DAKOTA

            The gentleman had the misfortunate of having a large heart attack when he was 41 years old.  At that time, he lost about 30% of the heart muscle available to pump blood.  Note that a 40% loss of muscle is fatal so his survival was marginal.  South Dakota farmers know and understand well how to take care of their equipment (not themselves, but they do good with equipment).  They know that when they overuse it, or don’t maintain it, equipment wears out early.  And that is what happened to this gentleman over the next 15 years.  He continued normal activity going hunting and participating in active athletic endeavors.  By age 55, his heart was no longer able to do the work of pumping blood to his body.  The heart muscle that he had left was simply overworked and worn out.  He retired from his job and went on disability.  But other than the fatigue of his heart failure, he was a healthy individual.  He enjoyed life and wanted to know what could be done to improve his situation and prolong his life.

            The symptoms he had included fatigue with any effort.  His hands and feet were cold.  He needed more sleep than normal.  He had difficulty concentrating except for a brief period of time after he had rested.  After long consideration, he elected to pursue a heart transplant and proceeded to the University of Minnesota for consideration.  There it was recognized that he was in the very late stages of heart failure and had a 95% chance of not living more than six months unless a heart transplant could be achieved.

            But heart transplants can not be scheduled.  In order to receive a heart transplant, a person has to have an adequate match of the tissue type to someone who passes away from causes other than cancer or heart disease.  The waiting list is long.  Unfortunately, today many people pass away from heart failure before their transplant can be achieved.

            Years ago, the media made big splash of something called the Jarvik heart.  This was an artificial heart invented by Dr. Jarvik and was designed to take the place of the failed heart in an individual.  The thought was that a mechanical heart would simply act as a pump and engineers can certainly make a pump that should work.  Several individuals that used this Jarvik heart lived for 100 days or more but complications occurred with mortal outcomes.  The Jarvik heart fell off the map.

            But science and technology are relentless and new developments go on whether newspapers and TV are around or not.  Very quietly in the past 10 years an artificial heart different from the original Jarvik heart has been developed.  The new artificial heart is designed to bridge the gap between the time when a person needs a heart transplant and the time that they can finally get one.  As mentioned, this is an unknown long length of time during which many individuals died before the heart transplant could be achieved.  Now with the new artificial heart, the person receives an additional “lease on life” to bridge the gap until a heart transplant becomes available.  This may sound like science fiction but now there is an individual in central South Dakota who has this artificial heart device in place awaiting his heart transplant.  Placement of this device requires surgery in which a pipe is sewed into the outflow tract from the heart.  That pipe is then connected to a pump which is then connected to the aorta (the major blood vessel supplying blood to the entire body).  Even though the person’s heart is failing and can’t pump enough blood out by itself, the blood is now sucked out of the heart and pumped on forward into the aorta with the artificial heart.  It runs on a battery device.  At night the device is plugged into the wall socket and recharges. During the day, the person can be independent to go to the grocery store or other activities for 4-6 hours a day.  He carries a “fanny pack” containing the battery and a computer device to run his artificial heart.  He says the fanny pack is really not very cumbersome and is easy to manage.

            The gentleman says that when he woke up from the surgery, the first thing that he remembers is his hands and feet were warm for the first time in months.  That is because the artificial heart could improve his heart output by about 80%.  His own heart continues to beat but produces relatively little output of blood.  Most of the output of blood that supply his body is now done by the artificial heart.  This device will remain in place until a heart transplant comes along.

            While he is waiting for the heart transplant to occur, he needs to be on 24/7 call for when someone has an accident or a fatal injury. He needs to get to Minneapolis as quickly as possible to receive the heart transplant.  He remains on blood thinners to avoid clotting in the artificial heart and on a number of medications to control his blood pressure and the rhythm of his own heart.  He has been advised not to play football or to rodeo but more or less leads a “normal life” in regard to his activities.  He acknowledges that his attention span is improved and the fatigue that was so disabling before is gone.

            I have been in the doctoring business for more than 40 years now.  When I was in medical school, we talked about developments that would come in the future.  It was easy to conceive of an artificial pump to take the place of the heart but then the Jarvik heart in the mid 1990’s was a disappointment.  Now very quietly but very effectively, the artificial heart has become available and it is not just for people in major medical centers.  There is a gentleman right here in central South Dakota that has one and he is doing fine.  Medical success stories are inspiring.  In these times where there are suicide bombers, people who kill each other over cartoons, and people squabbling over who is going to have atomic weapons, it is inspiring that some people spend their lives developing something like an artificial heart or transplant biology that permits a person to have a new life when a heart fails.  All that said, the best advice to take home from this column is to take care of the heart you already have.