Meeko the calf stood nuzzling a pile of hay. He didn't seem to have much appetite, and he looked a little bored. Every now and then, he glanced up, as though wondering why so many people with clipboards were standing around watching him.
Fourteen hours earlier, I'd watched doctors lift Meeko's heart from his body and place it, still beating, in a plastic dish. He looked no worse for the experience, whisking away a fly with his tail as he nibbled, demonstrably alive—though above his head, a monitor showed a flatlined pulse. I held a stethoscope to his warm, fragrant flank and heard, instead of the deep lub-dub of a heartbeat, what sounded like a dentist's drill or the underwater whine of an outboard motor. Something was keeping Meeko alive, but it was nothing like a heart.
As many as five million Americans suffer some form of heart failure, but only about 2,000 hearts a year become available for transplant. The obvious solution to that scarcity is to build an artificial heart, and how hard could that be? The heart's just a pump, after all, and people have been making pumps since the Mesopotamians invented the shadoof to raise river water 3,000 years before the birth of Christ. Doctors started thinking seriously about replacing the heart with a machine around the time Harry Truman was president.
To understand why they still haven't succeeded, pick up a two-pound barbell and start curling it. Two pounds: nothing. But see how long you can keep it up. Twenty minutes? An hour? Two? Your heart does that all day and all night—35 million beats a year—for as long as you live, without ever taking a rest. Manufacturing a metal and plastic heart capable of beating that way for more than about 18 months has so far proved impossible.
The problem is the "beating" part. Among the first to envision an artificial heart was, amazingly, the ventriloquist Paul Winchell. When not in front of a TV camera manipulating his dummies Jerry Mahoney and Knucklehead Smiff, Winchell was developing patents, some 30 in all, including one for an artificial heart that he invented with Dr. Henry Heimlich, of the eponymous anti-choking maneuver. Back then, and up through the famous Jarvik-7—the first machine to replace a human heart, in 1982, albeit briefly—inventors could only imagine imitating the heart's lub-dub. That is, they envisioned filling a chamber with deoxygenated blood returning from the body and pumping it out to the lungs to be infused with oxygen—lub—and then drawing that good red blood back into a second chamber and pumping it back out to the body—dub.
It turns out that imitating a beating heart with metal and plastic has several limitations. First, the Jarvik-7 and its successors that are still in use require an air compressor outside the body. Through hoses that pierce the skin, the compressor fills a balloon inside one of the Jarvik's chambers, pushing blood to the lungs. Then it fills a second balloon in another chamber to push blood back out to the body. The two balloons inflate and deflate in an alternating rhythm. It works, but it also means that a patient has to sit beside a big, noisy compressor 24 hours a day. That's better than dying of heart failure, but it doesn't make for a great quality of life. Barney Clark, the first person to live entirely on a Jarvik-7, asked his doctors several times, during his 112 days on the device, to let him die.
Clark probably would not have been able to hang on much longer in any case. Those balloons, and all other moving parts in a beating mechanical heart, wear out quickly. That's why, almost 30 years after the first Jarvik-7, artificial hearts remain what is delicately termed "bridges to transplant"—something to keep you alive until a real heart can be found.
A transplantable heart, alas, is an increasingly rare find. It has to come from a person who is in the blush of good health and also, somehow, dead. As cars have gotten safer and states have passed laws requiring seatbelts and motorcycle helmets, the number of such hearts has dwindled. The need for hearts, on the other hand, has grown with the world's population and the conquering of other diseases. And even when a heart is found, patients face the risk of tissue rejection.
Building a heart that mimics nature's lub-dub may be as comically shortsighted as Leonardo da Vinci designing a flying machine with flapping wings. Nature is not always the best designer, at least when it comes to things that humans must build and maintain. So the newest artificial heart doesn't imitate the cardiac muscle at all. Instead, it whirs like a little propeller, pushing blood through the body at a steady rate. After 500 million years of evolution accustoming the human body to blood moving through us in spurts, a pulse may not be necessary. That, in any case, is the point of view of the 50-odd calves, and no fewer than three human beings, who have gotten along just fine with their blood coursing through them as evenly as Freon through an air conditioner.
"His giant heartbeat," Rainer Maria Rilke wrote of God early in the past century, "is diverted in us into little pulses." Nowadays, maybe not.
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If you enjoyed this article, watch the movie about these guys and the implantation of their device: www.vimeo.com/33741794
The documentary, "Heart Stop Beating," is about 3 minutes and it is on vimeo, directed by Jeremiah Zagar and produced by Jeremy Yaches. This doc was first released at the Sundance Film Festival in January. The article above is beautifully written and the documentary will really bring the two surgeons to life.
Actually, the Jarvik heart and other artificial hearts that do beat cause problems with blood clotting. The "beating" itself in nature is the sound of the valves closing, I think, after they push the blood out to the lungs or the body. So this heart is a solution to that problem.
My main questions are:
1. Does the VA cover this possibly?
2. How painful is the recovery?
@ Don Gibson:
If you could change your profile to allow people to send you messages that would be great because I had some questions and that setting sends you a message but does not give out your email.
OK, I have had a Heartmate and a heartmate II. I was in a car accident, the heartmate didn't stop. It keeps running. It is also very obvious that I had heart disease and an assist device to pump my blood for me. You can't miss that if you're a paramedic. So the person's live would not be in jeopardy because the paramedics called him/her dead, because that scenario is just not going to happen.
No one knows yet, for sure, whether you need a heartbeat to survive. That is being studied, but this technology is so new, no one will know what it is like to live without a pulse for 50+ years, since that amount of time hasn't passed yet since assist devices were created.
In a lot of ways, living with an assist device was easier than it is now, post-transplant. I had a lot more energy with my blood flowing as quickly as I needed it to. I have never noticed an increase in body temperature because of the device, and it is set to run pretty fast (in my opinion), so my problem was slowing down or sleeping, because I otherwise had great circulation.
The implantation of these devices are expensive, and there is a decent hospital stay. You will not need to take out a second mortgage on your house to pay for it. Hospitals have a lot of people who help you get your finances in order, and work with your insurance company. They are really great, helpful people. I do not know about the VA, but social security, I believe, covers a substantial portion of this. And whoever is silly enough to say it would get repossessed, is clearly joking, because medical procedures have never been reversed because someone couldn't pay. Anyway, it's not like you walk into a hospital one day and say, 'you know, I'd like to get a heart assist device today, I wonder where I sign up...'
You will always hear the buzzing of the impeller as it creates bloodflow in your body. You just will be so happy that you're alive and can walk down the street, you really won't care that it makes a quiet noise.
As far as recovery goes, it really isn't as bad as you think. It is an open heart surgery, but once you come out of surgery, your circulation has improved so much, that you feel like you can live your life again. Takes a little while for your ribcage to heal, as any open heart surgery would involve, but you already feel tons better than you did before.
If you get a huge cut anywhere, where it would bleed, the only problem is if you are on blood thinners. That makes the bleeding not want to stop (obviously). Other than that, cuts are exactly the same as they are with a regular, beating heart. I never notice any pulsing of blood when I get cut now. Coumadin (blood thinner medication) is just a difficult thing to take in general.
What I'm trying to say here, is that a support device that gives you no heartbeat, makes your life similar to your ordinary life. You can do just about anything and everything you were doing. It seems scary because it is so innovative, but your lifestyle is so much better, because you are not walking around limited by the ability of a failing heart. You have a life similar to that of when you had a normally working heart. A lot of things 'could' happen, but these things don't usually happen to us in our everyday lives, so the chances of being affected by a car accident, for example, is no greater once you have a heart pump.
But really, at this stage, you can't 'hide' this technology. A paramedic will be able to tell you are a heart failure patient who has an assist device, and you will walk around the world feeling lucky you still get to live to see it.
I was reading the article today and I KNEW I recognized a name in there. For those who don't know Billy Cohn's older brother mentioned in the article, John Cohn, was on a discovery channel show call "The Colony" a couple of years back. I think the episodes are online at the moment.
If you've never seen the first season of The Colony, John is a lot like his little brother (though I suppose it could be the other way round). As I learned about John before reading about Billy, I'm just tickled that the "Mad Scientist" gene seems strong in their family.
Dr. Frazier installed a new kind of LVAD in me one year ago. It is called a Heart Ware. Works just like the Heart Mate ll but it is somewhat smaller and the batteries are much smaller and so it is easier to get around. I don't ever notice any sound at all coming from it and I'm a musician who records a lot and I've never heard it on tape (digitally speaking, of course). So to celebrate making it one year I walked a 1/2 marathon - 13.1 miles! Thank you very much.
The only thing I miss is swimming. I used to love to go to the local pool or to the ocean and swim. I can't do that any more because of the batteries I carry around and I have to keep the wound dry at all times. We had purchased a new hot tub for our home a year before I got sick and now I just watch while my wife and kids get in it. In the big scheme of things, it's okay with me. I'm alive and living just a full a life as I did before getting sick. I feel better than I have in over SEVEN YEARS. That's how long my heart failure went on before I took a nose dive.
Thank you Dr. Frazier and Dr. Cohn!
Since I began reading science fiction novels in my early teens, I have nursed the vague hope that I would live to see the technological human future. For decades, nothing seemed to change much. Even the advent of space missions and powerful computers did not seem to usher in that much-anticipated time.
Suddenly, though, starting just last month, I began reading web articles which fell into categories not even previously imagined. I can now say with confidence: I have lived to see the future.
Along with that future we get many benefits as well as some disturbing questions. For example, if Dr. Cohn's prediction comes true and surgeons begin installing hundreds of thousands of miniature heart replacements, there will be many, many people living longer and longer. How will we take care of these recharged individuals? What will they do with their extra decades of life?
I am now 61, and I do not personally relish the idea of living on and on after all my family and friends have moved away or died. That could happen even without an artificial heart, of course, but as more such little machines come along, many of our natural limits may eventually be removed.
If that turns out as I worry it might, and if my own life ever becomes too hard to bear, it may be a comfort to know that I can just disconnect both of my batteries.