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.
This article has been cited by other articles:
Loisance, D.
(2008). Mechanical Circulatory Support: a Clinical Reality. Asian Cardiovasc. Thorac. Ann.
16: 419-431
[Abstract][Full Text]
Stephenson, L. W.
(2008). History of Cardiac Surgery. Card Surg Adult
3: 3-28
[Full Text]
Frazier, O.H., Myers, T. J., Gregoric, I.
(2008). Total Artificial Heart. Card Surg Adult
3: 1629-1638
[Full Text]
Treasure, T, Davies, M K, Hollman, A
(2006). Stamps in cardiology. Artificial heart.. Heart
92: 584-584
[Full Text]
Jauhar, S.
(2004). The Artificial Heart. NEJM
350: 542-544
[Full Text]
Stephenson, L. W.
(2003). History of Cardiac Surgery. Card Surg Adult
2: 3-29
[Full Text]
Kukuy, E. L., Oz, M. C., Naka, Y.
(2003). Long-Term Mechanical Circulatory Support. Card Surg Adult
2: 1491-1506
[Full Text]
Frazier, O. H., Shah, N. A., Myers, T. J.
(2003). Total Artificial Heart. Card Surg Adult
2: 1507-1514
[Full Text]
Thielmeier, K. A., Pank, J. R., Dowling, R. D., Gray, L. A. JR
(2001). Anesthetic and Perioperative Considerations in Patients Undergoing Placement of Totally Implantable Replacement Hearts. SEMIN CARDIOTHORAC VASC ANESTH
5: 335-344
[Abstract]
Niklason, L. E., Langer, R.
(2001). Prospects for Organ and Tissue Replacement. JAMA
285: 573-576
[Abstract][Full Text]
Rose, A. G., Park, S. J., Bank, A. J., Miller, L. W.
(2000). Partial aortic valve fusion induced by left ventricular assist device. Ann. Thorac. Surg.
70: 1270-1274
[Abstract][Full Text]
Pepper, J. R
(2000). Surgery for heart failure: options and outcomes. Perfusion
15: 287-293
Arabia, F. A., Copeland, J. G., Pavie, A., Smith, R. G.
(1999). Implantation technique for the CardioWest total artificial heart. Ann. Thorac. Surg.
68: 698-704
[Abstract][Full Text]
El-Banayosy, A., Deng, M., Loisance, D.Y., Vetter, H., Gronda, E., Loebe, M., Vigano, M.
(1999). The European experience of Novacor left ventricular assist (LVAS) therapy as a bridge to transplant: a retrospective multi-centre study. Eur. J. Cardiothorac. Surg.
15: 835-841
[Abstract][Full Text]
Dohmen, P. M., Laube, H., de Jonge, K., Baumann, G., Konertz, W.
(1999). MECHANICAL CIRCULATORY SUPPORT FOR ONE THOUSAND DAYS OR MORE WITH THE NOVACOR N100 LEFT VENTRICULAR ASSIST DEVICE. J. Thorac. Cardiovasc. Surg.
117: 1029-1030
[Full Text]
Goldstein, D. J., Oz, M. C., Rose, E. A.
(1998). Implantable Left Ventricular Assist Devices. NEJM
339: 1522-1533
[Full Text]
Hunt, S. A.
(1998). Current Status of Cardiac Transplantation. JAMA
280: 1692-1698
[Abstract][Full Text]
Arabia, F.A., Copeland, J.G., Smith, R.G., Sethi, G.K., Arzouman, D.A., Pavie, A., Duveau, D., Keon, W.J., Masters, R., Foy, B., Carrier, M., Dembitsky, W., Long, J., Kormos, R.
(1997). International experience with the CardioWest total artificial heart as a bridge to heart transplantation. Eur. J. Cardiothorac. Surg.
11: S5-S10
[Abstract]
Akins, C. W.
(1996). Long-Term Results With the Medtronic-Hall Valvular Prosthesis. Ann. Thorac. Surg.
61: 806-813
[Abstract][Full Text]
Hager, J., Brandstaetter, F., Dietze, O., Koller, I., Unger, F.
(1990). The Spindle Pump--A Nonpulsatile Blood Pump for Assisted Circulation. J Biomater Appl
4: 225-330
Diethrich, E. B, Bahadir, I., Mandile, G., Gordon, M.
(1987). A new ventricu lar assist device for acute cardiac failure: report of initial use for biventricular support. Perfusion
2: 245-261
[Abstract]
Kantrowitz, A.
(1986). Restoring Cardiac Function: An Emerging Spectrum of Therapeutic Options. J Biomater Appl
1: 13-38
[Abstract]
