Snags Hit Implant in Oldest Artificial Heart Recipient

In a surprisingly difficult six-hour operation Sunday, Dr. William C. DeVries implanted an artificial heart in a retired railroad engineer, making his latest patient the fourth living recipient of a permanent mechanical heart.

Jack C. Burcham of Le Roy, Ill., was in critical and stable condition after surgeons replaced his damaged and “barely twitching” natural heart with a Jarvik-7 pump. At 62, he is the oldest person ever to receive the device.

It took surgeons longer than usual to position the heart because Burcham’s chest cavity was smaller than they had expected, and that additional maneuvering strained suture lines and caused some bleeding, said Dr. Allan M. Lansing, chief clinical spokesman for Humana Heart Institute International.

As a result, Burcham’s chest was kept open two additional hours until his bleeding had slowed. Both previous heart patients at Humana have suffered bleeding problems that required additional surgery.

It was DeVries’ fourth implant operation and until Sunday each procedure had been progressively easier and more routine.

“We had hoped and expected this one would be easier still, but in fact it was the hardest and the most difficult technically” since Barney Clark’s pioneering operation in 1982, Lansing said.

DeVries, who has Food and Drug Administration approval for three more implants, has accelerated the pace of his experiment. Three implants have now been performed here in less than five months and DeVries has said he hopes to complete three more within a year.

But the hitch Sunday, and the slow recovery of the previous two artificial heart recipients, William J. Schroeder and Murray P. Haydon, has pointed up the experimental nature of the controversial device. Many questions remain about possible complications--such as blood clots and depression--and about the quality of life that recipients can expect when tethered to a drive system outside the body.

Clark, a Seattle-area dentist who lived 112 days with the artificial heart, suffered seizures that produced weeks of depression. He was 61 when the heart was implanted on Dec. 2, 1982.

Schroeder, 52, of Jasper, Ind., received a mechanical pump on Nov. 25, 1984. His rapid recovery was interrupted on its 18th day by a series of severe strokes. Although he moved to a specially equipped apartment across the street from the hospital last week, he still has difficulty speaking.

Haydon, 58, of Louisville, received his pump on Feb. 17 and underwent a second operation March 2 to stop some bleeding. He is now back in intensive care because of breathing difficulties.

Last week, Leif Stenberg, 53, received a Jarvik-7 heart in an operation at Karolinska Hospital in Sweden. His doctors, one of whom has observed DeVries at Humana, have said their patient is doing “surprisingly well.”

Burcham’s spirits were high before the operation. As he was being wheeled to the operating room, he said: “Let’s go for it!”

Earlier, he had quipped that all he needed was “eight hours’ sleep and a new heart and I will be OK.”

The father of four suffered a severe heart attack in October. His heart became weaker, his medication was no longer working and he was too old to be considered for a heart transplant, doctors said. Doctors said he had perhaps two months to live without the implant.

The operation began shortly before 8 a.m. With an assortment of music, from Vivaldi to Willie Nelson, playing in the background, DeVries removed the natural heart, sewed cuffs onto the arteries and then snapped the polyurethane pump into place.

Lansing said the 163-pound Burcham’s chest cavity was smaller than earlier scans had indicated and although the Jarvik-7 used was slightly smaller than earlier versions it was still a tight fit.

“There was never any thought that it would not go in, it was just very difficult to insert it without damaging any of the suture lines,” Lansing said.

The difficulties tended to confirm the heart program’s rule that candidates must weigh at least 150 pounds, Lansing said. DeVries and Dr. Robert K. Jarvik, inventor of the heart, have said they hope one day to develop pumps of various shapes that can be implanted in smaller patients.

Before the operation, doctors said they were worried about Burcham’s poor kidney function. “We’ll be watching how quickly his kidneys show signs of recovery,” Lansing said.

Burcham’s wife of 42 years, LaVonne, and about 20 other family members waited in a room at the hospital. Lansing said he saw tears of joy and relief in their eyes when he and DeVries visited them after the operation.

“They all realize this is just the first step and we have a long way to go,” Lansing said.

Across the street, in his new apartment, Schroeder was following news of the operation on television.

“‘He hears the news and points his finger to it,” said Schroeder’s wife, Margaret. “He knows there’s going to be another person in the family.”