Must Balance Risks of Heavy Bleeding, Clots : Artificial Heart Surgeons Face Dilemma

Jack C. Burcham’s internal bleeding was under control Tuesday, but doctors were “walking a tightrope” in giving him just enough blood thinners to avoid blood clots and yet not cause excessive bleeding, a spokesman said.

Burcham was still bleeding slightly Tuesday, but it was “standard for any major operative procedure,” said Dr. Allan M. Lansing, chairman of the Humana Heart Institute. Additional X-rays later in the day confirmed that the bleeding was controlled.

Burcham had begun to wake up from sedatives given him after his second operation, Robert Irvine, a hospital spokesman, said.

Operation Successful

The use of blood-thinning agents was resumed Tuesday after doctors were satisfied that Burcham’s second operation at Humana Hospital Audubon had successfully stemmed the bleeding near his artificial heart.

Burcham, 62, of Le Roy, Ill., was first given the blood-thinners after the difficult six-hour operation Sunday to implant the world’s fifth Jarvik-7 heart in his smaller-than-expected chest.

But those anti-coagulants were stopped after Burcham began bleeding internally, losing more than 10 quarts of blood until his two-hour surgery Monday, when surgeons restitched and reinforced suture lines anchoring his mechanical heart in place.

Clots Caused Stroke

His surgeons now face a dilemma. They want to avoid a recurrence of the stroke the world’s second Jarvik-7 patient, William J. Schroeder, suffered 18 days after his Nov. 25 implant, when tiny blood clots from the area of the mechanical device traveled to his brain.

But Murray P. Haydon, who on Feb. 17 received the third Jarvik-7, still is in intensive care after bleeding caused pressure to build against his lungs, causing long-term damage. Haydon, 58, had been given blood-thinning agents to ward off a stroke, Lansing said.

“At the present time, in this learning process, we are walking a tightrope. Too much anti-coagulation (causes) bleeding problems--too little, and (there are) clotting problems,” Lansing said.