Complex Events Led to Burcham’s Death : Clot Apparently Shut Off Circulation and Blood Filled His Lung

The death of the world’s fifth artificial heart recipient resulted from a complex series of events--beginning with bleeding during kidney dialysis and ending when blood in his chest squeezed an artery to the heart, doctors in Louisville, Ky., said Thursday.

Jack C. Burcham’s recovery had been rocky during his 10 days with the Jarvik-7 heart, but his sudden downturn and death Wednesday night shocked Dr. William C. DeVries and the surgical team at Humana Hospital Audubon.

DeVries said he had “learned some valuable lessons” from his fourth implant patient, and he vowed to push ahead with the experiment he began more than two years ago with Barney Clark’s implant in Utah.

‘A Very Difficult Thing’

“This is a very difficult thing . . . the loss of a loved one and the loss of a patient,” DeVries said. “However, it’s experimentation and we’ve learned a great deal that could help other patients.

“We look forward to doing many other patients and finding out more.”

Burcham, a retired railroad engineer from Le Roy, Ill., and at 62 the oldest recipient of an artificial heart, had been in stable condition most of the day Wednesday. However, his kidney disease had worsened and DeVries began a second dialysis session late in the afternoon.

During dialysis, patients are put on blood-thinning agents which inhibit clotting but put them at risk for bleeding. When a nurse noticed that Burcham’s breathing seemed labored, dialysis was halted.

Blood Pressure Fell

Blood had collected outside the heart and put pressure on the artery leading into the device. A few hours later, the patient’s blood pressure fell and his left lung filled with blood. At 9:48 p.m., DeVries turned off the key to the heart-pumping machine.

Although doctors could not yet specify the cause of death, they said they found blood in the chest during an autopsy and tentatively concluded that a clot of blood had compressed the artery, shutting off blood returning from the body to the mechanical heart. The accumulating blood had then passed into Burcham’s lung, causing respiratory failure.

When a pool of blood puts pressure on the heart and the arteries leading to it, the condition is known as cardiac tamponade. The condition, difficult to diagnose in patients with natural hearts, is even harder to spot in artificial heart patients because the plastic-and-metal heart is rigid and does not exhibit warning signs such as a drop in the heart rate, DeVries said.

Poor Kidney Function

The initial bleeding was probably caused by Burcham’s poor kidney function as well as the anti-coagulants, DeVries said. Excessive bleeding has beset all of DeVries’ patients because of his desire to keep their blood thinned to make them less susceptible to blood clots and strokes.

“The tightrope we walk between undercoagulation and over-coagulation will have to be examined again a little closer,” DeVries said.

Burcham’s family members said they had no regrets about the implant decision. “I think everyone should have a chance to have an (artificial) heart,” said Burcham’s son, Jack.

“There’s no way of knowing whether it shortened or lengthened his life,” DeVries said. “You have a patient who is desperately ill and you don’t really know how long he’ll live.”

Doctor Cites Lessons

When told of her husband’s death, Lavonne Burcham asked DeVries if it would help future implant patients. The surgeon assured her it would.

Among the lessons DeVries said he learned from Burcham: the difficulty of diagnosing cardiac tamponade, the effect of poor kidney function on artificial heart patients and the need for closer regulation of anti-coagulation.

“Those are all important,” DeVries said. “As in the case with Barney Clark, with Bill Schroeder and with Murray Haydon, each will make a contribution that will help the other ones.”

Clark, a Seattle-area dentist who received the first permanent artificial heart in 1982, lived 112 days with the heart before dying of multiple organ failure.

Advisory Panel Named

DeVries moved his program last year to Humana Hospital Audubon, where he has done three implants. Humana announced last week the appointment of a three-member panel to advise it on scientific and ethical issues surrounding artificial heart implants. The members are Dr. Dwight E. Harken, a pioneer in heart surgery at Harvard; Albert R. Jonsen, Ph.D., chief of medical ethics at the University of California, San Francisco, and Walter J. Wadlington, professor of medical law at the University of Virginia.

“My views are on the critical and skeptical side, and I have told Humana so,” Jonsen said in a telephone interview.

He said he feels that way because artificial hearts “add a high-expense technology to a health system that needs a different sort of strengthening.”

Speech Difficulty

William J. Schroeder, 53, who suffered a stroke several weeks after his Nov. 25 operation, still has difficulty speaking. He now lives in a specially equipped apartment across the street from the hospital.

Murray P. Haydon, 58, who received his Jarvik-7 heart Feb. 17, is on a respirator due to lung complications believed related to transfusions he received during periods of excessive bleeding.

Swedish doctors implanted a Jarvik-7 heart in Leif Stenberg on April 7 and his recovery has been described as steady.

Times Medical Writer Harry Nelson also contributed to this story.