Heart Patient in S.F. Improves; Condition Stable
The condition of artificial heart recipient Richard Dallara improved Sunday, as physicians at the Pacific Presbyterian Medical Center continued their search for a human heart suitable for transplantation.
“He is very stable,” said Dr. J. Donald Hill, his surgeon, who added that a tube assisting the breathing of the 33-year-old auto mechanic from Sonoma was removed Sunday. “He is awake, taking sips of water, and talking to his family. There is no contraindication to a transplant.”
Dallara is the first patient in California to have mechanical assistance for both sides of his heart and the fourth patient in the United States to receive two of the devices called the Thoratec heart at the same time.
Dallara was near death Friday morning at Memorial Hospital in Santa Rosa from cardiomyopathy, a severe deterioration of the heart muscle, when Hill was contacted. Six hours later, Hill performed the surgery in San Francisco.
Pumps Are Outside Body
The Thoratec pumps, made of polyurethane, plastic and steel, are outside the body. Each is connected to the patient’s own heart, which remains in his chest, by two tubes made of polyurethane and plastic.
The pumps are driven by compressed air and regulated through an electrical device the size of a washing machine at the patient’s bedside. One pump supplies blood from the right side of the heart to the patient’s lungs and the other sends blood from the left side to the rest of the body.
Dallara is currently receiving no medications to stimulate blood circulation or to prevent blood clots.
The Thoratec heart is “very versatile” and “has a proven record,” said Hill, who in September, 1984, became the first surgeon in the world to use it successfully as a “bridge to transplantation,” keeping the patient alive until an appropriate human heart could be found. In that case, only one device was used, to support the left half of the heart.
Hill said the record of Thoratec heart use shows no mechanical failures or development of blood clots. Clots have been a problem with the Jarvik-7 heart implanted first in Barney Clark at the University of Utah three years ago and since then to three patients at Humana Hospital in Louisville.
While licensed only for use outside the body, the Thoratec heart has been implanted in animals and in the future might be used inside the body in humans, according to Hill.
The ventricular assist device was developed by Dr. William S. Pierce and engineer Jim Donachy of Pennsylvania State University in the 1970s and has been manufactured and marketed by Thoratec Laboratories Corp. of Berkeley since 1983, according to Philip Litwak, a company official.
Litwak said the Thoratec heart has been more extensively used and tested in both animals and humans than any of the other three artificial hearts that have been used in patients in the United States. These are the Jarvik-7 heart, recently used for a patient in Pittsburgh; the Penn State heart, also developed by Pierce and recently used by him for a patient in Hershey, Pa., and a left ventricular assist device called the Novacor, which has been used twice at Stanford University. One of these patients later received a heart transplant, and the other died before a transplant could be performed.
Used Temporarily
Animals have survived as long as six months with the Thoratec heart. In humans, it has been used temporarily in about 90 patients for up to 18 days, most frequently as a single device to help the left side of the patient’s own heart recover after cardiac surgery, according to Hill. The survival rate has been between 30% and 40%, he said.
Three patients, in Hershey, St. Louis and Louisville, have used two of the Thoratec devices as a bridge to transplantation since spring of this year. All received successful transplants two to seven days later, Hill said.
The surgeon said that while it took more time to connect two devices, the care of the patient after surgery was “easier,” because the two sides of the heart can work in conjunction with each other.
Since January of 1984, Hill has transplanted 14 hearts, and 13 of the recipients are still alive. He said that it has taken between two and 14 days to obtain donor hearts, with the average wait being six days.
The surgery and hospital care for Dallara may cost between $100,000 and $150,000, according to Hill. The patient is uninsured, but an application will be made retroactively for Medi-Cal coverage.
