Taking Heart : Implants, Despite Limits, Still Worth It, DeVries Says
Despite the tubes, the complications, the pain and the restrictions, there is no question that the quality of life improves for artificial heart recipients after their own ailing hearts are replaced with a mechanical pump, heart surgeon Dr. William C. DeVries said Friday.
“Everybody says, ‘I wouldn’t want an artificial heart because I couldn’t play golf or swim or play tennis.’ . . . I feel the same way, I wouldn’t want an artificial heart either, as I am,” said DeVries, who made medical history in December, 1982, when he implanted an artificial heart in dentist Barney Clark.
“But that doesn’t account for the fact that these patients are not water-skiing or playing tennis or anything else. These patients are fighting just to stay alive,” he said. The first recipient, Clark, was so ill and weak he could barely hold the pencil to sign his consent to the operation, he said.
“People in this type of condition make choices that other people who are healthy may not make,” he said.
DeVries, director of the Total Artificial Heart Program at Humana Hospital Audubon in Louisville, Ky., spoke to hundreds of operating room nurses gathered for their national meeting at the Anaheim Convention Center.
Afterward, DeVries said he plans to perform another implant as soon as his team identifies a patient who is “exactly right.”
Patients Being Sought
“We’re looking for patients now” to receive either a permanent artificial heart or a temporary “bridge” implant, which keeps the patient alive until a human donor heart can be transplanted, he said. Although so far he has implanted only permanent artificial hearts, he believes the bridge implant “is a very bona fide way of using the heart. But I think that permanents are important, too.”
Soon, a self-contained permanent artificial heart--one that does not require hookup to an outside power source--will be available, he said.
“As we get better and better with our implantation of the heart, and the hearts are getting better and better, we’re going to be doing more and more permanents,” he said. “I think with transplantations, you always will have less donors than you’ve got recipients. Recipients (number) 15,000 a year and you probably never get more than 800 donors a year in the United States,” he said.
DeVries’ first patient, Clark, lived for 112 days with the artificial heart. His second patient, William Schroeder, has had his artificial heart nearly 1 1/2 years and is the world’s longest survivor with the device.
The third, Murray Haydon, celebrated his first anniversary in February, but DeVries’ fourth patient, Jack C. Burcham, died 10 days after his April 14, 1985, implant. DeVries, authorized to perform three more operations, has not implanted an artificial heart since then.
DeVries was clearly a celebrity in the crowd of nurses. Before and after his presentation, members of the Assn. of Operating Room Nurses flooded the dais, clamoring for an autograph from the lanky, sandy-haired surgeon.
Team Approach Emphasized
DeVries was joined during the session by Linda C. Marsh, nurse-manager of surgery at Humana Hospital Audubon, to underscore the need for a team approach among doctors, nurses and other operating room staff during implant surgery.
The two irreverently gave some behind-the-scenes glimpses at the artificial heart implant process. DeVries arrived with much fanfare at Humana Hospital Audubon--his first implant was performed at the University of Utah--nearly two years ago, and the operating room nurses had to get ready for highly complex surgery they had never even seen before.
DeVries said he appointed Marsh as operating room traffic control officer to help police the many physicians, nurses and technicians needed for the then-revolutionary procedure. Marsh’s position even entitled her to order observing doctors out of the room, which drew applause from the nurses in the audience.
DeVries, 42, marveled at the advances in heart surgery within his own lifetime. The heart-lung machine, an apparatus that temporarily performs the function of those two organs during surgery, was developed in the 1950s, and today 150,000 open-heart surgeries are performed each year, he said.
Efforts to design an artificial heart began in the 1960s. After it was proven a few years ago that animals could survive for many months with the device, “we had to face our big decision, whether or not . . . it was all right to put it in a patient,” DeVries said.
Heart Disease Rampant
The affirmative answer came readily, he said, because heart disease is so rampant today.
“My chance of having a heart attack by the time I’m 65 years old is one in four. My chance of getting to the hospital alive is 50-50. By tomorrow morning, 1,000 Americans--grandmothers, grandfathers, children--will be dead of heart disease . . . so you can understand the push for this.”
Waiting for government approval to go ahead with the early artificial heart implants was one of the most difficult experiences of his life, DeVries said.
“You can’t imagine how frustrating it was to have all the team together and have patients die while the team (and) all the readiness was there,” he said.
“People, more than one, would come into my office and there were tears in their eyes, and they’d say, ‘Why are you doing this, why don’t you go ahead?’ And you have to say, ‘I’m sorry, I can’t do anything about it.’ It became very frustrating to deal with that.”
For candidates for artificial hearts, there is no contest between risks and potential benefits, he said. His third patient, Haydon, was so sick “he had to sit up with his head between his legs to catch his breath,” DeVries said. The recipients generally are malnourished because they are so sick they cannot eat, he said.
The public had some difficulty accepting the idea of an artificial heart, but that attitude is now fading, DeVries said. There were 13 artificial heart operations last year, and he expects that the number will double by the end of this year, he said.
He even displayed a cartoon showing paramedics of the future jump starting a patient’s artificial heart as if it were a dead battery.
“I think there’s no question that the artificial heart is here to stay,” he said.
