S.D. Doctors Transplant Mechanical Heart to Man
In the first use of an artificial heart in California, a team of surgeons in San Diego has implanted a Jarvik-7 mechanical heart in the chest of an Escondido man whose transplanted human heart had failed.
Randy Dunlap, 34, received the device at Sharp Memorial Hospital on Tuesday after his transplanted heart failed to support his circulation. Hospital officials said the device is to serve as a temporary “bridge” to keep Dunlap alive until another human heart can be found.
Dunlap had been suffering from familial cardiomyopathy, a chronic degenerative heart condition that runs in families. He had received a human heart transplant late Monday night; when the heart failed, the hospital was unable to secure a second human heart.
The Jarvik heart, initially intended for permanent use, has been used in nearly 60 patients worldwide since August, 1985, as a temporary bridge until a human heart can be found for a transplant. Sharp Memorial Hospital in December became the 15th medical center in the United States to receive federal government approval to implant the experimental device.
Scattered Sites
Other centers that have used the mechanical heart as a bridge are located in Pittsburgh, Minneapolis, Milwaukee, Tucson, Houston and Gainesville, Fla. Officials of the Utah firm that makes the device declined to say whether other California facilities have approval for its use.
The three-hour operation in San Diego occurred after Dunlap’s surgeons tried to support the faltering human heart with so-called ventricular assist devices and a balloon pump. When those steps failed, they implanted the artificial heart, hospital spokeswoman Cindy Cohagen said.
Dunlap, a backhoe operator who had been unable to work because of his heart condition, was reported late Thursday to be in critical but stable condition. Cohagen said he had emerged from anesthesia Wednesday in time to watch the evening news.
Cohagen said the surgical team intends to observe Dunlap’s condition for several days before looking for a new human heart. She said team members hope to find a heart and transplant it to Dunlap within several weeks.
“It’s an extension of the transplant program,” Cohagen said of the hospital’s decision to use the artificial heart. “When we get in a situation such as this one with a transplant that doesn’t work right away, or when a patient might be in critical condition awaiting a transplant, we now have this option.”
Long Preparation
The hospital had spent six months preparing for an artificial heart implant.
Gary Cole, a vice president of Symbion Inc. in Salt Lake City, said that as of June 1, 58 patients had benefited from the use of the company’s artificial heart as a bridge to the transplantation of a human heart. Forty-three of those patients eventually received human hearts, 11 died before transplantation and 4 are awaiting a transplant.
Cole said the recipients’ median duration on the polyurethane heart was nine days. One woman, who received two artificial hearts because two transplants failed, spent 243 days on the artificial devices.
Cole pegged the selling price of the device at “around the $18,000 number.”
The Jarvik heart, named after one of its designers, Robert Jarvik, was first implanted in a human in 1982. At the time, it was intended as a permanent replacement. The patient, Barney Clark, survived 112 days.
Patients Develop Problems
In 1984 and 1985, three more patients received permanent artificial hearts. The longest survivor lasted 620 days. Because the patients were plagued by blood clots, infections and other complications, surgeons turned to using the heart as a temporary bridge.
Dr. William DeVries, the Utah surgeon who pioneered the device, remains the only physician with federal approval to implant the permanent heart. However, he has not done the operation since 1985.
Donna Hazel, a spokeswoman for the Louisville, Ky. hospital where DeVries now works, insisted Thursday that DeVries has not written off the possibility of implanting additional permanent hearts. She said he is still waiting for “as strong a patient as possible.”
Several other types of artificial hearts are being developed, but are not widely available, at the University of Utah in Salt Lake City and at Penn State University in Pennsylvania.
