Mechanical Heart Pioneer Performs 5th Implant in Emergency Surgery

Pioneering heart surgeon William C. DeVries Friday implanted a Jarvik-7 mechanical heart in an emergency operation on a 60-year-old photographer who had undergone an unsuccessful heart bypass operation the previous day.

The 10-hour operation at Humana Hospital Audubon in Louisville, Ky., came two days after the fifth anniversary of DeVries’ epochal implant of a mechanical heart into Seattle dentist Barney Clark, who died 112 days later from multiple organ failure. It was the first time DeVries has implanted the Jarvik-7 mechanical heart since April, 1985, and only the fifth time overall.

A hospital spokeswoman, Donna Hazle, said the patient, Walton Jones Jr. of Louisville, is being evaluated for suitability for a transplant. She said it is hoped to find a donor heart, which means that the Jarvik is being used as a temporary “bridge” pending the availability of a donor heart.

If Jones is given a donor heart, it will mark the first time that DeVries has used the Jarvik-7 as a bridge. But DeVries “has not changed his philosophy about the use of the Jarvik-7 as a permanent implant,” Hazle said.

Virtually Alone

While other surgeons have been quick to adopt the use of the mechanical heart as a temporary measure until a human heart becomes available for transplant, DeVries has been virtually alone in his belief that the Jarvik can be used successfully as a permanent heart replacement.

But the high incidence of stroke, infections, bleeding and other problems among the first five recipients of a permanent mechanical heart--one of them in Sweden--as well as the increased success rate of heart transplants, has caused a critical reevaluation of the procedure by both DeVries and the U.S. Food and Drug Administration, which must approve the procedure.

After DeVries’ fourth implant patient, Jack Burcham, died from internal bleeding only 10 days after his 1985 surgery, the FDA imposed new restrictions on the surgeon. The most important was that it revoked his permission to perform a total of seven implants, ruling that permission would henceforth be granted for only one implant at a time.

Extremely Selective

The implication was clear, many observers believed, that another failure might mark the end of the program. DeVries has thus been extremely selective in his search for a new candidate for a permanent implant.

What he wanted was a patient with terminal heart disease, but who was younger than the previous mechanical heart recipients and unburdened with secondary diseases, such as kidney problems. However, patients matching that description are prime candidates for a transplant and thus ineligible for the implant.

DeVries was apparently pushed into a decision to use the mechanical heart by a rapid deterioration in Jones’ health, Hazle said.

The retired photographer had suffered a heart attack in 1984, after which a pacemaker was implanted. He suffered a second heart attack last July, and his health has declined since then. Three of his coronary arteries were clogged, Hazle said, and DeVries performed a bypass operation Thursday.

Lungs Swelled

Jones’ condition got worse during the night, and DeVries decided that the only way to save his life was the implant. The operation began at 7:30 a.m. EST and lasted much longer than expected. DeVries implanted one Jarvik-7 and observed that Jones’ lungs were swelling, indicating that the mechanical heart was too large.

DeVries’ removed it and implanted a second, smaller Jarvik-7. The operation was completed at 5:30 p.m., and Jones’ condition was listed as critical.

Jones and his wife, Wanda, have two sons, Walton III of Louisville and Wit of Dallas.

In addition to Clark and Burcham, who were both 62 at the time of their operations, DeVries has implanted the mechanical heart in William Schroeder, 54, who lived 620 days before his death on Aug. 6, 1986, and Murray Haydon, 59, who lived 487 days before his death on June 19, 1986.

The only other permanent recipient of a mechanical heart was Leif Stenberg, 53, of Stockholm, who lived for 229 days before his death on April 7, 1985. Norwegian surgeon Bjarne Semb performed the surgery at the Karolinska Hospital in Stockholm.