Saturday, July 3, 2004
Saving lives with artificial hearts
A Melbourne man has become the sixth person to receive an Australian-made artificial heart.
In a Melbourne hospital a man once on the verge of death due to a severe heart condition is now sitting up and hopefully taking the first steps towards recovery.
He is the sixth person to receive an Australian-made artificial heart, under a pilot trial.
The three decade long race to develop a workable artificial heart has been dogged by flawed mechanics and infection.
But doctors believe this new device can lengthen the lives of thousands of patients around the world who otherwise would have no hope.
"I call it me washing machine," recipient Max Hudson said.
"If I put my hand there, any time I can feel it going."
As part of a trial at Melbourne's Alfred Hospital, Max Hudson and three other patients are living with artificial hearts based on a continuously spinning rotor.
"So the pump is continuously pumping blood, unlike the heart, of course, which fills and empties and, as such, creates a pulse," said David Kaye, an associate professor at the Alfred Hospital.
"So it is an interesting phenomenon. When you first see these patients, you go to feel a pulse and, of course, they don't have one but here they are sitting up, talking to you, feeling fine."
Seventy-four-year-old Mr Hudson says in a way he has just celebrated his first birthday.
It was just a year and two days ago that he received his new heart after more than a decade of severe heart problems.
He says he can not compare his life now to the one he led before.
"It's like chocolate and toffee."
The only thing slowing Mr Hudson down now is a backpack powering his mechanical heart.
It is driven by a rotor suspended in a magnetic field, receiving blood from his own heart, returning it to the aorta.
The pump is inserted just below the left side of the rib cage, with a cable coming out the patient's right side.
It connects to batteries that beep before needing to be changed every four hours, or the patient can be plugged straight into the mains, which has led to at least one odd restaurant scene for Gerry Levine, another recipient, and his wife.
"So, we walked in and calmly asked the waitress, "Could we be seated near a power plug?"
"And there was a somewhat astonished look on her face," Mr Levine said.
The ventr-assist is called a third-generation device, differing from earlier, unwieldy models that agitate the blood more quickly and have wearable parts, typically causing three major problems.
"They are, basically, mechanical failure, blood clots forming in the pump or the pump stopping due to blood clots clogging the mechanism or the device gets infected and the patients get major complications from that, which can't be curable because it's an implanted system," Associate Professor Don Esmore said.
"And we really have not had any of those."
The question is now - how long can it live?
Professor Kaye says that is a good question.
"Certainly in experimental tests the device has been running continuously for over two years."
Mr Hudson, Mr Levine, Henry Nathan and another patient implanted just last week are the success stories for this trial.
But two others died, according to the doctors, for reasons unrelated to the device.
After the second death in March, shares in the manufacturer Ventracor fell sharply, but the hospital resumed the trial after an internal review of its processes.
"Look, I think we're certainly disappointed and sad that those patients didn't make it through," Professor Kaye said.
"I think, unfortunately, one has to recognise that for patients who are gravely ill coming into any device that this is not a cure all."
The company - and the technology - will get a further chance to prove their worth in a trial starting this month in other hospitals around Australia, as well as in New Zealand and the United Kingdom.
The trials will continue to target elderly patients who would have no prospect of receiving heart transplants, but who could then perhaps live on this device for some years.
"Fantastic, because without it I'm not here," heart recipient Mr Nathan said.
Each device is still handmade at a cost of up to $100,000, and as Professor Esmore acknowledges, some may see this as a luxury therapy.
"But I think for the individual who's 60, 70 years of age and otherwise well, and has end stage heart disease, and they can have a device like this implanted, either for a small or no cost, that gives them a chance at quality and duration of survival," he said.
"I think it's very, very hard for us, as individuals, to withhold that therapy from them merely based on cost."
For the ladies who are there to change the batteries and take over any duties with power tools, all the money and work is worth it.
"I'm extremely grateful," Mr Levine's wife, Marie Parkinson-Levine, said.
Mr Nathan's wife said: "We all said to Henry, 'It is up to you. It is your life at stake', and he said, 'I want to do it'.
"So we took the gamble and it has been a wonderful gamble."
The surgery has also allowed Mr Hudson to live to his 50th wedding anniversary a couple of months ago with the woman he calls "his little girl", Irene.
And he says his four kids are proud he is helping medical science.
"I don't think they were too unhappy with me before, but when I had this done for other people they said, 'We are so damned proud of you'," Mr Hudson said.