Israeli surgeons implant first permanent artificial ventricle
Fifteen surgeons who implanted the first permanent artificial left ventricle in a patient are confident that the tiny device will eventually be used in most heart transplantations around the world. The 64 year old patient was terminally ill when he received the implant, having experienced severe heart problems for several months, and he died five days later on 1 August of multiple organ failure. His own heart had been working at only 10% capacity at the time of the implant.
Dr Jacob Lavee, head of the
department of cardiothoracic
surgery at the Sheba Hospital,
near Tel Aviv, performed the 12
hour operation with the help of
colleagues. He said that guidelines allowed implantation of the
HeartMate II device only in a
patient with no other treatment
options. The man would have
died "within six hours" if he had
not received it, Dr Lavee said.
The device was "functioning perfectly" when he died of multiple
organ failure last week, and doctors said that the device was "not
responsible" for his death.
When implanted alongside the heart, the metallic device takes over the function of the damaged left ventricle and pumps oxygenated blood around the body (THERMONS INC)
The patient, a father of four
from a town near Haifa, had the
artificial ventricle inserted into
his abdomen. It was powered by
a lithium battery outside his
body via thin wires. The device
weighs only 350 g and measures
80*100 mm.
The metallic device, designed
at the Center for Development of
Artificial Organs in Pittsburgh,
Pennsylvania, and manufactured
by Thermo Cardiosystems,
pumps smoothly flowing, oxygenated blood into the patient's
damaged left ventricle and on to
the rest of the body. The patient's
own heart is not removed, and
the other chambers function in
coordination with the artificial
device.
Fortunately, most patients
who need heart transplants
have only a diseased left ventricle, thus making the new procedure ideal as an alternative
for human heart transplant
surgery. Previous use in animals showed that the device,
which lacks valves, offers long
term, trouble-free service. If
the patient recovers, a long
term battery (such as that in a
pacemaker) can be implanted
permanently inside his or her
body.
Asked why US surgeons were
not the first to perform the
implant, Dr Lavee explained that
the US Food and Drug Administration does not approve the use
of such devices in the US before
they are proved successful in
patients abroad. He added that
the administration would probably want to see "20 or 30 successful implants before beginning
the approval process in the United States."
Since the Israeli cardiac surgeon worked with the Pittsburgh team from 1989 to 1990,
he and his Israeli colleagues
were chosen to be the first to
do the implant - even though
many European medical centres had been keen on being
first. He expects that the next
recipient will be in better condition when the operation is
performed.
Judy Siegel-Itzkovich, Jerusalem
studentBMJ 2000;08:303-346 September ISSN 0966-6494
