The Seven-hour Surgery
The surgery to implant a AbioCor artificial heart is extremely delicate. Not only are the surgeons cutting off and extracting the natural heart's right and left ventricles, but they are also placing a foreign object into the patient's chest. The patient must be placed on, and later removed from, a heart-lung machine. The surgery requires hundreds of stitches, to properly secure the heart to artificial ventricles. Grafts connect the AbioCor to remaining parts of the natural heart. Grafts are a kind of synthetic tissue used to connect the artificial device to the patient's natural tissue.
Photo courtesy Abiomed
Surgeons implanting the AbioCor heart
In 1982, Dr. William Devries implanted the Jarvik-7, the first device designed to be a completely permanent replacement heart. The surgery was done at the University of Utah, and the patient was Dr. Barney Clark, a dentist from Seattle. Clark lived for 112 days on the heart before succumbing to complications caused by the device. Click here to see a photo of the Jarvik-7.
The Jarvik-7 was an air-driven heart designed by Dr. Willem Kolff and Dr. Don Olsen. Unlike the self-contained AbioCor, the Jarvik-7 heart required several external wires, which protruded from the patient and connected to a large external unit. These protruding wires led to several infections in Clark.
Four more patients received the Jarvik-7 before it was discontinued due to complications, including stroke, mechanical failure and anatomical fit issues. It has since been enhanced and renamed, now called the CardioWest heart. It is used only in experimental situations and as an investigative bridge-to-transplantation device.
Due to the complexity of the surgery, there are lots of medical personnel on-hand during the operation. The surgery on July 2, 2001, which was the first of its kind in the world, included a team of the two lead surgeons, 14 nurses, perfusionists, anesthesiologists and other support staff.
Here is the procedure, as described by University of Louisville surgeon Robert Dowling:
- Surgeons implant the energy-transfer coil in the abdomen.
- The breast bone is opened and the patient is placed on a heart-lung machine.
- Surgeons remove the right and left ventricles of the native heart. They leave in the right and left atria, the aorta and the pulmonary artery. This part of the surgery alone takes two to three hours.
- Atrial cuffs are sewn to the native heart's right and left atria.
- A plastic model is placed in the chest to determine the proper placement and fit of the heart in the patient.
- Grafts are cut to an appropriate length and sewn to the aorta and pulmonary artery.
- The AbioCor is placed in the chest. Surgeons use "quick connects" -- sort of like little snaps -- to connect the heart to the pulmonary artery, aorta and left and right atria.
- All of the air in the device is removed.
- The patient is taken off the heart-lung machine.
- The surgical team ensures that the heart is working properly.
Abiomed officials have cautioned against overly-optimistic results for the first patients to receive a transplant. While doctors hope for more, the device is only designed to double life expectancy for patients who had only about 30 days to live prior to the operation. The most optimistic predictions are that a patient could currently live up to six months with the AbioCor heart.
Robert Tools, the patient who received the heart transplant on July 2, 2001, at Jewish Hospital in Louisville, remains hospitalized. Doctors have not said when or if the patient will be able to return home. To find out more about Tools and who is a candidate for the four other initial operations, read the next section.