DR. ADRIAN KANTROWITZS MANY (contributions to heart surgery — early pacemakers and heart transplantation, for instance — include the most practical heart assist device in use today: the intra-aortic balloon pump. This novel device likely saves more than one hundred thousand lives every year worldwide.
Kantrowitz developed the device with his brother Arthur, a Ph.D. physicist and former rocket scientist. Shortly after returning from service in World War II, Kantrowitz worked in the laboratory at Case Western Reserve University in Cleveland. There, he coauthored a paper with his brother on arterial coun-terpulsation.
"We showed you could increase coronary bloodjlow and unload the left ventricle. We published this as a theoretical thing because I couldn't figure out how to do it practically. Then Dr.
Dwight Harken professor of surgery at Harvard Medical School, did his work It was really Harken who put the word to it — counterpulsation
"But the problem was you couldn't move enough blood. You had to move it through a small tube. My brother and I thought the way to do it was to put a balloon in — we literally thought of a balloon. We discussed this at our mother's house."
They soon learned that Dr. Willem Kolff had published a paper in which he actually tried a balloon pump in human cadavers but never in living humans. The brothers then developed a device that, in 1967, Kantrowitz tested in living humans.
"These were patients who were in cardiogenic shock," Kantrowitz recalls. The results in their first three patients were published in the Journal of the American Medical Assocation in 1968.
Dr. Adrian Kantrowitz, working with his brother, developed the intra-aortic balloon pump, which is used to help support the circulation with weakened hearts.
Fig. 11.2: The Intra-Aortic Balloon Pump:
This device is placed into the aorta and inflates rhythmically to help maintain blood pressure in the heart and arterial system. It is a temporary, but very valuable, therapy for weakened hearts.
Attached to external pump and power source
The concept of aortic counterpulsation (as used with the intra-aortic balloon pump) was first described by Dr. Dwight Harken in 1958. In 1962, Dr. Willem Kolffs group introduced a balloon catheter into the aorta of an animal. In 1967, Kantrowitz and associates reported the first use of the intra-aortic balloon pump in three patients. All were in shock but improved during balloon pumping. One survived to leave the hospital.
Nowadays, most hospitals in the United States and virtually all large hospitals around the world, particularly those that have a cardiac center, use the intra-aortic balloon pump. According to Kantrowitz, the intra-aortic balloon pump is used in the United States in about one hundred thousand patients every year.
Kantrowitz's team has also been approved by the FDA to surgically implant a permanent version of the intra-aortic balloon pump in a limited number of select patients.
Doctors also continue to work with the concept of implanting totally artificial hearts, which would alleviate the shortage of donor organs. Before this becomes a practical reality, however, there are several obstacles that need to be overcome.
The heart was first replaced with a mechanical device by Dr. Tetsuzo Akutsu and Kolff at the Cleveland Clinic in 1957. Working in animals, these two researchers implanted an artificial heart in a living dog. The animal survived for ninety minutes.
In 1966, a team of Houston doctors under the leadership of Dr. Michael DeBakey used a left ventricular assist device in a woman who could not be weaned from the heart-lung machine after having two heart valves replaced. After ten days of circulatory assistance with the pump, she was weaned successfully from the device and recovered. This woman was probably the first patient to be weaned from a heart assist device and leave the hospital alive.
The first artificial heart in a human was implanted in 1969 by Denton Cooley, who used it as a bridge to heart transplantation for a patient who would most likely have died if Cooley hadn't used it to support the patient's failing heart until a donor heart was found. Cooley's team performed the operation on a patient who could not be weaned from the heart-lung machine after heart surgery. After sixty-four hours of support with the artificial heart, heart transplantation was performed, but the patient died of an infection thirty-two hours after the heart transplant.
The first two patients successfully bridged (kept alive by a mechanical heart assist device) to heart transplantation were bridged at almost the same time and in the same metropolitan area but by different surgical teams. On September 5, 1984, in San Francisco, Dr. Don Hill implanted a Pierce-Donachy left ventricular assist device in a patient in cardiogenic shock. The patient's heart was replaced successfully two days afterward, and the patient was later discharged. Two days later, a team of surgeons at Stanford
University successfully replaced the heart of a patient who had been maintained with an electrically driven Novacor assist device.
jç^j Recent Artificial Hearts
The first implantation of an artificial heart, called the Jarvik-7, that was meant to be permanent (as opposed to a bridge to heart transplantation) was performed
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