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  • 6/13/2025
The work of two medical teams, one headed by Dr. Michael DeBakey and the other by Dr. Robert Jarvik, to invent a reliable mechanical replacement for a failing heart.

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00:00During the following program, look for NOVA's web markers, which lead you to more information at our website.
00:14On April 4th, 1969, Haskell Karp became the first human being to have his natural heart removed and replaced with an artificial one.
00:26Surgeon Denton Cooley, known as the man with the golden hands, performed the historic operation.
00:37The experiment vaulted him to fame and captivated the country's interest.
00:45The fact that Mr. Karp has regained organ function indicates that a mechanical heart is a feasibility.
00:53But within days, those with the most at stake began to question the experiment.
01:02I saw apparatuses going into the arms, the hands, the feet.
01:09He could not say anything.
01:13I don't think that he was really conscious.
01:18One day, they removed the tube from his throat.
01:23They put a sheet over all the apparatuses in back of him and had the media take their pictures saying, look how well he's doing.
01:37And immediately after this was done, they put back the resuscitation tube and opened up everything that they had closed up.
01:49Three days after receiving the artificial heart, a human one was found.
01:56But Karp died shortly after it was transplanted.
02:02After seven more failed attempts, the public and many doctors lost faith in the idea of replacing the human heart with a mechanical substitute.
02:15But now artificial hearts are back in a new high-tech incarnation.
02:22Will they at last fulfill the dream of giving dying patients a second chance at life?
02:31Major funding for NOVA is provided by the Park Foundation, dedicated to education and education.
02:37and quality television.
02:38To me, I have a chocolate bank.
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04:02Glenn Manderson is only 32 years old, but he's suffering from chronic heart failure.
04:21The muscle in his heart has become so weak, it can no longer pump enough blood.
04:30Surgeon Mehmet Oz fears Glenn will not survive the next 48 hours.
04:37Glenn desperately needs a new heart.
04:39But because of the scarcity of human donors, there is no organ at hand.
04:44If this was five years ago, we would have nothing to offer you.
04:48And so I think that you're much better off now,
04:51because we have options that we can use in a pinch, and this is definitely a pinch.
04:56Dr. Oz hopes to implant an electrical pump
04:59that can take over the work of Glenn's weakened heart.
05:02Now, you've seen pictures of it.
05:05This is what the pump looks like.
05:08It's called a heartmate VE, and weighs two and a half pounds.
05:13I know that it looks big, but it actually fits very nicely inside of you,
05:17especially because you've got reasonable size.
05:19What's fitting me pretty well is while it goes under the ribcage,
05:22and once it's in, you're not going to be able to see it.
05:25So, you're going to take the heart out?
05:26No, we're not going to take the heart out.
05:28No.
05:28The heart stays in. This is a piggyback pump.
05:30It's going to be inside of you.
05:31It's going to be inside of you.
05:33Because the pump takes over the work of the heart's left ventricle,
05:37it's called a left ventricular assist device, or LVAD.
05:43It's a direct descendant of the old artificial heart.
05:49For some reason, this evolution, because it was that and not a revolution,
05:54snuck up on the American public.
05:56And so many times, patients and their families don't know what a mechanical pump is,
05:59and they're scared by it.
06:00They don't realize that it is a safety net to keep you alive if things don't work out well.
06:04And that is a huge emotional barrier to overcome.
06:07Most people believe that if you get a mechanical heart,
06:10it's just delaying the inevitable.
06:12And it's not.
06:13That night, Glenn's kidneys begin to fail from lack of enough blood.
06:23Fluid fills his lungs.
06:25He has trouble breathing.
06:28There is a 30% chance he will not survive his LVAD surgery.
06:32But without it, death is certain.
06:34When we opened his chest, his heart was so big,
06:45it was literally pushing against the chest bone.
06:47That's very uncommon.
06:49And so we opened the bone with a saw.
06:51The heart was right there and got cut.
06:53Now, needless to say, not only do you not expect it,
06:56but what happens is a catastrophe,
06:57because you are completely uncontrolled.
07:01Glenn is in no condition to lose any more blood.
07:04His heartbeat fluctuates wildly.
07:08The surgical team quickly channels his blood
07:11into the heart-lung machine.
07:14Are you guys ready to go on?
07:17I don't care.
07:18You ready to go on?
07:19Yes.
07:19In minutes, the operation is back on track.
07:23Come on, podcast.
07:23Let's go now.
07:25Listen over.
07:27The team now focuses on implanting the heartmate.
07:30You don't know why in this orientation like that.
07:33We're done.
07:34So this is going to be where the device enters the heart.
07:37This is his heart.
07:38And it's just going to be passive
07:40and letting blood flow through it into the device.
07:49Within hours, the electrical pump
07:51has taken over the work of Glenn's heart,
07:54sending oxygen-rich blood to revitalize his failing body.
07:58Glenn Roy is a ghost.
08:04Five years ago, he would have died.
08:07Three years ago, we probably would have saved him.
08:09Today, we will almost always save him.
08:11That is the rapid degree of change that we've experienced.
08:14And what we've really learned more than anything else
08:16is how to use the machine in demand.
08:19That was the next barrier.
08:20We could build pumps.
08:22That's a pretty trivial issue.
08:24But making pumps that you can slip into the human body
08:26without the human body knowing that you've done it,
08:29that was the big challenge.
08:30And that's the battle that we've been able to win.
08:33The LVAD will allow Glenn to go home
08:39and lead an almost normal life
08:41until a donor heart becomes available.
08:45His survival is the culmination of decades of struggle
08:48to build a mechanical substitute
08:51for the most sacred part of the human body.
08:57Making an artificial heart
08:59to match the abilities of the human heart
09:02is a huge technological challenge.
09:06The heart is a remarkable organ,
09:08beating over 100,000 times a day
09:10without rest year after year after year.
09:13It's a very efficient pump, absolutely very efficient.
09:17It's probably the only organ in the body
09:19that we can actually feel it work.
09:23No matter what you do to it,
09:25how much beer you drink or how much food you eat,
09:28it just keeps going.
09:29Like those little battery commercials.
09:33It feeds itself.
09:34It energizes itself.
09:37In a lifetime,
09:39the human heart will beat
09:40over two and a half billion times
09:43unless it fails.
09:47Once the heart becomes injured or diseased,
09:50it can no longer pump enough blood.
09:54Victims have trouble breathing.
09:57Any activity leaves them exhausted.
10:01Heart disease is our number one killer
10:04and congestive heart failure is on the rise.
10:07As the population gets older,
10:11the incidence of heart failure increases dramatically.
10:16And really, there is an excellent treatment
10:19for end-stage heart failure,
10:20and that is heart transplantation.
10:22But because there are not enough donor hearts,
10:25it's only available for a very small proportion
10:28of those patients.
10:30Having a realistic artificial heart
10:33is a very important contribution.
10:40Dr. Michael DeBakey
10:42is a pioneer of the artificial heart.
10:45In the 1960s,
10:47he was one of a handful of leading heart surgeons.
10:51Known as the Texas Tornado,
10:54he both inspired and terrified those around him.
10:57What do you mean, it's not flushing?
10:59No, no, no, no, no.
11:00Put your finger over that.
11:01You're not concentrating.
11:02You're watching me.
11:03Oh, damn it.
11:04Dr. DeBakey was quite a taskmaster.
11:07It was like working under a marine drill sergeant.
11:10He was very tough.
11:12He expected actually much more of you
11:14than you could actually do.
11:21Outside of surgery,
11:22DeBakey was working with a team of researchers
11:24at the Baylor Medical College in Houston.
11:27To develop an artificial heart
11:29which would replace the natural organ.
11:33We were thinking the heart as just a pump.
11:36And it seemed logical
11:38that if that's the main function,
11:41you ought to be able to duplicate that mechanically.
11:47Placing a man-made heart in a human
11:49has always raised disquiet.
11:53The history of the artificial heart
11:54is rife with contention.
11:56There's been enormous controversy
11:59surrounding any artificial heart implant.
12:03I think part of the problem
12:04is that many of the operations
12:06have just been isolated one-off incidents
12:08that other physicians
12:10have been able to refer to as experimental.
12:13are we playing with a patient?
12:20In the 1960s, DeBakey's team
12:22was testing his artificial heart
12:24in animals.
12:27The principal researcher, Domingo Liotta,
12:30went to Dr. DeBakey
12:32with a startling proposition.
12:33Dr. Liotta was very ambitious
12:41to apply the pump in humans.
12:45And I explained to him
12:46that we couldn't do that
12:48because it had been used in seven caves,
12:51four of which died on the operating table.
12:53We couldn't go and get approval
12:56from our committee.
12:59I didn't realize that secretly
13:01he went to see Dr. Cooley about it.
13:05Denton Cooley was one of Dr. DeBakey's
13:07protégés and colleagues
13:09who also worked part-time
13:10at the nearby Texas Heart Institute.
13:13He seized the opportunity
13:16that the more cautious DeBakey
13:18wasn't prepared to take
13:20to do the first human trial.
13:24Now, Dr. Cooley had no experience
13:26with the artificial heart program at all.
13:28He didn't do any laboratory work.
13:30He was a good surgeon,
13:31but that's all.
13:33Dr. DeBakey seemed to show
13:35little interest in ever using it.
13:37Dr. Liotta thought he was just
13:38wasting his years
13:41in the laboratory
13:43working with animals and so on
13:44that this would never be tested clinically.
13:48And I thought,
13:49and agreed with Dr. Liotta,
13:51the time had come
13:52to really give it a test.
13:54And the only real test
13:55would be to apply it
13:57to a dying patient.
14:04The patient was Haskell Karp
14:06from Skokie, Illinois.
14:08He was a man
14:09with a long history of heart problems.
14:11On April 4th, 1969,
14:18Haskell Karp's own heart
14:19was completely removed
14:21and replaced
14:22with an artificial one.
14:25Denton Cooley
14:26had not sought any approval
14:27for this groundbreaking operation.
14:32Well, in those days,
14:33I didn't feel like
14:34we needed permission.
14:35I needed the patient's consent.
14:37That was essential, of course.
14:38And I think if I had sought permission
14:41from, say, the federal agency
14:44or the hospital
14:46or anybody else,
14:49I think I probably would have been denied
14:52and we would have lost a golden opportunity.
14:54I was in Washington
14:57when I read in the morning papers there
15:00about the use of this artificial heart
15:03that Dr. Karp had put in the patient.
15:05I was shocked.
15:06I didn't know that he had done all of this
15:10surreptitiously.
15:11You see, I didn't know he had taken it from the laboratory.
15:13We are most encouraged
15:15by our results so far
15:17and even if Mr. Karp
15:19goes nothing that doesn't go
15:21any more than another day,
15:22I think that we have demonstrated
15:24that there is validity
15:26to this concept
15:27of making every effort
15:29to prolong life
15:31at any cost
15:34in order to make possible
15:37a cardiac transplantation.
15:39Two days after the operation
15:43with Karp growing worse by the minute,
15:46his wife made an emotional appeal
15:48for a human heart.
15:50I see him lying there,
15:52breathing,
15:53and knowing that within his chest
15:55is a man-made implement
15:57where there should be a God-given heart.
16:03Within a day,
16:04a donor heart was found.
16:06But Haskell Karp
16:09died from infection
16:10shortly after receiving it.
16:15Dr. Cooley's justification
16:17was he was trying to save
16:18the life of this patient.
16:19But, you know,
16:20you don't take an experimental device
16:22to save the life of a patient.
16:24It has had no evidence
16:25that it would do that.
16:27There were no more human trials
16:38until the early 1980s
16:40when a new figure
16:41suddenly entered the race.
16:44Until his father died
16:46of heart disease,
16:47Robert Jarvik had planned
16:48to become an architect.
16:53He then switched to medicine
16:55and engineering.
16:57By 1982,
16:59Jarvik was conducting
17:00animal trials
17:01at the University of Utah
17:03with an artificial heart
17:05he called
17:05the Jarvik 7.
17:08The Jarvik 7 heart
17:10was a total heart,
17:11completely replaced
17:12the natural heart
17:12in the chest.
17:13And it's driven
17:14with compressed air.
17:15So if you look inside
17:17the heart here,
17:19see the diaphragm move?
17:22Jarvik's team was one of five
17:27in the U.S.
17:28working on artificial hearts.
17:30With funding tight,
17:33he decided the time was right
17:35for a high-profile human trial.
17:37Here was a whole section
17:42of a university
17:43that had done a lot of work,
17:45good work,
17:46to get to this point,
17:47and they were in danger
17:48of losing their financing.
17:50They knew
17:51that they needed
17:52something big.
17:53Once again,
17:56a volunteer was needed.
17:58Someone too ill
17:59for a transplant
18:00and large enough
18:02to receive
18:03the Jarvik 7.
18:05Someone
18:05like dentist
18:07Barney Clark.
18:08It's interesting
18:12and important
18:13that the team
18:14called it
18:15necessary therapy.
18:20If they had said,
18:21well,
18:21we don't know
18:22how long he'll live,
18:23then it would have been
18:25in the realm
18:25of experimentation
18:26and it wouldn't have
18:27been approved.
18:31Haskell Karp's
18:32artificial heart
18:33was temporary,
18:35meant to keep him alive
18:36while he waited
18:37for a transplant.
18:41But the Jarvik 7
18:42was intended
18:43to stay
18:44in Barney Clark's body
18:45for life.
18:47That intention,
18:49symbolically,
18:50is part of the thing
18:51that brought so much
18:52attention to the
18:53Barney Clark case.
18:54The patient
18:54is now in the process
18:56of having his chest
18:58closed.
18:58It's almost completed.
19:00Most,
19:02if not all,
19:03of the functions
19:04being monitored
19:05are stable.
19:07The full realization
19:09of what they had done
19:10surprised even
19:11some members
19:12of the surgical team.
19:14Here was a human being,
19:16alive,
19:17conversant,
19:18supported on
19:19a mechanical device.
19:21He had no heart.
19:23He had no
19:24conventional,
19:26traditional heart.
19:27and, you know,
19:35the poets
19:35and writers
19:36have always said
19:37that the heart
19:37is really the center
19:39of love
19:39and personality
19:41and so forth
19:42and so forth.
19:43And he had none.
19:44And it was
19:45a really,
19:47almost a spiritual experience
19:49with everybody
19:49in the room.
19:50This mechanical device
19:51couldn't be the seat,
19:54possibly be the seat,
19:55of love
19:56and respect
19:58and honor.
20:03It was,
20:04it was a polyurethane.
20:06This morning,
20:07which was five hours
20:09into his 13th day,
20:11there was this human drama
20:12that was almost like,
20:13like a serial,
20:15almost like a soap opera,
20:16what's going to happen tomorrow?
20:17Dr. Clark had a sudden drop
20:20in his blood pressure.
20:23He kissed his wife
20:24and was taken to surgery.
20:29One of the valves broke.
20:32It then came out
20:33that they had never tested
20:35that particular valve
20:37in the setting
20:38of an artificial heart.
20:40There were a few
20:41somewhat weak links
20:44in the system.
20:46We had to re-operate
20:47and replace
20:48that one half of the heart.
20:52What does it feel like
20:53to have an artificial heart?
20:54Do you have pain
20:55or is it uncomfortable?
20:56Three months after
20:57this weak link
20:58was repaired,
20:59Barney Clark
21:00was able to face
21:01the media.
21:02You get used to it.
21:04I imagine this pump.
21:06The noise of the pump?
21:08But you get used to that.
21:10Does that bother you
21:11much at sleep?
21:12No.
21:12It doesn't bother me at all.
21:14You didn't want him
21:15awake, it doesn't.
21:18Well, after the operation,
21:21he had almost no quality
21:24of life.
21:25He had a negative
21:25quality of life.
21:27He had bleeding
21:27from his nose
21:28and he required surgery
21:30on that.
21:30He had innumerable tests.
21:33Well, I tell them
21:34that it's worth it.
21:35There's an alternative.
21:37They either die
21:38or they have it done.
21:40Many days,
21:41he did not enjoy.
21:44But many days,
21:45he did enjoy
21:46the communication
21:47with his very
21:48attentive wife
21:49and he felt
21:51genuinely
21:52that he had
21:53made a contribution.
21:54It's a pleasure
21:55to deal
21:58to help people
21:59and maybe
22:01you folks
22:02learn something.
22:04last night,
22:14we lost
22:15a very dear
22:15friend,
22:16one of the
22:17greatest
22:17pioneers.
22:24The value
22:25that we got
22:26out of that
22:27experiment,
22:28and that's all
22:28it was,
22:29was that it
22:30was not fit
22:31to be used
22:31at that time.
22:32We realized
22:36this was a
22:37much more
22:38complicated problem
22:40than it first seemed.
22:43And after we had
22:45worked for almost
22:4620 years,
22:47I really came
22:48to the conclusion
22:49that it probably
22:51is best
22:52to quit
22:52working on
22:53the total
22:54artificial heart.
22:55DeBakey,
23:01Jarvik,
23:02and other
23:02researchers
23:03focused their
23:04efforts on
23:05perfecting
23:06simpler pumps
23:07called LVADs,
23:09pumps that
23:10would assist
23:11the heart
23:11rather than
23:12replace it.
23:17DeBakey had
23:18been the first
23:19surgeon to use
23:20an LVAD
23:21in the operating
23:21room.
23:22The device
23:24remained outside
23:26the patient
23:26as a temporary
23:28support until
23:29the natural
23:29heart recovered
23:30from the shock
23:31of surgery.
23:33As the
23:34technology
23:35progressed,
23:36researchers
23:37worked on
23:37developing devices
23:38that could move
23:39from temporary
23:40to long-term
23:41support for the
23:42heart's left
23:43ventricle.
23:47The biggest
23:48challenge was
23:49to create a
23:50pump that did
23:51not cause
23:52strokes.
23:54These white
23:55blood cells have
23:56detected a
23:57minute flaw in
23:58the surface of
23:59this glass.
24:00As they attempt
24:01to smooth out
24:02the defect,
24:03dangerous
24:04biological deposits
24:05accumulate that
24:06might break free
24:07and pose the
24:09risk of blood
24:09clots.
24:11Finally,
24:13medical engineers
24:14found a
24:15solution.
24:17After years of
24:18trying to overpower
24:19mother nature,
24:21the attack was
24:21changed and we
24:22said, let's
24:23allow you to
24:24coat your blood
24:25cells over a
24:26very rough surface,
24:27a surface so
24:28rough that once
24:29your blood sticks
24:29to it, it can't
24:30come off again.
24:31In fact, that's
24:32what happens.
24:33These devices,
24:33when you take them
24:34out after a few
24:35days, are completely
24:36covered by your
24:36cells.
24:37And that's the
24:38reason we've seen
24:38such a low stroke
24:39rate with these
24:40devices, we believe.
24:40only one completely
24:44implantable device
24:45called the HeartMate
24:46used this approach.
24:49Soon it dominated
24:50the market.
24:53Using this new
24:54technology, hospitals
24:55could keep patients
24:56waiting for a
24:57transplant alive for
24:58months, even years.
25:03Still, LVADs were
25:05seen only as a bridge
25:06to transplant, until a
25:08series of cases forced
25:10doctors to rethink
25:11their ideas.
25:15In September 1994,
25:18Norbert Hilbert was
25:19rushed to the Berlin
25:19Heart Institute,
25:21suffering from a viral
25:22infection in his
25:23heart.
25:28He told me my
25:29illness was very
25:31serious, and that I
25:33could have this
25:34assist device while I
25:35was waiting for a
25:36transplant.
25:36Otherwise, my chances
25:39of survival would be
25:40two, three, or five
25:42days at the most.
25:47This x-ray shows us
25:49the situation at two
25:52days actually before
25:53we placed him on the
25:55assist device, and
25:56what you can see is
25:58that the lungs are
26:00congested with fluids
26:01which cannot be
26:03transported by the
26:04failing heart.
26:05heart.
26:06You also may see that
26:07the heart itself, which
26:08is here, is quite
26:11enlarged, and we
26:13decided to implant the
26:15assist device.
26:20With their patient
26:21hospitalized for nine
26:22months, supported by an
26:24LVAD, the Berlin
26:26doctors noticed
26:27something unexpected.
26:29They approached him
26:30with the choice.
26:38Dr. Mueller said, you
26:42could have a transplant.
26:43We have an organ for
26:44you.
26:45But, against all
26:47expectations, your own
26:49heart has recovered
26:49considerably.
26:51So, it is possible your
26:52heart may recover to such
26:54an extent that we may
26:55consider removing the
26:57assist device.
26:57I was very hesitant
27:04to think about
27:10explanting in such a
27:11life-saving pump in such
27:12a patient.
27:14This x-ray shows us the
27:16situation after
27:17explantation.
27:18You clearly see how the
27:20lungs have improved.
27:22they are darker now,
27:23which means there is no
27:25fluid anymore.
27:26But, in particular, if
27:27you look closely, you
27:29see that the heart
27:30itself has shrinked
27:32considerably between
27:34these two pictures, and
27:37it's more or less normal
27:38size of a human heart on
27:41this x-ray.
27:49Three years after his LVAD
27:51was removed, Hilbert's
27:53natural heart is
27:54functioning as well as
27:55ever.
28:02What happens when you
28:04put in an LVAD into the
28:05left ventricle is that
28:07there is no longer
28:08pressure within that
28:10heart chamber, and
28:11completely rests the
28:13left ventricle.
28:15And what chronic rest
28:17does is allow the very
28:19very much enlarged heart
28:21cells to go back to
28:22normal size.
28:25If you intervene early
28:26enough, you'll start to
28:28get that heart failure
28:29process to reverse.
28:33Yet the majority of LVAD
28:35patients have hearts that
28:36are too damaged to
28:37recover.
28:41Patients like Peter Pivko,
28:43whose first heart attack
28:44destroyed 80% of his heart
28:46muscle, saved by a heart
28:49mate, he now must wait
28:51with 50,000 other
28:53Americans for a
28:54transplant.
29:00Patients like Peter,
29:00living months or years on
29:02LVADs, exemplify both the
29:05hopes and limits of the
29:06current technology.
29:07In a way, it gives you a
29:11certain amount of freedom
29:12because I can get up, walk
29:14around with this battery
29:15pack, go visit people, and
29:17virtually have a certain
29:19amount of freedom.
29:20But it's also very
29:22constraining because you
29:23are at the mercy of the
29:24clock.
29:25Batteries last about four and
29:27a half hours, so I'm
29:28constantly checking a
29:29little LED that I have to
29:31let me know how much power
29:32is left, and it becomes
29:33very stressful.
29:34Because the batteries are
29:38large, we are forced to
29:40have a line that goes
29:41between the battery and
29:42the device and penetrates
29:43the skin.
29:44This so-called
29:45percutaneous line is the
29:47Achilles heel of this
29:48technology because the
29:50line is rigid and the
29:51patients, as they move
29:52around and live their
29:54lives, rough up the line
29:55and it tends to tear the
29:57skin around the connection
29:58and then it gets infected.
30:01The driveline also vents
30:03air displaced by the
30:05pulsing of the pump,
30:07creating a loud swishing
30:08noise that disturbs
30:10patients.
30:14But despite these
30:16difficulties, Peter is
30:17fortunate that he is
30:18large enough to have a
30:19battery-powered LVAD fit
30:21into him.
30:22For small women and
30:27children in heart failure,
30:29the only available assist
30:30device to keep them alive
30:32is one that remains
30:33outside their bodies.
30:38Attached to large
30:39consoles, these patients
30:41remain bedridden while
30:43they wait for a
30:44transplant.
30:44These pumps that you're
30:49seeing today are the
30:50Model Ts of this industry.
30:52They're the first
30:52generation, they're the
30:54proof that this
30:55technology can work.
30:58And now that we have
30:58that evidence, that
30:59psychological barrier has
31:01been crossed, we can
31:02start to move at a very
31:03fast speed towards
31:04permanent devices that
31:05really are designed to be
31:06elegant, simple to implant
31:08and easily available for
31:10everybody who needs them.
31:14As scientists struggle
31:16to develop smaller blood
31:17pumps, they began to
31:19question whether they had
31:20to be pulsatile, mimicking
31:22the pumping action of the
31:23natural heart.
31:28Humans need a pulse so that
31:30the heart can rest between
31:31beats and absorb the energy
31:33it needs to pump blood.
31:37But if the natural heart
31:38needs time to rest,
31:40a mechanical pump does
31:41not.
31:45One researcher began to
31:47work on an LVAD that
31:48was not pulsatile.
31:50His name was Richard
31:51Wampler.
31:54There were a few
31:55scientific reasons why I
31:57believed you might not
31:58need a pulse.
32:00It is true that if you go
32:02out into your arm when you
32:03go to the doctor that you
32:04can feel your radial
32:05artery and you'll feel a
32:06pulse.
32:07But when you go out on
32:09the capillary level of
32:10water, by that time the
32:11pulsatility is totally
32:12damped, so really at that
32:14level the flow is continuous
32:17flow going through these
32:18capillaries.
32:18Wampler developed a tiny axial
32:23flow pump that could
32:24temporarily assist the heart.
32:27An axial flow pump works by
32:29spinning an Archimedes screw,
32:31which draws fluid in through one
32:33end, then sends it out the other.
32:35Through it, blood would flow
32:38continuously, without a pulse.
32:40In 1988, after two years of
32:44animal work, surgeon Bud Frazier
32:47used the pump in a dying
32:49transplant patient who could not be
32:50assisted with a conventional LVAD.
32:53with a conventional LVAD.
32:54I was extremely anxious because I'd
32:58never placed one in a human and I
33:00wasn't sure if it would really even go
33:02up the arteries because they're
33:03diseased arteries, the animals are
33:04healthy. I didn't know if there was
33:06something about the human anatomy that it
33:08wouldn't go into the heart like it was
33:10supposed to, but it all went perfect.
33:12The pump allowed the weakened heart to
33:17rest long enough to recover. Over 100
33:21more patients who could not use
33:23standard LVADs were saved. This
33:27echocardiogram shows how the blood,
33:30seen in color, is sucked out of a
33:33passive heart and circulated.
33:37That was a very dramatic thing because
33:40it showed us that, number one, patients
33:42could live without a pulse. I had one
33:44little boy that lived for about three
33:46days without a pulse at all. He was very
33:47small and this small pump could take
33:50over his entire circulation. He woke up,
33:53he ate popsicles and he did very well
33:56until his heart had recovered enough to
33:58start beating.
34:00Although the device could only pump a
34:02small amount of blood, it was enough
34:04to sustain a resting patient.
34:08And the thing that was astonishing to
34:10everybody in the field was a high-speed
34:12rotary pump with little blades that
34:14look like a blender doesn't chew the
34:16blood to pieces. So then the job was to
34:20make a pump of that general type, meaning
34:23an actual flow pump, that could be
34:26supported in such a way that it could
34:28run indefinitely.
34:31Walter's pump could only be used temporarily
34:33because it needed a constant infusion of
34:36liquid glucose to lubricate its moving parts.
34:42Robert Jarvik proposed the bold idea of
34:45using the blood itself as a lubricant.
34:50Around the world, researchers took up the challenge.
34:56The goal was to develop a permanent axial flow pump
34:59that was small enough to be implanted in the chest,
35:02but powerful enough to push blood through the
35:05thousands of miles of vessels in the body.
35:09Dr. DeBakey turned to NASA for help.
35:14I did a heart transplant on a NASA engineer
35:18by the name of David Saucier, and he did well.
35:22And he was very grateful and became interested
35:26in what we were doing with the artificial heart.
35:29So we showed him.
35:31It was interesting, the day they showed up,
35:33there was two great big limousines came,
35:35and there were six doctors in each of the limousines.
35:38And they had on their pinstripe suits,
35:41and there was the doctor of hematology
35:43and the doctor of hemodynamics
35:45and the doctor of hemo this and hemo that.
35:47And they brought a big box full of blood pumps
35:50that they had worked on.
35:51All of them had gears and electric motors,
35:55and I'm a mechanical engineer,
35:57and it just made my heart go pitter-pat
35:58to see all of this machinery.
36:01No one had more experience with axial flow motors than NASA.
36:07It's the system used to fuel the pumps
36:10of the space shuttle's main engines.
36:14NASA agreed to help DeBakey make a permanent axial flow pump
36:18at a fraction of the size of the current Pulsatil devices.
36:24I remember that I spent most of the Christmas holidays
36:27on my computer designing the pump blades for this thing,
36:30trying to get the flow, the diameter, and the length
36:34and all in the ballpark.
36:36The collaboration with NASA resulted in a prototype pump
36:43the size of a thumb.
36:46Inside a person, it would create no pulse,
36:50just a constant flow of blood.
36:54Essentially, this pump has just one moving component,
36:57and this is the inducer impeller.
36:59What makes this unique is the fact that we embed magnets
37:03inside of each one of the impeller blades.
37:06And the whole idea is now, in addition to being the pumping component
37:11of the pump, it also becomes the rotor of an electric motor.
37:14So what we do is we spin a magnetic field around the impeller,
37:18and as it spins, it drags this impeller with it.
37:21This impeller sits inside of this titanium body,
37:24suspended at both ends by ceramic bearings,
37:27and this coil here spins the magnetic field,
37:30and it spins the pump at about 10,000 RPM,
37:33drawing the blood in, propelling it out the back
37:36at about 5 liters per minute.
37:39But adding magnets affected the shape of blades.
37:43If the design was not perfect, blood cells could be damaged.
37:48The best analogy I can think of is pumping blood
37:51is like pumping a whole bunch of water balloons
37:53that are suspended in a liquid.
37:55You're trying to pump these water balloons
37:57without having them rupture.
37:59The biggest achievement came through
38:01the computational fluid dynamics at NASA.
38:03With their Cray supercomputers,
38:05they could actually model the flow fields inside the impeller.
38:09Very small or subtle changes to the geometry of the pump.
38:13For example, a change of 10 or 20 thousandths of an inch
38:17in a critical area of the pump would have a drastic effect,
38:21because what you would do is you would create localized areas
38:24of high pressure or low pressure,
38:26producing blood damage that is clinically unacceptable.
38:29After much trial and error,
38:32DeBakey's team approached their goal.
38:35Designing magnetic blades which rotated so fast
38:38that blood cells weren't damaged at all.
38:44It's sort of like passing your finger through a candle,
38:47you know, that you learn as a child.
38:50It's a trick.
38:51If it goes fast enough, it doesn't burn your finger.
38:55And you see...
38:56DeBakey now had his working model of a miniature LVAD.
38:59There's a heart, and there's a pump.
39:03And you see...
39:04By taking blood from the left ventricle,
39:07this is the outflow graph,
39:09so blood is flowing from the pump
39:11and into the ascending aorta.
39:13Now, the electrical connection here for the motor stator
39:19would come out and would be attached through the skin
39:23to the controlling device that you see here.
39:29So, this is the battery, and this is the controller
39:33with a belt on the patient.
39:35That's all they would need.
39:37But DeBakey was not alone in the race to make a tiny LVAD.
39:44In Manhattan, Robert Jarvik was nearing completion
39:47of his own axial flow pump, the Jarvik 2000.
39:54Working independently, Jarvik has now perfected his own designs
39:58and carefully supervises each detail of the machining.
40:03Jarvik's pump is so small it can be placed inside the heart.
40:10The blood pump is implanted inside the tip of the heart,
40:14so if there's a model of the heart,
40:16it fits here in the tip of the left ventricle.
40:20This whole part here is inside and surrounded by blood,
40:23and then the blood that's coming into the heart,
40:25coming back from the lungs,
40:26is pumped through the opening into the heart,
40:28down through the pump,
40:30and then through a tube it back to the aorta.
40:35Placing the Jarvik 2000 inside the heart
40:38allows blood to flow directly into the device.
40:44The only tube attached to the pump is one that exits the heart.
40:49By getting rid of the inflow tube,
40:52Jarvik has eliminated a place where blood clots usually form.
40:57When we started achieving the types of long survivals,
41:03that historically in this field of research is about the best
41:07that can be done with any kind of pump,
41:09which means having an animal of about six months,
41:12and those devices are clean,
41:17we didn't have any complications, we didn't have infections,
41:20we didn't have blood clots, we didn't have thromboembolism,
41:23and we were very happy about that.
41:26Okay, let's just put it right here.
41:28Jarvik is ready to use his LVAD in humans,
41:31and has applied for FDA approval.
41:40I don't know where it stays his devices in.
41:44I'm sure that he's trying to compete too.
41:49Yeah, but that's good.
41:51In Houston, DeBakey watches his device take shape
41:55at the manufacturing site.
42:02DeBakey's LVAD is now a business proposition
42:05financed by a company, Micromed.
42:08If you compare it to a prize fight,
42:15who throws the punch first is not so important
42:19as who's there at the end and who throws the punch last.
42:27Instead of seeking FDA approval,
42:29DeBakey has come to Europe
42:31to oversee the trials of his new LVAD.
42:34The operations will be conducted in both Berlin and Vienna,
42:41where regulations governing clinical trials
42:44are less cumbersome than in the United States.
42:49Six seriously ill patients have been selected.
42:57It is difficult when I exercise.
42:59My heart hurts.
43:00It's like a shock running through my body.
43:04When I climb stairs,
43:07I have to go really slowly
43:10and I came out of breath.
43:12So I decided to take this.
43:14We're coming near the end of the Odyssey.
43:32It's gratifying
43:33in being able to extend the normal life expectancy
43:37of patients with chronic heart failure.
43:39the new LVAD.
43:42DeBakey's pump is the first
43:44of the newest generation of tiny LVADs
43:46to be implanted in humans.
43:50As it takes over the work of the human heart,
43:53hopes are high.
43:57The system works excellent.
43:59No problems.
44:01The team waits for the results.
44:03The first patient whose condition was critical
44:15at the time of the operation died six weeks later.
44:21The second had his device removed
44:23when a clot caught up in the mechanism.
44:27A third patient was switched to another device
44:30due to a connector failure.
44:35The remaining three patients,
44:37including Josef Prishtoff
44:39and Rudolf Hauer,
44:41were successfully supported
44:42for up to three and a half months
44:44until transplantation.
44:51Seven more devices have been implanted,
44:54but only three worked long enough
44:56to carry the patients to transplant.
44:58The doctors are not allowed to discuss the results.
45:04There is so much to be done
45:09that everybody's effort will have a place
45:13in the treatment, the successful efforts.
45:16The issue is that artificial heart
45:18will never be used on a widespread basis
45:21until it's so good
45:23that the quality of life
45:24and the safety and the durability
45:26can be taken for granted.
45:30When the newer generation
45:31of miniature LVADs
45:33are commercially available,
45:35small patients in heart failure
45:37may hopefully resume normal lives.
45:41But what about individuals
45:43whose hearts are so damaged
45:45they cannot be supported by an LVAD?
45:47Patients who are so sick
45:50they will not survive the necessary months
45:52until a human heart becomes available.
45:55Could the dream of a totally artificial replacement heart,
46:02once heralded as the Dracula of medical technology,
46:05be resurrected?
46:07Haunted by the image of Barney Clark suffering,
46:12most Americans had decided the technology
46:15just wasn't worth it.
46:17Because of the publicity
46:20and perhaps exaggeration by some
46:23as to what that technology promised at the time,
46:26it actually set back the field of artificial hearts
46:29because it left people who were very hopeful about this technology
46:35discouraged about the technology.
46:37This should have never happened.
46:39It was a very, very important pioneering effort.
46:42There were setbacks, but much was learned.
46:45And in fact, those systems are implanted
46:48in a few patients every year today
46:50as a bridge to transplantation
46:52and these patients are doing very well.
46:54Each time the Jarvik 7 heart was implanted,
46:58doctors learned how to better manage anticoagulant drugs
47:03and reduce the risk of strokes.
47:05Since 1993, 147 patients have been supported by Jarvik's original artificial heart.
47:15Like Clark, they were unable to leave the hospital.
47:19But 88 of these pioneers survived until they got a transplant.
47:28Spurred by technological advances and new insights into how the body works,
47:33a small group of engineers has labored for decades
47:37to perfect a total replacement artificial heart.
47:41It's a two pound electromechanical pump called the AbioCore.
47:46In the 21st century, we now know that operations that used to be very complex,
47:55like cataract operations, are today done with a laser.
47:58And the patient within 24 hours can see better than they did when they were younger.
48:02Now we know also that the wear and tear of the bones
48:06can be overcome in some cases by the replacement, orthopedic replacement.
48:09So the question is why is the heart any different?
48:13Why should life end?
48:15Because the heart is wearing out.
48:18In a laboratory outside of Boston, an AbioCore quietly pumps away in a tank of salty water.
48:27The salt mimics the corrosive effects that blood will have on the titanium and plastic-like materials.
48:38To receive FDA approval, this artificial heart must pump 200 million times without failing,
48:47enough to sustain life for five years.
48:49The challenge is daunting.
48:53A human heart beats 100,000 times a day.
48:57Commercially available plastic will crack if it's flexed that many times.
49:03Scientists had to invent a new material capable of bending 40 million times a year for 20 years without breaking.
49:12But how will the artificial heart work in a biological environment?
49:21At the Texas Heart Institute, animals with the device appear healthy, with no evidence of strokes.
49:29Unlike Javik 7 patients who were attached to a 350 pound console, this calf can walk untethered,
49:39its AbioCore temporarily powered by an internal battery.
49:44You know, one of the beautiful things about the AbioMed heart is it is so quiet.
49:51I remember our first animal that did well and was up and standing and eating,
49:55I got Dr. Cooley to come down and look at the animal,
49:59and he came down, looked at the animal and listened to it,
50:03and he thought we were tricking him because he didn't even think there was a,
50:06he thought it was an animal's own heart.
50:11Unlike the human heart where both ventricles pump blood simultaneously,
50:17the chambers in the AbioCore alternate.
50:20When the left fills with blood, the right side absorbs the displaced volume needed to create a pulse.
50:26This design eliminates the need for tubes piercing the skin to vent air.
50:35If you can solve that problem, then the transmission of energy across the skin,
50:42without going through the skin, that's been available for years.
50:47So there can be a small coil inside the body, and a small coil on the outside,
50:54and this coil can give energy through the skin.
50:59You then would wear a belt, and on the belt would be a circular space that would fit over the coil that's inside your body.
51:05You'd plug batteries into that belt, and it would charge the internal component up.
51:09That would allow you, if the technology improves as we suspect it will,
51:14to charge yourself at night while you're asleep, and then during the day you're untethered.
51:18You can go and do anything you want with no restrictions whatsoever.
51:21At five hospitals around the country,
51:28surgeons are preparing to implant the total replacement heart in humans next year.
51:34Robert Javik once wrote that the artificial heart must not only be dependable, but truly forgettable.
51:42Will this artificial heart allow dying patients to resume normal lives?
51:52Only human tests will yield the answer.
51:57We've developed these technologies in animals and with water.
52:02When you put them into man and let him go drink or exercise and stress himself in all the ways we know we can,
52:09you have to reevaluate everything from scratch, because they're not going to work all the time.
52:15But if we interpret every failure of a mechanical device as a failure of the program,
52:20of another proof that these devices can't work for mankind,
52:24we'll never get to the results that we desire.
52:28Today, mechanical devices save dying patients who await a transplant.
52:33But there are 50,000 people on the transplant list,
52:39and only a fraction will receive a heart.
52:44When you use technology to support a patient who will ultimately receive a donor heart,
52:51you are not really increasing the number of people whose lives are being saved.
52:54We have 2,000 hearts in the United States every year that will become available,
52:59and we will save 2,000 patients even if we didn't have any assist device.
53:03We are not increasing the number of human lives that are saved.
53:07And from the societal point of view, this is not a solution.
53:10So, the most important thing is to make a device that ultimately can be a permanent heart
53:16for widespread use in tens of thousands of patients.
53:20That's what's needed.
53:22If a weakened heart can be successfully assisted by an LVAD,
53:27no surgeon would take the radical step of removing it.
53:33But for patients whose hearts are beyond repair,
53:37who will never get a transplant,
53:40the total replacement heart may be their only hope.
53:43Today, there's hope for patients who need other artificial body parts,
54:02from livers to skin, even arteries.
54:05Explore the potential of the high-tech human on NOVA's website.
54:13To order this show or any other NOVA program for $19.95 plus shipping and handling,
54:26call WGBH Boston Video at 1-800-255-9424.
54:31…
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54:55Nova is a production of WGBH Boston.
55:13This program is funded in part by Northwestern Mutual Life, which has been protecting families
55:36and businesses for generations.
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