The Artificial Heart, Revisited

More than 4,000 Americans on any given day are waiting for a heart transplant. Because of a shortage of donors, about a third of them will die before a suitable replacement can be found. So when surgeons in Louisville, Ky., sewed a high-tech artificial heart into a desperately ill man last week, it seemed like the answer to a lot of prayers. The patient, whose name has not been released, is described as a diabetic in his mid to late 50s who developed congestive heart failure after suffering several heart attacks. If he survives and his health improves even a little, there's no telling how many other lives might someday be saved with similar artificial hearts.

Those are some mighty big ifs, of course. After all, the man was on the verge of dying before last week's operation--and still could die at any moment. His liver and kidneys are in pretty bad shape. He could suffer any number of surgical complications, from internal bleeding to infection to strokes.

And heart doctors remember all too well what happened to the handful of patients who were given artificial hearts in the 1980s. Each of them was tethered to a large external compressor that powered the device through tubes into the body. The first recipient, a retired dentist named Barney Clark, developed serious infections that ravaged his body. The artificial pump also triggered a lot of blood clots. The long, lingering death of one man in particular, William Schroeder, who was kept alive for 620 days with much of his brain destroyed, soured many physicians and the public on the artificial heart's long-term prospects.

Of course, technology has advanced considerably since then. The sophisticated pump used in last week's operation is designed to be completely implanted. Developed by Abiomed in Danvers, Mass., with funding from the National Heart, Lung and Blood Institute, the softball-size device is charged across the skin, so there's no need for chest tubes. Its batteries are miniaturized, and its pumping chambers are lined with a specialized coating that should cut down on blood clots.

But does the world really need an artificial heart? The answer, surprisingly, might be no. There has been some pretty good progress recently in the medical treatment of congestive heart failure, which affects some 5 million Americans. (Despite the scary-sounding name, congestive heart failure doesn't mean the old ticker has stopped working; rather, the heart has trouble pumping out as much blood as the body needs.) In many cases the condition can be controlled with medications like beta blockers and ACE inhibitors without any surgical intervention.

Meanwhile, doctors have had growing success with a different kind of mechanical pump, called a left ventricular assist device (LVAD), that is also implanted in the body but helps boost the heart's output without replacing the organ. In some cases the ailing heart gets enough rest on the LVAD that it no longer needs artificial support. Researchers are trying to figure out if they can nudge that process along, perhaps by using stem cells to stimulate healing.