Medicine: Buying Time with an Artificial Pump

Michael Drummond seemed to be adjusting smoothly to his new artificial heart. Within days after a Jarvik-7 pump was implanted in his chest late in August, the 25-year-old Phoenix assistant grocery manager was eating solid food, walking with help and doing leg and arm exercises. Drummond's steady progress seemed to augur well for the next phase of his treatment: a second operation, to remove the mechanical device, which had been implanted only as a stopgap measure, and to replace it with a human donor heart.

Last week, as Cardiac Surgeon Jack Copeland was examining his patient in the sixth-floor intensive care unit at University Medical Center in Tucson, he noticed that Drummond was slurring his words. Soon afterward, the patient's right hand became immobile. Though Copeland hoped that Drummond's problems might be caused by abnormal levels of blood sugar or the aftereffects of sleeping medication, he feared the worst. "I had to admit it to myself," he says, "but I didn't want to." A neurologist confirmed that Drummond had suffered a mild stroke, most probably from tiny blood clots forming in or around the artificial heart.

Although Drummond quickly recovered almost complete use of his right hand and the ability to speak clearly, the stroke left him "depressed and frustrated" and forced his doctors to speed up the transplant timetable. Rather than wait for Drummond to build up his strength for the second operation, as had originally been planned, they decided to perform the transplant as soon as a suitable donor organ became available. That happened at week's end, when doctors obtained and transplanted a heart from a 19-year-old Texas motorcycle accident victim.

Drummond's stroke-caused crisis cast doubt on a new phase in the artificial heart program, one with a more limited and, to many, a more realistic goal: to use the mechanical device not as a permanent implant but only as a bridge, keeping a seriously ill heart patient alive until a human donor heart can be found. The Food and Drug Administration had authorized Copeland to use the Jarvik-7 for that purpose only a few weeks before, and has since granted permission to a handful of other surgeons. "We're not really doing this in an attempt to further develop the artificial heart, to prove that it's good or bad," explained Copeland. "We are just trying to take something that's available and use it for what it's worth."

Of the five patients who have so far received permanent Jarvik-7 hearts, three are still alive. But all have suffered serious complications. William Schroeder, 53, at 42 weeks the longest survivor, has had two strokes; his speech and memory are impaired. Murray Haydon, 59, also had a stroke. Swedish Businessman Leif Stenberg, 53, the only non-American to receive a Jarvik-7 and the patient who had fared the best so far, recently suffered a severe stroke in Stockholm. Stenberg's misfortune was particularly disappointing to Heart Developer Robert Jarvik; the heart implanted in the Swede was a newer version, in which Jarvik had replaced the original polycarbonate valve housings and aluminum base with polyurethane components to reduce the danger of clotting. Stenberg's surgeon Bjarne Semb told TIME, "It seems now that we have to be somewhat restrictive. The main indication is that the heart has to be used as a temporary aid."