New Frontiers
in Cardiac
Surgery

 

By Rita M. Rooney

When it comes to heart replacement procedures, as well as innovative approaches to the treatment of common cardiac defects, Peter M. Scholz, MD, James W. Mackenzie Professor of Surgery and chief, division of cardiothoracic surgery, and his team, Sherry Smith (left) surgical technician, and Mary O’Brien, CRNFA, employ only the newest and best technology to save lives

By historical measurements, thirty-eight years isn’t very long. However, in the annals of medicine, it might well be recorded as a lifetime. it was in 1968 that famed surgeonDenton Cooley, MD, first transplanted a human heart into a patient who then lived 204 days. Today, more than 3,000 heart transplants are done annually on people who have lived as long as 20 years afterward. Now, through a technology that the U.S. Food and Drug Administration (FDA) approved in September 2006, a selective number of those who need heart transplantation, but are not eligible for the surgery, are being offered an alternative: an artificial heart available at Robert Wood Johnson University Hospital (RWJUH) / UMDNJ-Robert Wood Johnson Medical School.The new “heart” is the result of more than 25 years of research and may well be the most complex medical device ever designed. The AbioCor heart is the first self-contained and fully implantable artificial replacement heart developed with the support of the National Heart, Lung and Blood Institute. It is designed to sustain the body’s circulatory system and extend the lives of patients who otherwise would die of heart failure. Unlike artificial hearts of the past, it is totally implanted within the body; patients are not connected to an air-pumping console and do not have wires or tubes piercing their skin.Mark Anderson, MD, associate professor of surgery, chief of cardiac surgery, and director of cardiopulmonary transplantation at RWJUH, reports that the artificial heart replacement is not an option for most heart failure patients. “Heart transplantation remains the gold standard,” Dr. Anderson says. “The AbioCor heart is intended for patients with severely damaged hearts who, because of age or medical circumstances, are not candidates for a transplant, and have no other treatment alternative. It’s a lifesaving procedure that gives end-stage patients mobility to enjoy a satisfactory lifestyle.”The FDA granted approval of the AbioCor heart under a Humanitarian Device Exemption (HDE), which allows Abiomed, Inc., a Massachusetts-based company, to sell up to 4,000 in the United States annually. However, the company plans to have a controlled roll-out of this sophisticated technology at five to ten centers, including: RWJUH, The Johns Hopkins Hospital, Baltimore, and the Jewish Hospital/ University of Louisville, Kentucky.Dr. Andersonsays other sites may be added, but RWJUH will remain the only center in the Northeast. The AbioCor heart operates by moving blood through the lungs and to the rest of the body, while it simulates the rhythm of a heartbeat. It consists of an internal thoracic unit that weighs about two pounds and has two artificial ventricles with corresponding valves and a motor-driven hydraulic pumping system. An internal battery continually recharges from an external console carried by the patient, and an implantable electronics package monitors and controls the pumping speed of the heart based on the patient’s needs.