Origins A synthetic replacement for the heart has long been a major goal of modern medicine. A functional artificial heart could reduce the need for heart transplantation, as the demand for donor organs exceeds supply. Although the heart is conceptually a pump, it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Artificial hearts have historically had issues from both a biomedical standpoint, regarding clotting and foreign object rejection, as well as longevity and practicality, regarding the lifespan of the device as well as the equipment required to run it. Since the inception of the device, artificial hearts have been continually improved as medical technology has. More recent devices, such as the Carmat heart, have sought to improve upon their predecessors by reducing complications resultant from device implant, such as
foreign-body rejection and
thrombus.
Early development The first artificial heart was made by the Soviet scientist
Vladimir Demikhov in 1938. It was implanted in a dog. On 2 July 1952, 41-year-old
Henry Opitek, suffering from
shortness of breath, made medical history at Harper University Hospital at
Wayne State University in Michigan. The
Dodrill-GMR heart machine, considered to be the first operational mechanical heart, was successfully used while performing heart surgery. Ongoing research was done on calves at
Hershey Medical Center, Animal Research Facility, in Hershey, Pennsylvania, during the 1970s.
Forest Dewey Dodrill, working closely with Matthew Dudley, used the machine in 1952 to bypass Henry Opitek's left ventricle for 50 minutes while he opened the patient's left atrium and worked to repair the
mitral valve. In Dodrill's post-operative report, he notes, "To our knowledge, this is the first instance of survival of a patient when a mechanical heart mechanism was used to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated on." A
heart–lung machine was first used in 1953 during a successful open heart surgery.
John Heysham Gibbon, the inventor of the machine, performed the operation and developed the heart–lung substitute himself. Following these advances, scientific interest for the development of a solution for heart disease developed in numerous research groups worldwide.
Early designs of total artificial hearts In 1949, a precursor to the modern artificial heart pump was built by doctors William Sewell and
William Glenn of the
Yale School of Medicine using an
Erector Set, assorted odds and ends, and dime-store toys. The external pump successfully bypassed the heart of a dog for more than an hour. On 12 December 1957,
Willem Johan Kolff, the world's most prolific inventor of artificial organs, implanted an artificial heart into a dog at Cleveland Clinic. The dog lived for 90 minutes. In 1958,
Domingo Liotta initiated the studies of TAH (Total Artificial Heart) replacement at Lyon, France, and in 1959–60 at the
National University of Córdoba, Argentina. He presented his work at the meeting of the American Society for Artificial Internal Organs held in Atlantic City in March 1961. At that meeting, Liotta described the implantation of three types of orthotopic (inside the pericardial sac) TAHs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor, and a pneumatic pump.
Paul Winchell designed a model of artificial heart with the assistance of
Henry Heimlich (the inventor of the
Heimlich maneuver) and submitted a patent for a mechanically driven artificial heart implementing a cam driven roller mechanism to compress flexible bags containing blood, on 6 February 1961. This is contrary to the popular claim that Winchell submitted the patent in the summer of 1956, as well as contrary to the claim that Winchell "invented" the artificial heart. In fact, two patents existed prior to Winchell's submission. These patents were filed 10 April 1956, and 17 April 1959, respectively. Winchell also claims that the design within his patent was used in later models of the Jarvik hearts, a claim in which Robert Jarvik, the principle designer of those hearts, denies on the basis that his pneumatically driven hearts share little in common with Winchell's mechanically actuated patent. In 1964, the
National Institutes of Health started the Artificial Heart Program, with the goal of putting an artificial heart into a human by the end of the decade. The purpose of the program was to develop an implantable artificial heart, including the power source, to replace a failing heart. In February 1966,
Adrian Kantrowitz rose to international prominence when he performed the world's first permanent implantation of a partial mechanical heart (left ventricular assist device) at
Maimonides Medical Center. In 1967, Kolff left Cleveland Clinic to start the Division of Artificial Organs at the
University of Utah and pursue his work on the artificial heart. • In 1973, a calf named Tony survived for 30 days on an early Kolff heart. • In 1975, a bull named Burk survived 90 days on the artificial heart. • In 1976, a calf named Abebe lived for 184 days on the Jarvik 5 artificial heart. • In 1981, a calf named Alfred Lord Tennyson lived for 268 days on the Jarvik 5. Over the years, more than 200 physicians, engineers, students and faculty developed, tested and improved Kolff's artificial heart. To help manage his many endeavors, Kolff assigned project managers. Each project was named after its manager. Graduate student Robert Jarvik was the project manager for the artificial heart projects, from which the Jarvik line of artificial hearts get their name. There, physician-engineer
Clifford Kwan-Gett invented two components of an integrated pneumatic artificial heart system: a ventricle with hemispherical diaphragms that did not crush red blood cells (a problem with previous artificial hearts) and an external heart driver that inherently regulated blood flow without needing complex control systems. Jarvik also combined several modifications: an ovoid shape to fit inside the human chest, a more blood-compatible
polyurethane developed by biomedical engineer Donald Lyman, and a fabrication method by Kwan-Gett that made the inside of the ventricles smooth and seamless to reduce dangerous stroke-causing blood clots.
First clinical implantation of a total artificial heart On 4 April 1969,
Domingo Liotta and
Denton A. Cooley replaced a dying man's heart with a mechanical heart inside the chest at
The Texas Heart Institute in
Houston as a bridge for a transplant. The man woke up and began to recover. After 64 hours, the pneumatic-powered artificial heart was removed and replaced by a donor heart. However thirty-two hours after transplantation, the man died of what was later proved to be an acute pulmonary infection, extended to both lungs, caused by fungi, most likely caused by an
immunosuppressive drug complication. The original prototype of Liotta-Cooley artificial heart used in this historic operation is prominently displayed in the
Smithsonian Institution's
National Museum of American History "Treasures of American History" exhibit in Washington, D.C.
First clinical applications of a permanent pneumatic total artificial heart The first clinical use of an artificial heart designed for permanent implantation rather than a bridge to transplant occurred in 1982 at the
University of Utah. In 1981,
William DeVries submitted a request to the FDA for permission to implant the Jarvik-7 into a human being. On 1 December 1982, William DeVries implanted the Jarvik-7 artificial heart into Barney Clark, a retired dentist from Seattle who had severe
congestive heart failure. Clark's case was highly publicized and received much media attention, garnering attention from television networks, newspapers and periodicals. Clark lived for 112 days tethered to the UtahDrive pneumatic drive console, a device weighing some . During that time Clark required several re-operations, suffered seizures, experienced prolonged periods of confusion and a number of instances of bleeding and asked several times to be allowed to die. Clark, however, still believed his being part of the initial experiment was an important contribution to medicine, and maintained an overall positive outlook on his condition. Barney Clark died on 23 March 1983, of multiorgan system failure. Despite the complications, DeVries considered Clark's case a success. DeVries subsequently moved his practice to Humana Hospital Audubon in Louisville, Kentucky to continue studies using the Jarvik-7. DeVries' first artificial heart patient in Louisville was
Bill Schroeder. DeVries replaced Schroeder's failing heart with a Jarvik-7 on 25 November 1984. Like Clark, Schroeder suffered from bleeding that required re-operation to resolve. In the first weeks the outlook was good and Schroeder was allowed to have a can of Coors beer and he was given a phone call by President
Reagan, in which he famously asked the president for an update on a late Social Security check. However, 19 days after the operation, Schroeder suffered the first of four
strokes. Despite this, his recovery continued and was allowed to live in a specially outfitted apartment near the hospital for a period of time, as well as use a newly developed battery-powered portable drive unit for the heart which allowed him to venture out of the hospital for short periods. Schroeder's health continued to decline as three more strokes plagued his time with the artificial heart. He died on 6 August 1986, from complications from a stroke,
respiratory failure and
sepsis, after 620 days with the artificial heart. Three more patients received the Jarvik-7 as a permanent heart. Murray Haydon, DeVries' third patient, received a Jarvik-7 on 17 February 1985. Haydon suffered pulmonary issues and was required to be on a mechanical ventilator for the duration of his time with the artificial heart. Haydon died of infection and
kidney failure on 19 June 1986, after 488 days with his artificial heart. On 7 April 1985, Dr. Bjarne Semb of Karolinska Hospital in Stockholm, Sweden implanted a Jarvik-7 in Swedish businessman Leif Stenberg. Stenberg lived 229 largely uneventful days with the heart, but suffered from a stroke and subsequently died on 21 November 1985. Jack Burcham was DeVries' fourth and final patient to receive a Jarvik-7 as a destination therapy. Burcham received his heart on 14 April 1985, but due to complications from the size of the device, bleeding and kidney failure, Burcham died just 10 days later on 25 April 1985. In the mid-1980s, artificial hearts were powered by large pneumatic drive consoles. Moreover, two sizable catheters had to cross the body wall to carry the pneumatic pulses to the implanted heart, greatly increasing the risk of infection. To speed development of a new generation of technologies, the
National Heart, Lung, and Blood Institute opened a competition for implantable electrically powered artificial hearts. Three groups received funding:
Cleveland Clinic in Cleveland, Ohio; the College of Medicine of
Pennsylvania State University (
Penn State Milton S. Hershey Medical Center) in Hershey, Pennsylvania; and AbioMed, Inc. of Danvers, Massachusetts. Despite considerable progress, the Cleveland program was discontinued after the first five years.
First clinical application of an intrathoracic pump On 19 July 1963, E. Stanley Crawford and
Domingo Liotta implanted the first clinical
Left Ventricular Assist Device (LVAD) at
The Methodist Hospital in Houston, Texas, in a patient who had a cardiac arrest after surgery. The patient survived for four days under mechanical support but did not recover from the complications of the cardiac arrest; finally, the pump was discontinued, and the patient died.
First clinical application of a paracorporeal pump . On 21 April 1966,
Michael DeBakey and Liotta implanted the first clinical LVAD in a paracorporeal position (where the external pump rests at the side of the patient) at The Methodist Hospital in Houston, in a patient experiencing
cardiogenic shock after heart surgery. The patient developed neurological and pulmonary complications and died after few days of LVAD mechanical support. In October 1966, DeBakey and Liotta implanted the paracorporeal Liotta-DeBakey LVAD in a new patient who recovered well and was discharged from the hospital after 10 days of mechanical support, thus constituting the first successful use of an LVAD for
postcardiotomy shock.
First VAD patient with FDA approved hospital discharge In 1990, Brian Williams was discharged from the
University of Pittsburgh Medical Center (UPMC), becoming the first VAD patient to be discharged with Food and Drug Administration (FDA) approval. The patient was supported in part by bioengineers from the University of Pittsburgh's McGowan Institute. ==Total artificial hearts==