Artificial Heart May Offer New Hope

By PAUL RECER, AP Science Writer

WASHINGTON (AP) - A daring experiment testing a self-contained mechanical heart offers new hope for thousands of Americans with failing hearts, many of whom may die while waiting for transplants.

``This is the next step and it's a positive step'' in a decades-long search for mechanical devices to assist people in end-stage heart failure, said Dr. Robert S. Higgins, chairman of cardiology at the Medical College of Virginia.

``This is something we've all been looking for,'' said Dr. John Conte, head of the Johns Hopkins University Medical Center heart-lung transplant program. ``I think it is wonderful - a great step forward.''

But the doctors are quick to emphasize that implanting the Abiomed Inc.mechanical heart in an unidentified patient in Louisville does not mean that replacement hearts will be ready immediately to take off the shelf and install in dying patients.

They forecast it will take at least five years before the new device is widely available - and then only if it proves itself in long-term use among several dozen experimental patients.

``Some of the established cardiac surgeons will have to grow comfortable with the reliability of this device,'' said Higgins, who participated in development of an earlier mechanical heart that was later abandoned.

``People are dying for lack of donor organs,'' said Dr. Timothy J. Gardner, head of heart surgery at the University of Pennsylvania medical center in Philadelphia. ``We have yet to come up with a mechanical device that gives the quality of life that makes it all worthwhile. This may be the one, but that's yet to be proven.''

Dr. O. H. Frazier, chief of cardiopulmonary transplant at the Texas Heart Institute in Houston, said he was ready to use the device now to save lives.

``People who would receive the devices really have no other options,'' he said. ``It could rescue them from certain death.''

Frazier said he expects that about 10 of the devices will be installed and the cardiac surgery community will then closely examine the results before widening the circle of surgeons who use them.

For surgeons, said Frazier, who has put the Abicor device in calves, ``it is technically not that tough. It does require some training, but it is not that tough.''

Dr. Clyde W. Yancy Jr., head of the St. Paul's Medical Center transplant program which is affiliated with the University of Texas Southwest Medical Center, said that the emotional-mental-social elements of a mechanical heart ``may be the biggest problem.''

``How does a patient respond to having a totally artificial system in place?'' asked Yancy. ``How are the patient and the family members going to respond?''

These questions must be answered, he said, before a mechanical heart can assume an essential role in medicine.

Right now, about 46,000 Americans die annually of heart failure. About half of these die suddenly and can never benefit from heart surgery or replacement. Last year, there were more than 4,200 patients on lists waiting for donor hearts, but only about half ever received an organ. The rest die waiting.

Only about a tenth of those with end-stage heart disease are good candidates for heart transplant, doctors say.

``A transplantation requires intensive compliance,'' said Gardner. This means that to be successful, a patient must have a dedicated determination to take the required medicines, get the required blood tests and stick to the diet and exercise regimen ordered by the doctor.

Many patients with end-stage heart disease also suffer from other organ failures or lack the domestic support resources required by transplant.

It is possible, said Gardner, that a dependable mechanical heart will not have the same rigid requirements, thus making more people eligible for life-sustaining heart replacement surgery.

But Higgins said that even if the new device appears to work well, it is unlikely to soon replace the demand for donor hearts.