An Implanted Half Heart

Mrs. Louise Ceraso, 63, was not the first patient to have an artificial "half heart" sewn into her chest. But she survived the heroic operation longer than any of her four predecessors, and the very fact that she was still alive at week's end, ten days after her operation, was a significant medical record. More important, she was improving steadily, sitting up and eating well.

The pump implanted in Mrs. Ceraso by Dr. Adrian Kantrowitz and his surgical team at Brooklyn's Maimonides Hospital was similar in shape and design to the first type of half heart tried by Houston's Dr. Michael DeBakey three years ago. But it bore little resemblance to the current DeBakey models (TIME, Apr. 29 and May 6) recently used for two patients who died within five days of their operations.

No Valves. Inventive Surgeon Kantrowitz, 47, began research on partial heart replacements a dozen years ago. He had a natural and close ally in his brother, Physicist Arthur Kantrowitz, 52, director of the space-oriented Avco-Everett Research Laboratory. The surgeon spelled out the need for a design and materials that would work without valves and thus do little damage to blood cells. He wanted to use the heart's natural electrical impulses to control the pump, he said. And he wanted the device to be a permanent implant, ready for use whenever needed, with detachable connections at the chest wall so that the patient would not be encumbered when his heart could get along without the pump.

Arthur Kantrowitz and his associates worked with the Maimonides research laboratory to meet the design requirements. They built a crescent-shaped device consisting of a flexible Silastic inner tube and an outer casing of rigid Fiberglas (see diagram), from which an air hose leads outside the chest. They devised a sensitive electronic amplifier to use an electrical pulse from the heart to regulate an external pump.

Bypassed Arch. Dr. Kantrowitz had first used the device in a human patient in February, when it maintained heart function for 24 hours before the man died of liver disease. Then came Mrs. Ceraso, who had been bedridden for six years with congestive heart failure, diabetes, kidney disease and impaired liver function. The implant, Surgeon Kantrowitz convinced her, offered her best, perhaps her only, hope.

One thing in the patient's favor was that she had a working aortic valve, which this type of pump requires. Implantation of the Kantrowitz device did not require the use of a tricky heart-lung machine. The surgeons constricted Mrs. Ceraso's aorta with a Dacron band placed about an inch above the valve and the point where the coronary arteries branch off. Between this band and the heart, the surgeons sutured one tube leading to the Silastic inner cham ber of the pump. Bypassing the aortic arch and the arteries leading to the arms and head, they stitched the tube from the far end of the pump into the descending aorta.

With the air tube and electrical leads hooked up, Mrs. Ceraso's circulation took a new turn. When her left ventricle contracted, it propelled most of its blood, against negligible resistance, into the pump's Silastic chamber. The electrical impulse signaling this event then triggered the pump, and a gush of oxygen into the outer Fiberglas chamber squeezed the blood out of the Silastic core into the aorta. In the process, it pushed the blood along with much more force than Mrs. Ceraso's enlarged and enfeebled left ventricle could have mustered unaided. To reduce the risk of blood damage or other complications, Dr. Kantrowitz and the hovering cardiologists did not leave the pump running continuously but switched it off every couple of hours.

"The equipment is working perfectly," said Dr. Kantrowitz, "and there is evidence that the heart has been helped enormously." Then he added, with due medical caution: "Our definition of success is when Mrs. Ceraso can go home again"--with the artificial half heart still in her chest, disconnected, but with a portable air pump for use as needed.

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