The Artificial Heart, Revisited

By Christine Gorman With Reporting by Alice Park/New York

More than 4,000 Americans on any given day are waiting for a heart transplant. Because of a shortage of donors, about a third of them will die before a suitable replacement can be found. So when surgeons in Louisville, Ky., sewed a high-tech artificial heart into a desperately ill man last week, it seemed like the answer to a lot of prayers. The patient, whose name has not been released, is described as a diabetic in his mid to late 50s who developed congestive heart failure after suffering several heart attacks. If he survives and his health improves even a little, there's no telling how many other lives might someday be saved with similar artificial hearts.

Those are some mighty big ifs, of course. After all, the man was on the verge of dying before last week's operation--and still could die at any moment. His liver and kidneys are in pretty bad shape. He could suffer any number of surgical complications, from internal bleeding to infection to strokes.

And heart doctors remember all too well what happened to the handful of patients who were given artificial hearts in the 1980s. Each of them was tethered to a large external compressor that powered the device through tubes into the body. The first recipient, a retired dentist named Barney Clark, developed serious infections that ravaged his body. The artificial pump also triggered a lot of blood clots. The long, lingering death of one man in particular, William Schroeder, who was kept alive for 620 days with much of his brain destroyed, soured many physicians and the public on the artificial heart's long-term prospects.

Of course, technology has advanced considerably since then. The sophisticated pump used in last week's operation is designed to be completely implanted. Developed by Abiomed in Danvers, Mass., with funding from the National Heart, Lung and Blood Institute, the softball-size device is charged across the skin, so there's no need for chest tubes. Its batteries are miniaturized, and its pumping chambers are lined with a specialized coating that should cut down on blood clots.

But does the world really need an artificial heart? The answer, surprisingly, might be no. There has been some pretty good progress recently in the medical treatment of congestive heart failure, which affects some 5 million Americans. (Despite the scary-sounding name, congestive heart failure doesn't mean the old ticker has stopped working; rather, the heart has trouble pumping out as much blood as the body needs.) In many cases the condition can be controlled with medications like beta blockers and ACE inhibitors without any surgical intervention.

Meanwhile, doctors have had growing success with a different kind of mechanical pump, called a left ventricular assist device (LVAD), that is also implanted in the body but helps boost the heart's output without replacing the organ. In some cases the ailing heart gets enough rest on the LVAD that it no longer needs artificial support. Researchers are trying to figure out if they can nudge that process along, perhaps by using stem cells to stimulate healing.

Originally, only people who were already on a waiting list for a heart transplant could get an LVAD. The pumps simply weren't designed to be permanent. But so many patients have done so well on the newer-generation devices--playing golf or even tennis--that doctors are considering whether to expand their use. We should have a better idea later this year when researchers finish analyzing data from a study in which LVADs were given to a group of patients with end-stage congestive heart failure who, because of age or other medical conditions, were not eligible for a transplant.

Does that mean we should forget about total artificial hearts like Abiomed's? Not at all. There will always be some folks whose hearts are so worn out they cannot be salvaged. A review panel convened by the National Heart Lung and Blood Institute in 1999 estimated that between 5,000 and 10,000 patients a year might be helped by the development of total artificial hearts. But as with many medical advances, the early going will probably be grim. Doctors in Louisville will consider their experiment an astounding success if their patient manages to live an extra two months. And if he dies before then? That might answer a few questions too.

--With reporting by Alice Park/New York

Go to time.com/personal for more on heart failure. E-mail Christine at gorman@time.com