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RECIPIENT OF IMPLANT HOLDING OWN

Utah's most famous anonymous patient - the Idaho grandfather who got an artificial heart Wednesday - was holding his own on Friday.

"No change - critical but stable," said LDS Hospital spokesman Jess Gomez. The designation "critical" is standard for patients who are in intensive care.The 56-year-old patient is the first in Utah to receive an artificial heart since Barney Clark got the world's first permanent implant in 1982. At the request of his family, LDS Hospital is not releasing information that could identify the man for now.

The operation began late Tuesday night, with the CardioWest C-70 device placed in the patient's chest after midnight. The operation ended about 4 a.m. Wednesday, and by Thursday the patient was feeling better than he had in weeks.

"As of this morning he was sitting up in bed smiling, wearing a baseball cap" that his granddaughter had brought for him, said Dr. James W. Long, the thoracic surgeon who led the operating team.

During a press conference Thursday afternoon at LDS Hospital, a panel of specialists involved in the operation described its details. They were delighted by the return of the artificial heart to the state where it was developed and buoyed by the patient's good response.

"We feel that this is the culmination of the efforts of many, many individuals and organizations . . . many years of effort," said Long.

The artificial heart technology holds tremendous promise and will be important in saving patients, he said. "Its return to Utah is indeed a great, momentous event."

Dr. David Taylor, the attending physician for the Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, said the patient developed coronary disease at an early age. At 42, he had a bypass operation and did well for nine years afterward.

But in 1991, he suffered a massive heart attack and his heart began failing. With careful medical management, including some experimental treatments, he lived on.

As he developed severe heart failure, he had a balloon device implanted in his leg to help his circulation. But his heart continued to fail, and doctors realized he could not survive much longer without a heart transplant or mechanical assistance.

He was put on a list for a donor heart, but the waiting list is long. "Within the last several days it became obvious we would not be able to support him" until a donor organ became available, Taylor said.

Doctors considered implanting a left-ventricle assist device, which helps that side of the heart do its work. But then they discovered that not only was the left side of his heart failing, but the right side was giving out too. The LVAD couldn't save him.

According to Long, the heart failure accelerated. The muscle declined "abruptly at the end." The man's kidneys began to lose function and would have failed within hours.

Dr. Donald J. Doty, chief of surgery at LDS Hospital, said the years of illness had taken a toll on the man's body. He "had wasted down nearly to death."

Taylor said that without the artificial heart, the man's life would continue "days to no longer than a week, probably."

Still, the patient had a real zest for life. "He is a very enthusiastic guy," said Dr. Steven C. Horton, the patient's attending cardiologist.

On March 24, the U.T.A.H. team announced the U.S. Food and Drug Administration had approved using the artificial heart once again in this state. Considering the Idaho man's physical condition and less tangible factors like the positive attitude that could boost his recovery, the team decided he was an ideal candidate for the plastic and steel device.

The team discussed the operation with the patient and his family. According to Long, when the patient's wife heard an artificial heart could be used, she asked, "Oh, like the one they put in Barney Clark?"

Told that it was similar to that device, she exclaimed, "Oh, Oprah, here we come!"

"The operation proceeded very well," said Long.

According to Doty, "The team was well-prepared. They had rehearsed, worked, and had experience in implanting artificial heart for well over a year, with a single ventricle." The single ventricle device is the LVAD or its mirror image, the right ventricle assist device.

Doty said that although many people were present in the operating room, the procedure had "a sort of orderliness . . . and a lack of excitement."

Horton said that on Thursday morning, he greeted the patient. "He said, `Hey Doc, let me have your hand back,' " and then gripped Horton's hand firmly to show he had strength.

"He's the most enthusiastic member of the team."

Doty said the patient reported that "he could feel the heart when he put his hand to his chest," but that it was so quiet he could not hear it pumping.

Donald B. Olsen, director of Biomedical Engineering at the University of Utah and one of the mechanical heart's main inventors, said the primary differences between the CardoWest C-70 and the Jarvik 7 that was implanted in Clark is that the newer device has improved valves.

A valve in the Jarvik 7 failed 13 days after it was placed in Clark's chest, and a second operation was required to fix it.

Long said the new heart is smaller, too, so it fits more easily in the chest cavity. Another difference is that procedures are improved and "we know how to select these patients better."

Under rules set up by the FDA, the device can be used only as a bridge to transplantation, although team members believe it could keep a patient alive indefinitely. Because of the FDA regulations, a patient must remain in the hospital until a transplant takes place.

Olsen's group is researching newer artificial hearts, including one that would be totally implantable and powered by electricity. One drawback to the present heart is that is powered by air pumped in through tubes, which require an opening in the patient's heart.