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YEARS PUMP CHANGES INTO IMPLANT SCENE

Twila Van Leer was Deseret News medical writer in 1982. She joined dozens of local, national and international reporters who followed the first permanent artificial-heart implant in Barney Clark at University of Utah Health Sciences Center.or a dozen years - makes.

On Thursday, an alert, talkative and grateful Alvin Marsden met the media in a conference room at LDS Hospital, trailed by the sophisticated support equipment on which he will depend until a donor heart becomes available.Although obviously still weak from his former proximity to death due to irreversible heart disease followed by surgery, the 56-year-old Idahoan was chipper and personable, ready and willing to answer questions and to praise the process that led to the surgery implanting an artificial heart in his chest 10 days ago.

Marsden's media debut as the second patient to have an artificial-heart implant in Utah was in marked contrast to the first implant.

For three months in late 1982 and early 1983, hordes of reporters from all over the world converged on the University of Utah Health Sciences Center to stay abreast of developments. Dr. Barney Clark was the first patient to receive a permanent artificial heart, and the world was watching every twist and turn, fascinated that a human could survive when a man-made device had replaced his heart.

Reporters, even those who ventured onto the forbidden third floor to see if they could catch a glimpse of the famous patient (one reportedly dressed in janitor's garb) were disappointed. Until his death on March 23, 1983, Clark remained in seclusion behind a wall of medical and public relations personnel. It appeared initially that Clark eventually would be able to meet the press, and there was talk of a "pool of representative reporters and photographers" that set media mouths drooling and media brains plotting to see how they could make their way into the select group.

But a series of setbacks forestalled the meeting, and the only pictures of Clark and his mechanical heart released to the public were those doled out to the media by the university's public relations staff.

LDS Hospital's understated handling of Marsden's implant is different in several ways:

- The media, although aware for the past couple of weeks that an implant was imminent, were not informed that the surgery had taken place until it was over. There was no wee-hours vigil such as the one that took place in a curtained-off section of the U. hospital cafeteria the night of Dec. 2-3 1982. No day-to-day hovering clutch of reporters anxious for any little tidbit to file.

- The physicians who have cared for Marsden have not found their pictures smiling back at them from virtually every magazine and newspaper in America and most of the rest of the world. With half a dozen medical centers using artificial hearts for bridge-to-transplant, an implant is no longer the novelty it once was.

- Marsden, although very near to death, was healthier than Clark at the time of surgery. The Idaho man had been involved in a heart-care program at the University medical center that made him a better risk for the surgery. Many of Clark's body systems had been irretrievably damaged by his weak heart before his surgery.

- Most importantly, artificial-heart technology has improved since the Jarvik 7 was implanted in Clark's chest. What was learned in his case has benefited subsequent implant patients. Though the first heady predictions in 1982 that artificial hearts would soon be supporting tens of thousands of people with intractable heart disease did not prove accurate, the groundwork was laid. The Barney Clark the media never met pioneered the technology that has greatly improved the chances of Alvin Marsden, whom they did.

Dr. James Long, Marsden's surgeon, acknowledged that improvements in the heart - it is now smaller - and in the pneumatic support system make a better prognosis for today's implant patients. Improved selection criteria also have developed to help doctors narrow the field of potential recipients to those who will do best, he said.

Finally, the artificial device as a bridge to transplant rather than as a permanent life support has proved more practical. A smaller support system that could be worn like a backpack is not far in the future, Long said, predicting that the UTAH Cardiac Transplant group may be using them for artificial-heart patients as early as this year. Eventually an electric-powered, fully implantable heart will be available, developed in small steps through the accumulated experiences of patients such as Clark and Mardsen.