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Utah heart paved the way

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The artificial heart fully implanted in the chest of a patient Monday in the University of Louisville Hospital is making big news around the world. But it isn't the first time Louisville has been the focus of attention where such technology is concerned. And Utah connections abound.

In a news conference early Wednesday, the patient was reported to be resting well and responding to family members, although not speaking. He was very near death from heart disease when the decision was made to use the device, called AbioCor and developed by Abiomed, a Massachusetts company. Officials of Jewish Hospital, where the surgery took place, declined to release the patient's name or his hometown.

Because of his poor condition — he had been given an 80 percent chance of dying within 30 days — he had been turned down for a heart transplant elsewhere, doctors said.

"He had no other option," Dr. Laman Gray told reporters. "He was in as dire shape as you can ever have anybody in."

The man, who is in his mid- to late 50s, has chronic kidney failure, diabetes and has had multiple heart attacks, Gray said. He had coronary bypass surgery, around 1992.

The softball-sized titanium and plastic pump was implanted Monday by Gray and colleagues from the University of Louisville during a seven-hour operation at Jewish Hospital. The Louisville group in Kentucky is making cautious predictions about how long the device will be functional but hope the first patients may be able to leave the hospital and survive for a year or more. AbioCor requires recharging from a coil that transfers energy through the skin. Ultimately, patients may enjoy long-term survival, with a portable battery pack to recharge their mechanical hearts.

Five surgical centers around the country are prepared to use the AbioCor device, and the implant has been anticipated this spring. The federal Food and Drug Administration has approved five experimental uses of the heart, but only for patients whose other options have been exhausted. Extensive animal research preceded the human trial.

The procedure received a cool reception from one of the field's best-known pioneers, Dr. Robert K. Jarvik, whose invention, dubbed the Jarvik Heart, was used in the first Utah implants in the 1980s. He now lives in New York.

"Many years of experience have taught us that cutting out the heart is unnecessary," said Jarvik. Researchers should instead focus on devices that assist the heart in healing, without total replacement, he said Tuesday.

The AbioCor heart used Monday is the descendant of a less sleek, more cumbersome artificial heart implanted in the chest of Bill Schroeder on Nov. 25, 1984, in Louisville. The surgeon, Dr. William C. DeVries, had earlier made headlines worldwide when he performed the first permanent artificial heart surgery on Dr. Barney Clark in Salt Lake's University Hospital in December 1982.

While the world watched, intrigued, Clark survived 112 days, providing invaluable information on the potential for keeping humans alive on such devices. His artificial heart was kept beating by a bulky support unit outside his body — one of the primary drawbacks to those earliest models.

After cooling his heels for almost two years after the historic Clark implantation, DeVries was impatient for another chance. Disgruntled that U. officials weren't eager to grant permission for additional implants, he left Utah and went to Louisville, where Humana Hospital promised to underwrite the costs of up to 100 implants. Although artificial heart research has continued in Utah, the spotlight shifted to other centers, including Louisville.

Schroeder was the first of four patients who received the Utah-developed Jarvik heart in Louisville. He lived until mid-May 1985, the others for shorter periods. Each of these artificial heart pioneers added to the scientific base that has led, over 20 years, to the creation of fully implantable devices that appear to hold promise for hundreds of thousands of people who suffer from irreversible heart disease.

After those early Louisville implants, it became apparent that more work was needed to resolve problems related to the early heart models. In the interval, the artificial heart has been used as a device to maintain a patient only until a human donor heart was available, with no intent that it be a permanent solution.

"The basic concept was established here (in Salt Lake City)," said Dr. Chase Peterson, who as U. vice president for health sciences was the official spokesman for the Clark implant. "Lots of (research centers) took off based on what we did . . . . Everyone used the Utah heart as a pattern." Peterson, now retired from his administrative duties, continues to teach part-time in the U. School of Medicine.

He sees the current Louisville success as the natural progression of the science and a tribute to Drs. Willem Kolff, Jarvik, DeVries and others involved in the Utah experience who were not afraid to take the first steps into uncharted waters.

Dr. George Pantalos, one of the doctors involved in Monday's implant, took a lot of experience he gained in heart research in Utah into the operating room. For several years, he was involved in Utah-sponsored artificial heart studies in space, designed to determine the effects of space flight on heart function.

A Utah-100 heart was aboard the space shuttle Discovery in the fall of 1998 to gather data that NASA officials hoped would help answer questions about why weightlessness causes the heart to perform less efficiently. After the experimental flight aboard Discovery, Pantalos said that it was apparent that gravity helps the heart to fill under normal Earth conditions. Lack of gravity in a spaceship affects that function.

As a chief researcher on Utah's Hearts in Space project, Pantalos also primed U. students Mike Fowler and Lane Christensen for flights in NASA's KC-135, which simulates space conditions.

One Utahn who greeted the latest step up in artificial heart experimentation was Una Loy Clark-Farrer, Barney Clark's widow, who now lives in St. George.

"How wonderful!" she exclaimed.

In the 20 years since Barney Clark's death, Clark-Farrer said she has seen the effects of his decision, as she hears of step-by-step progress in the science from doctors, patients and their families.

Contributing: The Associated Press

E-MAIL: tvanleer@desnews.com