TRANSPLANTATION of donor hearts last week into three patients who had been hooked to artificial heart pumps appears to mark a return to the original concept for artificial heart research.
The first implantation of artificial hearts into patients was performed by Dr. Denton Cooley of Houston, first in 1969 and later in 1981. Neither of Cooley`s patients lived more than a few days.
Cooley implanted the machines without federal approval, contending an emergency effort to save a patient`s life outweighed federal regulations, but his goal was to keep the patients alive only long enough to find a donor heart for transplantation, not long-term investigation of artificial heart technology.
The notion of using an artificial heart as a permanent replacement for the human organ has been a dream of researchers since the 1950s, but many physicians don`t believe that research has progressed enough to implant such devices permanently in humans.
At a Washington seminar sponsored by the Foundation for American Communications, Cooley said he still believes that artificial hearts are useful as a bridge to a transplant, but not as a permanent therapy for a patient.
Two doctors who thought the time was ripe for long-term artificial heart implants were Robert Jarvik and William DeVries. In December, 1982, working with approval of the federal Food and Drug Administration, DeVries implanted a Jarvik-7 model artificial heart into Dr. Barney Clark, a Seattle dentist, as a permanent replacement for Clark`s failing heart.
A valve broke on Clark`s Jarvik-7 and the patient suffered seizures, bubbles in his lungs, kidney failure, depression, mental disorientation and, after 112 days on the artificial heart, death.
After moving from the University of Utah to Humana-Audubon Hospital in Louisville, DeVries implanted three more ``permanent`` Jarvik-7 hearts into patients.
One man, Jack Burcham, died of excessive bleeding 10 days after being hooked to the Jarvik-7, and the others, William Schroeder and Murray Haydon, are alive and have suffered strokes associated with their artificial hearts. Both continue to be hospitalized.
In the early days of their research, DeVries and Jarvik both championed using the Jarvik-7 as a permanent measure. DeVries noted that with the number of possible recipients greatly outnumbering the donor hearts available, anyone implanted with an artificial heart should be prepared to live with his pump for a long time, perhaps the rest of his life, because a donor heart might never turn up.
An unspoken consideration was also that long-term use of the mechanical hearts is necessary to answer many research questions.
Although DeVries has FDA approval to implant three more Jarvik-7 models into patients, and he says he will do another permanent implant as soon as a patient becomes available, Burcham may have been his last permanent implant attempt in the current series.
DeVries now says he will use the Jarvik-7 for either permanent or temporary purposes. Jarvik himself now says he will work with doctors using his machines as bridges to donor transplants as well as with those interested in permanent uses.
One reason for this shift may be the growing number of players entering the field.
Surgeons at the Hershey Medical Center in Pennsylvania gave a Penn State heart to Anthony Mandia as a bridge to his transplant. At Pittsburgh`s Presbyterian Hospital, Thomas Gaidosh was attached to a Jarvik-7 for four days before receiving a donor transplant. Richard Dallara survived for four days with two Thoratec pumps assisting his ailing heart before receiving a donor transplant at Pacific Presbyterian Medical Center in San Francisco.
If Jarvik and DeVries had continued to insist that patients must accept artificial hearts as permanent replacements for their own hearts, they would have risked being left on the sidelines as others offered alternative approaches.
Another factor in the research shift is the disappointing early results in the Jarvik-7 experiments, results that have been widely reported to the public.
About eight months before Barney Clark received the first Jarvik-7, a Florida fireman with a failing heart threatened to go to the University of Utah and camp out in protest until he got a heart, notes Barton Bernstein, a Stanford University historian.
Because of federal requirements, the fireman wasn`t eligible for a Jarvik-7 at that time, and Clark received it after the requirements were loosened. Ironically, the fireman outlived Clark by about a year.
Mel Schroeder, son of the man who will observe his first anniversary on the Jarvik-7 later this month, said at the Washington seminar that he and other family members wish they had understood more completely the full implications of the procedure, especially the ``worst situation``