Artificial Heart

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• JIM LEHRER:

  It was a month ago today that doctors in Louisville implanted the first self-contained artificial heart. The patient, still unidentified, was a terminally ill man in his 50s. The device put in his chest was built by a Massachusetts company. It's made of titanium and plastic. It has an internal motor and a battery pack worn outside the body.

  Today, one of the surgeons offered a one-month report. And he joins us now. Dr. Robert Dowling is Associate Professor of Surgery at the University of Louisville School of Medicine. Dr. Dowling, welcome.

• DR. ROBERT DOWLING:

  Thank you.

• JIM LEHRER:

  In general, sir, how is your man doing?

• DR. ROBERT DOWLING:

  He's doing remarkably well. We're thrilled with his progress. He has had good return of his kidney function, his liver function, and his lung function, all three of which were very abnormal before his surgery from his heart being so ill. He's had a lot of improvement in it strength. He's able to get up without assistance; he's able to ambulate without assistance. Thirty days into this, we're just thrilled with how well he's coming along.

• JIM LEHRER:

  When you say ambulate, you mean he can get up and walk around?

• DR. ROBERT DOWLING:

  Yeah. Absolutely.

• JIM LEHRER:

  How far does he walk? What does he do? Where does he go?

• DR. ROBERT DOWLING:

  Well, he's been taking trips to various sites throughout the hospital. Mostly he just walks around in the nurses' station or just to interact with the nurses or with his family, but this is a fellow, when we first saw him barely had the strength to lift his head — certainly couldn't take more than a few steps at best and then only with assistance – who's now able to hold his head up, joke and laugh, interact with the nursing staff, the doctors, the physical therapists, and, you know, if you were to just see him stand up from the sitting position, you would never have guessed how sick he was one month ago.

• JIM LEHRER:

  Now, does he still need some help breathing?

• DR. ROBERT DOWLING:

  No. He's been off the ventilator for some time so he's breathing on his own. We did have to place a tracheostomy tube mostly for his comfort. He really was bothered by having the tube down his throat. The major reason we placed the tracheostomy tube– and that was just a bedside procedure — was for his comfort.

• JIM LEHRER:

  You said today at your news conference that he remained a sick man. What do you mean?

• DR. ROBERT DOWLING:

  Well, even though his kidneys, liver, lungs and other organs are improving he is still very malnourished. He has gained tremendous strength, and as I said —

• JIM LEHRER:

  Give us a feel for that. What can he do now that he could not do 30 days ago?

• DR. ROBERT DOWLING:

  Even standing up for him, he couldn't do it without assistance 30 days ago. He couldn't take two steps on his own 30 days ago. Now he can get up and he can walk across the room and back.

• JIM LEHRER:

  Can he hold things in his hand?

• DR. ROBERT DOWLING:

  Oh, yeah. As a matter of fact, the nurses at the press conference pointed out that as part of his physical therapy he lifts dumbbells. He's already worked past the set of dumbbells that he has and we have to get a heavier set of dumb bells from the respiratory therapist.

• JIM LEHRER:

  What about his weight?

• DR. ROBERT DOWLING:

  His weight hasn't gone up much but his strength has.

• JIM LEHRER:

  What about… What's he eating? How are you handling that?

• DR. ROBERT DOWLING:

  Yeah, well, right now we are just starting to advance his diet to get him on solid food. Probably in the next couple days we hope to be transitioning him on to solid food. Most of his nutrition now is coming from a very small feeding tube that is placed through his nose and into his stomach. He's getting just shy of 3,000 calories a day from the feeding tube. He's just starting to take orally regular foods.

• JIM LEHRER:

  Why is he still being fed through a feeding tube?

• DR. ROBERT DOWLING:

  Just the stress of surgery and the weakness. A lot of those patients have trouble with their swallowing mechanism. So we worry when there is trouble with the swallowing mechanism that if they don't struggle correctly, they can get particulate matter or liquid into the lungs and that can cause pneumonia. So until he demonstrates the strengths to handle all types of food we're being very cautious and still feed him through the feeding tube. I would anticipate within a week or so that he'll be taking all his calories on his own and orally and the feeding tube will be a thing of the past.

• JIM LEHRER:

  And feeding himself?

• DR. ROBERT DOWLING:

  And feeding himself. Oh, yeah, yes, absolutely. What can he do, you say? We had a little party, a get-together at the nurses' station in the unit he's in. He was able to stand up, move around, stand up and get some sherbet and eat it on his own without any difficulty at all.

• JIM LEHRER:

  Has he expressed any desires for any particular kind of food?

• DR. ROBERT DOWLING:

  He likes root beer. And he has a fondness for cheesecake.

• JIM LEHRER:

  He can eat cheesecake, right?

• DR. ROBERT DOWLING:

  Oh, yeah, yeah.

• JIM LEHRER:

  How does he spend his day? What is his life like right now in that hospital?

• DR. ROBERT DOWLING:

  You know, he gets up early. He interacts with the nurses a lot. He spends most of the day, almost the entire day out of bed. He likes to go on trips outside of his room, so, for instance, he'll come up to the — our offices and visit with the staff up there. Most of the time he just interacts with his family. His wife has been at his bedside almost constantly. He has developed a large CD collection. He listens to his music. He watches videotapes.

  The physical therapists come by — keep him busy with bedside exercises. The nurses are keeping him busy staying active working on his dumbbells and so forth. He has a pretty busy schedule but he also has some free time where he can just relax and usually sits at the nurses' station – he's kind of, I think, bored with his own room — and interact with all the people that are coming through to see him.

• JIM LEHRER:

  But he now is spending more time out of bed than he is in bed, right?

• DR. ROBERT DOWLING:

  Absolutely, absolutely — I haven't… I see him three or four times a day at least and I can't… I haven't seen him in bed since last week.

• JIM LEHRER:

  All right. Now, how is the heart — the artificial heart itself functioning?

• DR. ROBERT DOWLING:

  Yeah, excellent question. The heart has functioned flawlessly since the day we put it in one month ago.

• JIM LEHRER:

  How do you know that?

• DR. ROBERT DOWLING:

  Well, excellent. There's a… There's a number of components to the artificial heart itself. There is what we call the thoracic unit, which actually pumps the blood and there's an internal battery and an internal controller. The internal controller controls the function of the heart. In addition to doing that, it sends information through radio frequency telemetry to a unit that picks up that information and converts it into data that shows us on a beat-by-beat basis how that heart is working.

  We can look at any point in time and see on that particular beat what the hydraulic pressures in the heart were on the left side of the heart or the right side of the heart — how the balance chamber is functioning. The balance chamber is designed to regulate the balance between the right and the left side of the heart. So, you know, this heart has beat, you know, probably over six million times by now and every beat we monitor. And if there is an abnormality the console is designed to tell us that there's an abnormality that falls outside given parameters. We haven't had any of those.

• JIM LEHRER:

  Not one abnormality, not one problem with the heart at all?

• DR. ROBERT DOWLING:

  No, not a single one.

• JIM LEHRER:

  He's not hooked up to anything, right? I mean, the heart isn't hooked up to anything, this artificial heart?

• DR. ROBERT DOWLING:

  Right. Well, the heart can either be driven by an internal battery, in which case he's entirely untethered, free, move about, spin circles if he wanted to. But most of the time it receives energy across the skin. Most of the time he has what we call a TET coil – it stands for Transcutaneous Energy Transfer – on top of his skin, which transmits energy across did skin to another TET coil that powers the device.

• JIM LEHRER:

  But it's not hooked up to a wire — it's plugged not plugged into a wall – or anything like that – that's what I'm getting at.

• DR. ROBERT DOWLING:

  Well, the TET coil that transmits energy across the skin is either hooked into external batteries or it's plugged into the wall. The battery, itself, will only give power for brief periods of time, say maybe up to an hour.

• JIM LEHRER:

  I see.

• DR. ROBERT DOWLING:

  So most of the time he is receiving energy on the top of the skin with that TET coil that's on top of the skin being plugged into either a regular old wall outlet or into external batteries.

• JIM LEHRER:

  Is it in general terms impossible to compare the function as we sit here now, the function of this artificial heart with a real heart?

• DR. ROBERT DOWLING:

  Well it's very different. But you can compare the function. A real heart automatically knows how to balance the right and left side of the heart. By that I mean the right side of our heart always gets back a little bit of different blood than the left side of the heart. This heart is extremely sophisticated in terms of its engineering capabilities. It's able to do that on its own. We don't have to program that in anymore. We can choose to program that in but the heart itself — like our own hearts — knows how to balance that left and right chambers. It also knows how to regulate the heartbeat like our own hearts do.

• JIM LEHRER:

  So far so good on all that.

• DR. ROBERT DOWLING:

  So far so good on all that; it's worked wonderful.

• JIM LEHRER:

  Now is there a timeline for this patient, in other words, when you think he may be ready to do more than just walk around, he may be able to walk around outside, he may be able to go public, he may be able to talk in public, he may be able to go home, he may be able to resume… Have you got something like that in mind?

• DR. ROBERT DOWLING:

  We don't have any definite time lines. We're just taking it day by day, week by week. We're grateful and we're just ecstatic that he's doing as well as he is. He's anxious to meet people. He wants to get out there and show people that he's just an ordinary guy who happened to have an unusual set of circumstances, you know, fall on him and how he reacted to it. I think he wants to get a little stronger. I think he wants his voice to be stronger.

• JIM LEHRER:

  But that's coming fairly soon do you think?

• DR. ROBERT DOWLING:

  I think that's coming soon, yeah, I think… I don't know exactly when. I don't really… But, yeah, I'm excited. I'm excited because he's a wonderful person with a wonderful family. And I'm just so excited for that day when he does get to meet everybody.

• JIM LEHRER:

  In a word you're on schedule from your point of view?

• DR. ROBERT DOWLING:

  From our point of view we're ahead of schedule. We absolutely think that — if you'd have told me this is how he's going to be doing 30 days after his surgery I'd have said, "no, I don't think he can be doing that well. That would be too good to be true."

• JIM LEHRER:

  Dr. Dowling, thank you very much.

• DR. ROBERT DOWLING:

  Thank you.