50 Years and Counting, UPMC Artificial Heart Patients Reach Half-Century Milestone That They Have Been on Assist Devices
PITTSBURGH, December 16, 2002
— The Artificial Heart Program at the University of Pittsburgh Medical Center (UPMC) recently reached a new milestone. Its 234 patients who have received implants of “artificial hearts” at UPMC within the past 17 years have together clocked more than a half century that they have been supported on heart assist devices while awaiting heart transplantation.
“In essence, these patients faced certain death due to the lack of available donor organs, but the device technology gave them 50 years of hope, and for those successfully transplanted or treated, the technology offered them a lifetime,” stated Robert Kormos, M.D., professor of surgery and director of thoracic transplantation and the artificial heart program at UPMC.
“The fact that 50 years of valuable clinical information has been collected in just 17 years is quite a feat as well. This experience has taught us about the complex interface between man and machine and has prepared us for the next phase of patient care using mechanical support, whereby the devices will most likely be used as long-term medical therapy or, alternatively, as a bridge to recovery instead of to transplantation,” he added.
“Moreover, the experience has provided us with a window into the future of what new technology needs to be developed.”
The first device implanted in a patient at UPMC was the Jarvik-7, and the surgery – the world’s second implant of the Jarvik as a bridge to transplant – took place on Oct. 24, 1985. Tom Gaidosh received a heart transplant within four days, becoming the first patient to successfully undergo transplantation after being supported by an artificial heart. He went on to live for 12 more years.
UPMC’s artificial heart program is one of the first to be established in the United States and is considered one of the most experienced centers. Over the years, the center has worked with a number of device manufacturers, performing laboratory and clinical studies as well as serving as a national training center for other medical centers implementing programs. As such, the team has seen the technology evolve to better meet the needs of patients with heart failure.
“When the technology was less evolved, patients were required to stay in the hospital tethered to cumbersome units nearly the size of a dishwasher and to be under the constant watch of clinical personnel and specially trained bioengineers. Today, devices are much smaller and lighter, and many patients can expect to be discharged to home with a spouse or other caregiver being able to manage much of the day-to-day care without the constant involvement of the nurses and engineers,” explained Steve Winowich, clinical director of the Artificial Heart Program.
In 1990, UPMC was the first center to demonstrate that it was feasible to discharge a patient on a ventricular assist device (VAD) to await heart transplantation outside the hospital. Of the nine patients currently on devices, three are living at home.
In the 17 years that the UPMC program has been in existence, the longest that one of its patients was supported on a VAD was 670 days. The shortest period a patient was on a device was one day – a donor heart became available and organ transplantation was performed. About 75 percent of UPMC’s patients have been successfully “bridged” to transplant. VADS typically are used to provide support to a failing heart until a donor organ is available. The technology has allowed 10 of UPMC’s patients to regain heart function, allowing surgeons to remove the device and making heart transplantation no longer necessary.
“We’ve come a long way in a relatively short period of time. For some patients, devices are now viewed as a means to recover from heart failure. Still, certain other devices are being considered a potential long-term or permanent solution for select patients with end-stage chronic heart failure who may not qualify for heart transplantation,” said Dr. Kormos, who also is medical director of the McGowan Institute for Regenerative Medicine at the University of Pittsburgh, where research to develop new artificial heart technologies is taking place.
Among the many milestones and firsts associated with the Artificial Heart Program are:
1985 – UPMC is the world's second center to implant the Jarvik-7 artificial heart as a bridge to transplant and the first to discharge a patient after successful device implant and organ transplantation.
1987 – UPMC surgeons are among the first to implant the Novacor Left Ventricular Assist Device.
1990 – A patient with a Novacor Left Ventricular Assist Device is the world's first patient to be discharged with an implanted device to await human organ transplantation outside the hospital.
1990- MCI founder and CEO William G. McGowan makes a gift to the UPMC that establishes the McGowan Center for Artificial Organ Development (now called the McGowan Institute for Regenerative Medicine). He had undergone a heart transplant at UPMC in 1987.
1996 – A UPMC bioengineer travels to Japan to assist with that country’s first implant of a Novacor device.
1997 – UPMC has its first patient whose heart recovers while on a device. The device is removed and the patient taken off the transplant waiting list. Research begins – and continues today – to develop a means to identify device patients whose hearts are recovering and could avoid transplantation.
1999 – UPMC discharges a patient from the hospital who is supported with a TLC-II Portable Driver, marking the first time ever a patient with that device is able to leave the hospital.
2000 – UPMC team of two surgeons and a bioengineer travel to Israel to participate in the world's first implant of a new left ventricular assist system called the HeartMate II, which was co-developed by researchers at the University of Pittsburgh's McGowan Center for Artificial Organ Development. UPMC is to lead the U.S. trial.
2000 – UPMC surgeons report what is believed to be the first case of a patient with ischemic cardiomyopathy to completely recover while on a heart assist device meant to be a bridge to transplant.
2001 – Building upon the talent and experience of UPMC's Artificial Heart Program, UPMC creates Vital Engineering in order to provide essential clinical experience and support to manufacturing and engineering companies in the process of developing or testing new technologies. Its team, composed mostly of bioengineers, provides direct patient care and technical support during implantation as well as outpatient monitoring of patients on devices.
2002 – Its 234 patients to receive devices since 1985 collectively amass more than 50 years of total support. UPMC has experience with five different devices (Jarvik, Novacor, Thoratec, HeartMate and TandemHeart) and provides training to centers initiating Thorotec and Novacor VAD programs.