With Each Operation, Artificial Hearts Show More Promise

June 27, 2012— -- Grant Feusner, a 64-year-old security systems engineer, started having an odd constellation of health symptoms a year ago.

"I had difficulty breathing, a dry mouth, couldn't sleep, and had difficulties performing my job," said Feusner, of Maryland. "My quality of life was pretty good up until that point."

Feusner went to go see a cardiologist at the University of Maryland, where, after a battery of tests, he was diagnosed with heart failure. Worse, doctors told him that his condition could not be managed by drugs alone.

"I wasn't doing very well with medication adjustments," said Feusner. "I responded well in the short-term, but my [body] was pushing back."

Even after doctors implanted a defibrillator into his heart to shock it back into rhythm when necessary, his heart failure continued to worsen.

Feusner needed a new heart.

Not long ago, patients like Feusner would have faced a grim prognosis, as there would have been few options available to sustain him until a donor heart became available. But that may be changing.

On June 21, physicians at Brigham and Women's Hospital in Boston announced that they had performed the first successful artificial heart transplant in New England for a patient who, like Feusner, had advanced heart failure.

"It's a regional milestone," said Dr. Gregory Couper, surgical director of the heart transplant program at Brigham and Women's. "This is the first implantation of an artificial heart in a patient needing a heart transplant in New England."

Although this is the first transplant in New England, other artificial heart transplants have already been performed around the United States and internationally. In fact, artificial hearts are being manufactured by a few companies, one of which is testing their device at 30 sites across the country.

More than 5 million people in the United States currently have heart failure. In heart failure, the heart muscles weaken such that the heart is unable to pump a sufficient amount of blood through the body. If the heart failure is left untreated, then other organs, including the kidneys, begin to fail.

Physicians will first attempt to manage heart failure patients with medications that help get rid of excess fluid in the body while also controlling blood pressure. For the 50,000 to 100,000 patients with advanced heart failure who cannot be treated with medications, a device known as the left ventricular assist device (LVAD) may be helpful. LVADs are devices that replace the function of the failing heart, and artificially pump blood throughout the body's circulatory system.

But in some cases even LVADs may not be effective in helping heart function. That is where artificial hearts come into play. The artificial heart acts as a bridge therapy -- a temporary measure until a patient can get off the organ donor waiting list and receive a heart transplant. About 2,000 heart transplants are performed in the U.S. each year, although thousands more -- if enough donors were available -- could potentially benefit from them.

Artificial Heart Patients Benefit From New Technology

In the past, surgeons at Brigham and Women's Hospital were reluctant to implant artificial hearts because patients were effectively sequestered at the hospital, thus severely compromising their quality of life. However, in the last two years, new technology has become available which allows artificial heart recipients to go home with an external driver that powers the manmade hearts.

"We envision that somewhere between two to five cases a year of total artificial hearts at Brigham and Women's Hospital," said Couper. "This is in the context of a total of 25-30 patients needing heart transplants. We will do 10-20 LVADs for every artificial heart."

Some physicians agree that LVADs will continue to be more commonly used than artificial hearts.

"LVADs are a much more common and less complex bridge [for heart transplants]," said Dr. Marc Gillinov, a cardiac surgeon at the Cleveland Clinic.

"There are LVADs that are now the size of Double A batteries," Gillinov added. "They…look promising and could help people and perhaps prevent them from getting to the stage of needing a whole new heart."

However, other physicians are more optimistic about the use of artificial hearts.

"There are many specific indications that cannot be rescued with LVADs," said Dr. Jack Copeland, a transplant surgeon at the University of California at San Diego, who performed the first successful bridge-to-transplant with an artificial heart in 1985. "Total artificial hearts have been found to salvage the sickest patients while the LVAD often fails."

"I see the artificial heart as a useful tool," said Copeland. "I suspect that…the artificial heart is going to succeed medically and commercially."

In the end, Feusner spent two and a half months at the University of Maryland Medical Center. He received an artificial heart, which kept him alive long enough to get a donor heart five weeks later.

"The experience with the artificial heart was good," said Feusner. "It kept me alive….because the LVAD wasn't an option.

"The artificial heart absolutely saved my life."

About a month ago, Feusner was sent home from rehabilitation. Today he can stand up on his own and walk around the house if he uses a walker. His appetite has returned.

And most importantly, he's been able to spend quality time with his 3-year-old granddaughter.

"By all accounts it's been amazing," he said. "What the doctors did was amazing."