Inventive, ingenious and daring surgery took another step last week toward the ultimate goal of replacing human hearts hopelessly damaged by disease. The operation at Houston’s Methodist Hospital was not, as racing-pulse press reports first proclaimed, “history’s first implant of an artificial heart,” but it incorporated famed Surgeon Michael E. DeBakey’s latest refinements of a device on which he and his colleagues at Baylor and Rice universities have worked for eight years. And it gave a doomed patient renewed hope of life.
Marcel L. DeRudder, 65, a former miner, long a victim of rheumatic heart disease, had been unable to do any work for 21 years. Dr. DeBakey (TIME cover, May 28) and the cardiologists on his team soon found that DeRudder had a badly damaged and calcified mitral valve, through which blood passes from the left auricle to the left ventricle. This valve had worked so poorly for so long that the overtaxed left ventricle had become enlarged, flabby and inefficient. It was possible that Patient DeRudder could survive with nothing more than an artificial valve, but the surgeons could not be sure until they cut into his chest and saw for themselves.
Hours of Decision. The operation began at 7:40 a.m. With a ten-inch incision across his chest, DeRudder was hooked up to a heart-lung machine. And then, as five cameras recorded every step, the surgeons opened his left auricle. They replaced the diseased valve, but even this promised little. The left ventricle, the main pumping chamber, which does more than half the heart’s work, was too badly diseased. Standing ready in the operating room was a team of doctors and engineers with the one device that might help: a “half-heart” to assist the left ventricle by partially bypassing it (see diagram). An instrument based on the same principle but of different design and materials had been first tried in man 2½ years ago, when Dr. DeBakey used it to keep a moribund patient alive for 3½ days (TIME, Nov. 8, 1963), and for only the second time last February, when Brooklyn’s Dr. Adrian Kantrowitz used a comparable device for 24 hours.*
Was Patient DeRudder’s condition so grave as to justify the admitted risk? It took Dr. DeBakey, with three assisting surgeons, until 10:14 to decide that the answer was yes. Swiftly Dr. DeBakey took one of the two plastic tubes attached to the pump device and stitched it into the hole in the left auricle. Then he took the other tube and sewed it into a hole in the side of the aorta. At DeRudder’s chest wall, the round plaque holding these tubes, together with smaller tubes for priming and flushing with saline solution, was attached to a hemispheric chamber 3 in. in diameter. Inside this was a Silastic diaphragm, which alternately generated pressure and exerted suction as it was worked to and fro by an external pump.
The device was switched on at 11:15. It seemed to be working well until it overdid its job, delivering more blood under greater pressure than DeRudder’s weakened arterial system could handle. After a flurry of alarm involving hand massage of DeRudder’s heart, this was soon corrected.
Pull & Push. Oxygenated blood from DeRudder’s lungs then flowed normally into his left auricle. From there, up to 80% of it was drawn by suction into the pump chamber, held for an instant by a check valve, then pushed by the pressure of the pump’s downstroke into the aorta, which supplies all the body’s arteries. The rest took nature’s course. It passed through the newly implanted artificial mitral valve into the ventricle, which continued to beat, and out into the aorta.
In this way, the cardiologists hoped, the ventricle would be spared much of the strain under which it had labored. While it would not literally rest, it would have a chance to regain muscle tone and strength. That might take as long as three weeks. If everything worked out as hoped, Dr. DeBakey planned to detach the pump from his patient’s chest but leave the ¾-in plastic tubes implanted. They might come in handy later. At week’s end DeRudder’s condition had the doctors baffled. The pump was working extremely well, but he remained in a coma. If he had suffered brain damage, the cause remained obscure. Dr. DeBakey could only hope that this difficulty would eventually clear up.
* In an operation at Maimonides Hospital that was not publicized. “We chose to study our attempt carefully and analyze the results,” said Dr. Kantrowitz.