Medicine: Medicine: Mar. 4, 1985

THE ARTIFICIAL HEART: ACT III A retired autoworker becomes the third recipient of the Jarvik-7 ONCE AGAIN THE SOUNDS OF CLASSICAL MUSIC FILLED THE OPERATING ROOM AT HUMANA HOSPITAL AUDUBON IN LOUISVILLE. AND ONCE AGAIN, AS THE OPERATION DREW TO A CLOSE, A STRANGE, PERCUSSIVE ACCOMPANIMENT AROSE FROM THE PATIENT’S CHEST: ch, ch, ch. FOR DR. WILLIAM DEVRIES, THE ONLY SURGEON IN THE WORLD AUTHORIZED TO IMPLANT THE ARTIFICIAL HEART, THESE WERE THE SOUNDS OF SUCCESS, AS REASSURING TO HIM AS A NEWBORN’S FIRST SQUEAL IS TO THE OBSTETRICIAN.

LAST WEEK’S SURGERY ON MURRAY HAYDON, 58, THE THIRD MAN IN HISTORY to receive a permanent artificial heart, could not have gone more smoothly. DeVries finished the job in 3 1/2 hours, about half the time it took to implant the device in William Schroeder last November, and four hours faster than the first implant surgery conducted more than two years ago on Seattle Dentist Barney Clark. This time there were no problems with bleeding (as there had been with Schroeder), and no breathless moments when the device failed to work (as in Clark’s case). Said a nurse: “Boy, this is a dull operation.” DeVries and Dr. Robert Jarvik, designer of the Jarvik-7 heart, were jubilant. “We’re getting so good at this operation,” said DeVries, “we ought to start charging for it.” (DeVries has been waiving his fees.)

By week’s end Haydon was breathing on his own, slurping Popsicles and doing passive exercises. He also stood briefly by his bed, and was scheduled to sit in a chair. The quiet-mannered former Ford assembly-line worker from the Louisville suburb of St. Matthews also displayed a wry sense of humor. “Would you please turn on the television?” he asked two days after surgery. “I would like to see if I’m alive and how I’m doing.”

Like his two predecessors, Haydon became a candidate for heart replacement because of terminal cardiomyopathy, a progressive weakening of the heart muscle. But his chances seemed better than those of either Clark or Schroeder. Clark, who was all but dead at the time of his implant surgery, not only had heart disease but was suffering from emphysema; Schroeder had diabetes and advanced atherosclerosis.

Still, Haydon was deathly ill. In the month preceding his operation, his weight had fallen from 175 lbs. to 150 lbs. His breathing was labored, and he felt so weak that just brushing his teeth was exhausting. “I’m tired of being tired,” he told DeVries. Doctors estimated he had only two to three weeks left to live. His family urged him to try the artificial heart. “We % wanted it desperately,” said Diana Welsh, 30, the oldest of his three children, “but it had to be his decision.”

Haydon was aware of the considerable risks involved. Though Barney Clark had survived 112 days with the device, he had suffered unexplained brain seizures that left him depressed and disabled. Schroeder, too, was struggling with serious neurological problems, caused primarily by a stroke that occurred 18 days after his implant surgery, leaving him with impaired speech, loss of short-term memory and weakness on his right side. Schroeder’s recovery was further hampered in January by seizures (a common complication of strokes) and, in recent weeks, by fever that ranged as high as 105 degrees.

At a press conference early last week, Dr. Allan Lansing, spokesman for the medical team, expressed doubts about Schroeder’s “quality of life,” and whether he would ever be able to leave the hospital. He described Schroeder, 53, as weak, unable to speak in complete sentences, withdrawn and confused. “If he doesn’t get stronger and he remains discouraged,” said Lansing, “that could be a threat to his life.”

The remarks upset Schroeder’s wife Margaret and enraged DeVries. The next day officials gave a rosier account of Schroeder’s condition. They announced that his fever was subsiding and that he might be allowed to attend his son’s wedding on March 16. They released photos showing Schroeder waving to Haydon. Schroeder was also treated to his first trip outdoors: a brief excursion to the hospital parking lot, from which he could glimpse the “transitional care” apartment building where he will live if he leaves the hospital. Two children rushed over to greet the famous patient. “It was like shaking hands with history,” said Kim Nasief, 10, but she added, “I’m not sure he knew we were there.”

Unresolved questions about Schroeder’s condition and what caused his strokes led some doctors to criticize Humana for rushing ahead with another implant. “They should have waited until this thing with Schroeder is over and looked closely at that before going forward,” says Dr. Donald Hill, chief of cardiovascular surgery at San Francisco’s Pacific Presbyterian Medical Center. The strokes may have been caused by blood clots that formed somewhere in or near the artificial heart and then traveled to the brain. According to Cardiologist Fredarick Gobel of the Minneapolis Heart Institute, the risk of such traveling clots, or emboli, is great “whenever you have foreign + materials in the vascular system.” To reduce this risk for Haydon, doctors gave him anticoagulants before and after surgery, though this increases the risk of bleeding.

As the week progressed, Schroeder, as if inspired by the new kid on the ward, seemed to improve dramatically. According to Lansing, he was initiating conversation, pronouncing difficult words like Mississippi, counting correctly and, perhaps most important, “laughing more.” New dentures apparently eased things for him. Though prospects for a complete recovery of speech and mental functions remained slight, doctors were once again talking about transferring Schroeder to the transitional home, perhaps as early as this week.

Haydon meanwhile was “recovering very nicely,” according to DeVries, though suffering from a mild kidney problem and continued weakness from loss of weight. Without the implant, “he wouldn’t be here today,” said Juanita Haydon. “Every day is precious.”