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Tuesday December 11, 2007

Italy’s First Total Artificial Heart Implant

Fifty-four-year-old operated at Padua. Transplants in Italy began at the same hospital twenty-two years ago.
MILAN – Twenty-two years ago, Italy’s first transplant of a donor human heart took place here. Now, Padua has witnessed the country’s first implant of a total artificial heart. It seems that the local cardiosurgery unit has a taste for firsts. Twenty-two years ago, the surgeon was Vincenzo Gallucci. Today, Gino Gerosa has taken over from his trail-blazing predecessor, who died tragically in a car accident. In fact, the centre Professor Gerosa directs is named after Vincenzo Gallucci.
A fifty-four-year-old man from Veneto is the first Italian to receive a compressed air-driven, polyurethane heart. The heart doesn’t beat: it blows. The recipient was on the operating table for thirteen hours a week ago, surrounded by a ten-strong team of surgeons, anaesthetists and nurses, as well as several bioengineers, all led by the fifty-year-old Professor Gerosa. The patient regained consciousness forty-eight hours later on his birthday, waking to new hope for the future. He no longer has his heart, which was beyond repair and had compromised other vital organs, including his liver and kidneys. In fact, the man would not have survived a transplant or anti-rejection treatment. Now he can recover – with the artificial heart, all he needs is anti-thrombosis therapy – and get ready to receive a real heart.
In the meantime, he is the first Italian with a rhythmic beat in his chest and a dead man’s ECG reading. The ECG is completely flat because in effect he has no heart. How long he will stay like depends on various factors. Some four hundred totally artificial hearts, of which a hundred or so are the latest model, have been implanted since the 1990s. The record holder is a German patient, who lived for two years with a compressed-air pump.
The “heartless” Italian was in a serious condition when he went into hospital at Padua on 30 November. Two previous operations had been unable to repair his natural heart. His life expectancy was low as he lay without hope, intubated and attached to a machine that supported his failing heart. He needed a cardiac output of at least nine litres but even with help his own heart was unable to deliver more than four. The health of his other organs was beyond recovery. But Professor Gerosa had been waiting for the right patient for the CardioWest TAH (Total Artificial Heart) and the operation went ahead.
The news was announced yesterday, when doctors were sure that the patient was making a satisfactory recovery. Professor Gerosa notes: “The device implanted does more than enable the patient to survive. It gives him the assurance of an excellent quality of life”. The president of the Veneto regional authority, Giancarlo Galan, was delighted: “Another prestigious achievement for our health service and a source of pride and satisfaction for Veneto residents”. The artificial heart weighs 160 grams, about half the weight of a natural organ. It is made up of two ventricular chambers, each comprising a semi-rigid polyurethane housing containing a flexible membrane that separates the chamber for the patient’s blood from the air chamber that pumps the blood into circulation. The polyurethane diaphragms “beat”, driven by compressed air from a fixed or portable external console. The portable version, which weighs one and a half kilograms and can be shoulder slung, has a maximum running time of six hours, after which it has to be recharged with new canisters of compressed air. The cost of the artificial heart implant alone is eight thousand euros. The next step is a totally artificial, totally implantable heart with its own source of energy. It’s ready and waiting.
Mario Pappagallo