TIME: Almanac 1993/TIME Almanac 1993.iso/time/caps/82/82clark

Text File | 1992-10-05 | 8.5 KB | 167 lines

                î±                                                            December 13, 1982 

Barney Clark's Artificial Heart

Living on Borrowed Time

Barney Clark get the first permanent artificial heart


Shortly after he awoke last Thursday morning in Salt Lake City,
Barney Clark recognized the familiar sight and voice of his wife
Una Loy, who was near by. There was also an unfamiliar noise:
 a soft, rhythmical clicking coming from his chest. And he
realized, to his surprise, that he was still alive.

Clark, a 61-year-old retired dentist from Des Moines, Wash., had
just become the first human to receive a permanently implanted
artificial heart. As he stirred to consciousness, Clark signaled
Surgeon William DeVries that he was not in pain. For DeVries,
38, that satisfying moment was the culmination of the three
years he had spent perfecting the technique that made the
implant possible, and waiting for a patient who met the rigorous
criteria established for implant candidates by the Food and Drug
Administration. No wonder DeVries described the 7 1/2-hr.
operation as being "almost a spiritual experience.

When he flew to Salt Lake City on Monday, Clark was clearly
dying. Once a vigorous man and an avid golfer (handicap in his
prime:  six), Clark was suffering through the final stages of
cardiomyopathy, a progressive weakening of the heart muscle that
inevitably leads to congestive heart failure. The only permanent
cure for cardiomyopathy is replacement of the heart, but at 61
he was eleven years over the usual age limit agreed upon by
surgeons for a transplant.

Last September, Clark visited the University of Utah Medical
Center to review his only real option:  a pneumatically powered
heart developed there by Dr. Robert Jarvik, a 36-year-old
medical prodigy who began to design his first invention, a
surgical stapler, at age 17. Clark toured a facility where
several sheep and calves are kept alive by Jarvik's hearts, and
even witnessed an implantation. A calf named Tennyson set the
survival record of 268 days before succumbing to an infection
last year.

Clark went home because his condition "wasn't bad enough,"
recalls Dr. Chase Peterson, vice president of the Utah hospital.
But in recent weeks Clark's heart deteriorated rapidly, and he
became bed- ridden. Finally, says Peterson, "he called us last
Saturday and said, `It's time.'"

It was almost too late. When Clark arrived at the hospital, his
heart was pumping one liter of blood per minute, one-fifth the
normal rate. Surgery was set for 8 a.m. Thursday. Clark had
already been approved by the hospital's selection committee. In
addition to suffering from a fatal heart condition with no
alternative treatment, he more than met the criteria for
psychological stability and a strong will to live. "This man was
worth waiting for," said Committee Member Peg Miller.

On Wednesday night, Clark's heart began to beat irregularly.
"Why don't we get this over with?" he murmured to his wife. A
few minutes later, DeVries decided to do just that and readied
himself for his third operation of the day and the most
significant of his career.

As a gentle snow began to fall outside, Clark was wheeled into
a specially equipped surgical suite. Already assembled was a
17-member team with Jarvik as an observer. Working quietly and
steadily to the hushed strains of Ravel's Bolero, DeVries made
a 9 1/2-in. incision from the breastbone to the abdomen and
carefully completed the delicate task of connecting Clark to a
heart-lung bypass machine that would pump and oxygenate his
blood until the plastic heart was in place.

Then DeVries removed the two pumping chambers (or ventricles)
of Clark's heart, leaving the two atria, which function as
storage chambers for blood. In all, about two-thirds of the
heart were cut away. The cavity in the chest of the 6-ft. 2-in.
Clark could easily accommodate the Jarvik-7. "There's room
enough for two!"  said DeVries with delight. The prosthesis is
slightly larger than an average heart and too large, in fact,
for most women.

Next came trouble. Before the artificial heart could be put in
place, Dacron connectors had to be sewn onto the ends of the
two atria, the aorta and the pulmonary artery. The heart snaps
into these grooved, circular connectors in a manner that DeVries
says is "like closing Tupperware."  However, when he attempted
to install the connectors, he found that the tissue around
Clark's heart "would tear like tissue paper."  Slowly, gingerly,
DeVries managed to attach the four cuffs and finally to snap in
the Jarvik-7. The device was primed with blood, but DeVries was
dissatisfied with its performance. He resutured the connectors
and tried again. Still no good. Finally DeVries decided to
install a second left ventricle "that we had on the shelf. It
worked beautifully."  Clark's blood pressure slowly rose to a
normal 119/75, compared with a feeble 85/40 before surgery.

"He's through the worst part," said DeVries after the operation,
"but there are many more hurdles to come."  Clark cleared one
on Saturday when, after he had been taken off the critical list,
he was ordered back into surgery for minor repairs. The
operation went well, but Clark still faces a high risk of blood
clotting, pneumonia and especially infection, which could
develop around the tubes that enter his chest; they carry the
pulses of air that drive the heart. But the artificial organ
does have a key advantage over one from a human donor:  since
the plastic device contains no tissue, Clark's body is less
likely to reject it.

No matter how long he survives, life will not be easy for
Barney Clark. He is permanently tethered to 375 lbs. of
equipment that includes two compressors, a back-up compressor,
a three-hour supply of pressurized air to operate the heart in
case of a power failure, a drier to dehumidify the air, and
mechanisms that control the air pressure and heart rate. All of
this gear can be placed on what his doctors call a "shopping
cart," which must always be within six feet of the patient, the
length of the power lines that emerge from just below Clark's
rib cage.

The operation costs $15,000, and the equipment, including the
heart, $16,450. The hospital estimates that the family will have
to spend $2,700 to adapt an apartment to the patient's needs.
Clark's activities will, however, be limited not only by the
reach of his life lines but by the fact that the heart cannot
pump enough blood to support more than moderate activity. In the
past, DeVries has commented that "sex may be the most strenuous
thing these patients do."

Given these limitations, what is the role of the permanent
artificial heart?  "The best solution remains the heart
transplant," insists Dr. Christiaan Barnard, the South African
surgeon who pioneered that solution. Transplants have kept
patients alive for up to 14 years. (In the U.S., some 500 people
have received transplants since 1967; the current five-year
survival rate is 42%.)

But there are simply not enough donor hearts around for the up
to $75,000 U.S. patients who need them each year. For this
reason, Barnard's fellow pioneers, Michael DeBakey and Denton
Cooley, say the Utah heart is an important breakthrough. Both
believe, however, that it should be used only temporarily to
sustain patients until donors can be found. Cooley has in fact
twice used a more primitive apparatus than Jarvik's for this
purpose. Says Cooley:  "I've never thought of the artificial
heart and transplant as being competitive. They complement each
other."

Future patients may look forward to Jarvik's electrohydraulic
heart, a fully portable model powered by an implantable pump and
a 5-lb. battery belt worn strapped to the waist. Jarvik hopes
to have the device ready in three years. He has tested it in
animals. But there is already heavy demand for the model, used
last week, despite all its limitations. Still, DeVries says,
"I'm not prepared to do it again until we can get Dr. Clark
worked out."

The dentist's progress has already exceeded everyone's
expectations, including his own. Before the operation, Clark had
told his son Stephen that he did not expect the surgery to
succeed. By week's end, however, Dr. Peterson reported that
Clark "had gone from a man who was blue from not enough oxygen
before surgery to being pink." He was also talking, moving his
arms and legs and, thanks to a stalwart plastic heart, beginning
to enjoy a life on borrowed time.

--By Claudia Wallis. Reported by Cheryl Crooks/Salt Lake City