0
February 12, 1988, Vol 259, No. 6 >
ARTICLE | February 12, 1988

The Permanent Artificial Heart: Title and subTitle BreakFour Case Reports FREE

William C. DeVries, MD
[+] Author Affiliations

Reprint requests to Humana Heart Institute International, One Audubon Plaza Dr, Louisville, KY 40217 (Dr DeVries).


JAMA. 1988;259(6):849-859. doi:10.1001/jama.1988.03720060017024
Text Size: A A A
Published online
Article
References

This article describes the clinical course of four patients in whom the Jarvik-7-100 total artificial heart was implanted as a permanent device. Details of their preoperative assessment and comprehensive summaries of their postoperative course are presented. The neurological, hematological, renal, and infectious complications they experienced and the interventions initiated to achieve resolution of these problems are described. Finally, revisions in the treatment protocols as a consequence of the experience and knowledge gained are examined.

(JAMA 1988;259:849-859)

REFERENCES

1 +
The Working Group on Mechanical Circulatory Support of the National Heart, Lung, and Blood Institute: Artificial Heart and Assist Devices: Directions, Needs, Costs, Societal and Ethical Issues , US Dept of Health and Human Services publication (NIH) 85-2723. Bethesda, Md, Public Health Service, 1985;.
2 +
Evans RW, Manninen DL, Gersh BJ, et al:  The need for and supply of donor hearts for transplantation. J Heart Transplant 1984;;4:57-62.
3 +
Evans RW, Manninen DL, Overcast TD, et al: The National Heart Transplantation Study: Final Report . Seattle, Battelle Human Affairs Research Centers, 1984;, vols 1-5.
4 +
Akutsu T, Kolff WJ:  Permanent substitute for valves and hearts. Trans Am Soc Artif Intern Organs 1958;;4:230.
5 +
Dew PA, Olsen DB, Kessler TR, et al:  Mechanical failures in in vivo and in vitro studies of pneumatic total artificial hearts. Trans Am Soc Artif Intern Organs 1984;;30:112-116.
6 +
Hastings WL, Aaron JL, Deneris J, et al:  A retrospective study of nine calves surviving five months on the pneumatic total artificial heart. Trans Am Soc Artif Intern Organs 1981;;27:71.
7 +
Chiang BY, Olsen DB, Dries D, et al:  An analysis of animals surviving over 100 days on the total artificial heart. Artif Organs 1983;;7:12.
8 +
Jarvik R, Heimes HP, Rosenberg G, et al:  Panel Conference: Portable Artificial Heart Systems. Trans Am Soc Artif Intern Organs 1983;;29:754-756.
9 +
Mochizuki T, Hastings WL, Olsen DB, et al:  Postoperative hemodynamic changes in calves implanted with total artificial hearts designed for human application. Trans Am Soc Artif Intern Organs 1980;;26:55-59.
10 +
Jarvik RK, Olsen DB, Kessler TR, et al:  Criteria for human total artificial heart implantation based on steady state animal data. Trans Am Soc Artif Intern Organs 1977;;23:535-541.
11 +
Murray KD, Hughes S, Bearnson D, et al:  Infection in total artificial heart recipients. Trans Am Soc Artif Intern Organs 1983;;29:539-545.
12 +
Murray KD, Abbott T, DeVries WC, et al:  The microscopic evaluation of skin buttons used in a long-term human total artificial heart patient. Trans Am Soc Artif Intern Organs 1986;;32:42-45.
13 +
Cooley DA, Liotta D, Hallman GL, et al:  Orthotopic cardiac prosthesis for two-staged cardiac replacement. Am J Cardiol 1969;;24:723.
14 +
Frazier OH, Akutsu T, Cooley DA:  Total artificial heart utilization in man. Trans Am Soc Artif Intern Organs 1982;;28:534-537.
15 +
Cooley DA:  Staged cardiac transplantation: Report of three cases. Heart Transplantation 1982;;1( (2) ):145.
16 +
DeVries WC, Anderson JL, Joyce LD, et al:  Clinical use of the total artificial heart. N Engl J Med 1984;;310:273-278.
17 +
Joyce LD, DeVries WC, Hastings WL, et al:  Response of the human body to the first permanent implant of the Jarvik-7 total artificial heart. Trans Am Soc Artif Intern Organs 1983;;29:81-87.
18 +
Anderson FL, DeVries WC, Anderson JL, et al:  Evaluation of total artificial heart performance in man. Am J Cardiol 1984;;54:394-398.
19 +
DeVries WC, Joyce LD:  The artificial heart. Ciba Clin Symp 1983;;35:1-32.
20 +
Mays JB, Williams MA, Barker LE, et al:  Clinical management of total artificial heart drive systems. JAMA 1988;;259:881-885.
21 +
Starling EH: The Linacre Lecture on the Law of the Heart, Cambridge, 1915 . London, Longmans Green & Co, 1918;.
22 +
Olsen DB, Kolff WJ, Lawson J, et al:  Saving the aortic and pulmonary valves with total heart replacement. Trans Am Soc Artif Intern Organs 1976;;22:468-476.
23 +
Hastings WL, Joyce LD, DeVries WC, et al:  Drive system management in the clinical implantation of the Jarvik-7 total artificial heart. Prog Artif Organs 1983;, pp 219-220.
24 +
Willshaw P, Nielsen SD, Nanas J, et al:  A cardiac output monitor and diagnostic unit for pneumatically driven artificial hearts. Artif Organs 1984;;8:215-219.
25 +
Mays JB, Williams MA, Barker LE, et al:  Diagnostic monitoring and drive system management of patients with total artificial heart. Heart Lung 1986;;15:466-475.
26 +
DeVries WC, Mays JB, Hastings WL, et al:  Effect of drive system modification on hematologic profiles of two permanent total artificial heart recipients. Abstracts Am Soc Artif Intern Organs 1986;;15:15.
27 +
Levinson MM, Copeland JG, Smith RG, et al:  Indexes of hemolysis in human recipients of the Jarvik-7 total artificial heart: A cooperative report of 15 patients. J Heart Transplant 1986;;3:236-248.
28 +
Dobbins JJ, Johnson GS, Kunin CM, et al:  Postmortem microbiological findings of two total artificial heart recipients. JAMA 1988;;259:865-869.
29 +
Schwab TR, Edwards BS, DeVries WC, et al:  Atrial endocrine function in humans with the artificial heart. N Engl J Med 1986;;315:1398-1401.
30 +
Joyce LD, Johnson KE, Pierce WS, et al:  Summary of the world experience with clinical use of total artificial heart and cardiac support devices. J Heart Transplant 1986;;3:229-235.
31 +
DeVries WC:  Surgical technique for implantation of the Jarvik-7-100 total artificial heart. JAMA 1988;;259:875-880.
32 +
Duncan PE, Hughes SD, Jarvik RK, et al:  Choice of the Medtronic-Hall valve in the Jarvik-7 total artificial heart. Abstracts Am Soc Artif Intern Organs 1984;;13:3.
33 +
Harker LA:  Concepts of thrombus formation, dissolution, and antithrombotic therapy , in Guidelines for Blood-Material Interaction . US Dept of Health and Human Services publication (NIH) 85-2185, 1985;, pp 19-63.
34 +
Salzman EW, Merrill EW:  Interaction of blood with artificial surfaces , in Colman RW Hirsh J, Marder VJ, et al (eds): Hemostasis and Thrombosis . Philadelphia, JB Lippincott, 1987;, pp 1335-1347.
35 +
Mason RG, Mohammad SF, Chuang HYK:  Artificial devices in clinical practice , in Colman RW, Hirsh J, Marder VJ, et al (eds): Hemostasis and Thrombosis . Philadelphia, JB Lippincott, 1987;, pp 1348-1365.
36 +
Harker LA, Schlicter SJ:  Studies of platelet and fibrinogen kinetics in patient with prosthetic heart valves. N Engl J Med 1970;;283:1302-1305.
37 +
Sullivan JM, Harken DE, Gorlin R:  Pharmacologic control of thromboembolic complications of cardiac valve replacement. N Engl J Med 1971;; 284:1391-1394.
38 +
Hanson SR, Harker LA, Bjornsson TD:  Effects of platelet-modifying drugs on arterial thromboembolism in baboons. J Clin Invest 1985;;75:1591-1599.
39 +
Harker LA, Malpass TW, Branson HE, et al:  Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selective α-granule release. Blood 1980;;56:824-834.
40 +
Craddock PR, Fehr J, Dalmasso AP, et al:  Hemodialysis leukopenia: Pulmonary vascular leukostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest 1977;;59:879-888.
41 +
Chenoweth DE, Cheung AK, Henderson LW:  Anaphylatoxin formation during hemodialysis: Effects of different dialyzer membranes. Kidney Int 1983;;24:764-769.
42 +
Hammerschmidt DE, Stoncek DF, Bowers TK, et al:  Complement activation and neutropenia occurring during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1981;;81:370-377.
43 +
Chenoweth DE, Cooper SW, Hugh TE, et al:  Complement activation during cardiopulmonary bypass. N Engl J Med 1981;;304:497-503.
44 +
Wellhausen SR, Ward RA, Johnson GS, et al:  Immunologic complications of long-term implantation of a total artificial heart. J Clin Immunol , in press.
45 +
Ward RA, Wellhausen SR, Dobbins JJ, et al:  Thromboembolic and infectious complications of total artificial heart implantation. Ann NY Acad Sci , in press.
46 +
Stelzer GT, Ward RA, Wellhausen SR, et al:  Alterations in select immunologic parameters following total artificial heart implantation. Artif Organs , in press.
47 +
Kunin CM, Dobbins JJ, Melo JC, et al:  Infectious complications in four long-term recipients of the Jarvik-7 artificial heart. JAMA 1988;;259:860-864.
48 +
Gristina AG, Dobbins JJ, Giammara B, et al:  Biomaterial-centered sepsis and the total artificial heart: Microbial adhesion vs tissue integration. JAMA 1988;;259:870-874.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
The Working Group on Mechanical Circulatory Support of the National Heart, Lung, and Blood Institute: Artificial Heart and Assist Devices: Directions, Needs, Costs, Societal and Ethical Issues , US Dept of Health and Human Services publication (NIH) 85-2723. Bethesda, Md, Public Health Service, 1985;.
2 +
Evans RW, Manninen DL, Gersh BJ, et al:  The need for and supply of donor hearts for transplantation. J Heart Transplant 1984;;4:57-62.
3 +
Evans RW, Manninen DL, Overcast TD, et al: The National Heart Transplantation Study: Final Report . Seattle, Battelle Human Affairs Research Centers, 1984;, vols 1-5.
4 +
Akutsu T, Kolff WJ:  Permanent substitute for valves and hearts. Trans Am Soc Artif Intern Organs 1958;;4:230.
5 +
Dew PA, Olsen DB, Kessler TR, et al:  Mechanical failures in in vivo and in vitro studies of pneumatic total artificial hearts. Trans Am Soc Artif Intern Organs 1984;;30:112-116.
6 +
Hastings WL, Aaron JL, Deneris J, et al:  A retrospective study of nine calves surviving five months on the pneumatic total artificial heart. Trans Am Soc Artif Intern Organs 1981;;27:71.
7 +
Chiang BY, Olsen DB, Dries D, et al:  An analysis of animals surviving over 100 days on the total artificial heart. Artif Organs 1983;;7:12.
8 +
Jarvik R, Heimes HP, Rosenberg G, et al:  Panel Conference: Portable Artificial Heart Systems. Trans Am Soc Artif Intern Organs 1983;;29:754-756.
9 +
Mochizuki T, Hastings WL, Olsen DB, et al:  Postoperative hemodynamic changes in calves implanted with total artificial hearts designed for human application. Trans Am Soc Artif Intern Organs 1980;;26:55-59.
10 +
Jarvik RK, Olsen DB, Kessler TR, et al:  Criteria for human total artificial heart implantation based on steady state animal data. Trans Am Soc Artif Intern Organs 1977;;23:535-541.
11 +
Murray KD, Hughes S, Bearnson D, et al:  Infection in total artificial heart recipients. Trans Am Soc Artif Intern Organs 1983;;29:539-545.
12 +
Murray KD, Abbott T, DeVries WC, et al:  The microscopic evaluation of skin buttons used in a long-term human total artificial heart patient. Trans Am Soc Artif Intern Organs 1986;;32:42-45.
13 +
Cooley DA, Liotta D, Hallman GL, et al:  Orthotopic cardiac prosthesis for two-staged cardiac replacement. Am J Cardiol 1969;;24:723.
14 +
Frazier OH, Akutsu T, Cooley DA:  Total artificial heart utilization in man. Trans Am Soc Artif Intern Organs 1982;;28:534-537.
15 +
Cooley DA:  Staged cardiac transplantation: Report of three cases. Heart Transplantation 1982;;1( (2) ):145.
16 +
DeVries WC, Anderson JL, Joyce LD, et al:  Clinical use of the total artificial heart. N Engl J Med 1984;;310:273-278.
17 +
Joyce LD, DeVries WC, Hastings WL, et al:  Response of the human body to the first permanent implant of the Jarvik-7 total artificial heart. Trans Am Soc Artif Intern Organs 1983;;29:81-87.
18 +
Anderson FL, DeVries WC, Anderson JL, et al:  Evaluation of total artificial heart performance in man. Am J Cardiol 1984;;54:394-398.
19 +
DeVries WC, Joyce LD:  The artificial heart. Ciba Clin Symp 1983;;35:1-32.
20 +
Mays JB, Williams MA, Barker LE, et al:  Clinical management of total artificial heart drive systems. JAMA 1988;;259:881-885.
21 +
Starling EH: The Linacre Lecture on the Law of the Heart, Cambridge, 1915 . London, Longmans Green & Co, 1918;.
22 +
Olsen DB, Kolff WJ, Lawson J, et al:  Saving the aortic and pulmonary valves with total heart replacement. Trans Am Soc Artif Intern Organs 1976;;22:468-476.
23 +
Hastings WL, Joyce LD, DeVries WC, et al:  Drive system management in the clinical implantation of the Jarvik-7 total artificial heart. Prog Artif Organs 1983;, pp 219-220.
24 +
Willshaw P, Nielsen SD, Nanas J, et al:  A cardiac output monitor and diagnostic unit for pneumatically driven artificial hearts. Artif Organs 1984;;8:215-219.
25 +
Mays JB, Williams MA, Barker LE, et al:  Diagnostic monitoring and drive system management of patients with total artificial heart. Heart Lung 1986;;15:466-475.
26 +
DeVries WC, Mays JB, Hastings WL, et al:  Effect of drive system modification on hematologic profiles of two permanent total artificial heart recipients. Abstracts Am Soc Artif Intern Organs 1986;;15:15.
27 +
Levinson MM, Copeland JG, Smith RG, et al:  Indexes of hemolysis in human recipients of the Jarvik-7 total artificial heart: A cooperative report of 15 patients. J Heart Transplant 1986;;3:236-248.
28 +
Dobbins JJ, Johnson GS, Kunin CM, et al:  Postmortem microbiological findings of two total artificial heart recipients. JAMA 1988;;259:865-869.
29 +
Schwab TR, Edwards BS, DeVries WC, et al:  Atrial endocrine function in humans with the artificial heart. N Engl J Med 1986;;315:1398-1401.
30 +
Joyce LD, Johnson KE, Pierce WS, et al:  Summary of the world experience with clinical use of total artificial heart and cardiac support devices. J Heart Transplant 1986;;3:229-235.
31 +
DeVries WC:  Surgical technique for implantation of the Jarvik-7-100 total artificial heart. JAMA 1988;;259:875-880.
32 +
Duncan PE, Hughes SD, Jarvik RK, et al:  Choice of the Medtronic-Hall valve in the Jarvik-7 total artificial heart. Abstracts Am Soc Artif Intern Organs 1984;;13:3.
33 +
Harker LA:  Concepts of thrombus formation, dissolution, and antithrombotic therapy , in Guidelines for Blood-Material Interaction . US Dept of Health and Human Services publication (NIH) 85-2185, 1985;, pp 19-63.
34 +
Salzman EW, Merrill EW:  Interaction of blood with artificial surfaces , in Colman RW Hirsh J, Marder VJ, et al (eds): Hemostasis and Thrombosis . Philadelphia, JB Lippincott, 1987;, pp 1335-1347.
35 +
Mason RG, Mohammad SF, Chuang HYK:  Artificial devices in clinical practice , in Colman RW, Hirsh J, Marder VJ, et al (eds): Hemostasis and Thrombosis . Philadelphia, JB Lippincott, 1987;, pp 1348-1365.
36 +
Harker LA, Schlicter SJ:  Studies of platelet and fibrinogen kinetics in patient with prosthetic heart valves. N Engl J Med 1970;;283:1302-1305.
37 +
Sullivan JM, Harken DE, Gorlin R:  Pharmacologic control of thromboembolic complications of cardiac valve replacement. N Engl J Med 1971;; 284:1391-1394.
38 +
Hanson SR, Harker LA, Bjornsson TD:  Effects of platelet-modifying drugs on arterial thromboembolism in baboons. J Clin Invest 1985;;75:1591-1599.
39 +
Harker LA, Malpass TW, Branson HE, et al:  Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selective α-granule release. Blood 1980;;56:824-834.
40 +
Craddock PR, Fehr J, Dalmasso AP, et al:  Hemodialysis leukopenia: Pulmonary vascular leukostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest 1977;;59:879-888.
41 +
Chenoweth DE, Cheung AK, Henderson LW:  Anaphylatoxin formation during hemodialysis: Effects of different dialyzer membranes. Kidney Int 1983;;24:764-769.
42 +
Hammerschmidt DE, Stoncek DF, Bowers TK, et al:  Complement activation and neutropenia occurring during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1981;;81:370-377.
43 +
Chenoweth DE, Cooper SW, Hugh TE, et al:  Complement activation during cardiopulmonary bypass. N Engl J Med 1981;;304:497-503.
44 +
Wellhausen SR, Ward RA, Johnson GS, et al:  Immunologic complications of long-term implantation of a total artificial heart. J Clin Immunol , in press.
45 +
Ward RA, Wellhausen SR, Dobbins JJ, et al:  Thromboembolic and infectious complications of total artificial heart implantation. Ann NY Acad Sci , in press.
46 +
Stelzer GT, Ward RA, Wellhausen SR, et al:  Alterations in select immunologic parameters following total artificial heart implantation. Artif Organs , in press.
47 +
Kunin CM, Dobbins JJ, Melo JC, et al:  Infectious complications in four long-term recipients of the Jarvik-7 artificial heart. JAMA 1988;;259:860-864.
48 +
Gristina AG, Dobbins JJ, Giammara B, et al:  Biomaterial-centered sepsis and the total artificial heart: Microbial adhesion vs tissue integration. JAMA 1988;;259:870-874.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems