11 The Artificial Heart: Emergence, Progression, and Impact on Society
Madelyn Bullard
Keywords
- Biomedicine: The intersection of biological research and medicine.
- Heart Disease: heart conditions such as coronary artery disease, high blood pressure, and cardiac arrest that cause vessels to disease, heart muscles to weaken, and blood clots.
- Total Artificial Heart (TAH): An artificial heart that replaces the natural heart. Used to bridge the time to heart transplantation or to permanently replace the heart in which transplant is impossible.
- Ventricular Assist Device: An electromechanical device for assisting cardiac circulation, and is used either to partially or completely replace the function of a failing heart:
- Ventricles: Bottom two main chambers of the heart.
- Atrium: Two upper chambers of the heart.
- Pneumatic Drive Lines: A system that transforms energy from compressed air into rotational movement. Located outside of the body and allows for movement of blood.
- Driver: Control the pump of the artificial heart outside the body.
- Cardiopulmonary Bypass Machine: an external device used to function for the heart and lungs, for only a few hours at a time during surgery.
- Jarvik 7- Artificial Heart: The first authorized bridge to organ transplant operation.
Learning Objectives
- Discuss how the artificial heart works and its significance to the medical field.
- Describe the emergence and progression of the artificial heart.
- Understand the impact the artificial heart had on the Baby Boomer generation.
- List the benefits and limitations of the artificial heart.
11.1 Introduction
It is a popular misconception that technology is a foreign device to the Baby Boomer generation (Huyler, D. D., & Ciocca, D. J., 2016). However, during their prime, the Baby Boomer generation had many major technological advancements across a wide array of fields. One of those fields being biomedicine, which is the intersection of biological research and medicine. After the Cold War, biomedicine came to the forefront of research and public discussion, as there was a new initiative to focus on human health and disease (Jansen, A., & Roesch, C. 2022). There was also a sense of technological and medical competition, and the race to make strides in these fields. This generation witnessed major breakthroughs in biomedical technologies such as: DNA fingerprinting, the portable dialysis machine, controlled drug release technology, and what will be the focus of this chapter: the total artificial heart.
The 20th century was the first century in which heart disease was the most common cause of death in the US (Goldberg & Weinstein, 2014). Heart disease also known as coronary heart disease is a common condition that affects the major vessels of the heart. Heart disease peaked during the 1960’s due to an increase in smoking and unhealthy dietary changes such as the consumption of more processed foods (Goldberg & Weinstein, 2014). The heart is a vital organ for which we can not live without; for this reason medical scientist dedicated decades to a solution. The artificial heart was created as an endeavor to preserve a patients’ life as long as possible until a donor heart was available. There were both benefits and shortcomings to the creation of the artificial heart. An obvious benefit to this technology was that it gave hope to patients who had end-stage heart disease and the technology itself was revolutionary to the medical field. Yet, there were also limitations because as with most technologies there was not a guarantee the artificial heart would work. There were many possible complications to not only the implantation itself but also post-operatively. The artificial heart impacted the Baby Boomer generation by increasing life expectancy, changing the public’s perception of healthcare, and increasing the effectiveness but also the cost of healthcare.
11.2. What is an Artificial Heart
Key Takeaway(s)
The artificial heart is a synthetic organ that works by mimicking the pump-like mechanism of the human heart.
The human heart is a very mechanical organ, it works much like a pump where pressure, valves and volume equip its function. For this reason the design of the artificial heart is much like the design of a human heart. There are two types of artificial hearts that exist today, the total artificial heart (TAH) which is implanted after the natural heart is removed, and the ventricular assist device which is used to assist the patient’s natural heart. The ventricular assist heart replaces the lower chambers of the heart called the ventricles. The total artificial heart, which became prevalent during the Baby Boomer generation, is required when a patient has bi-ventricular failure, where both sides of the heart fail (Jarvik Heart, Inc., 2016). One goal of the technology is to prevent multi-system organ failure by mimicking the work of the ventricles, and restoring blood flow to the entire body. Another goal is to extend the patient’s life as they wait for a transplant.
Heart failure is a chronic condition defined by the heart’s muscular failure of the ventricles. The left ventricle is significantly larger than the right because it pumps blood to the entire body where the right only pumps blood to the lungs. Heart failure can result from the thinning of the heart’s muscles and valves from damage caused by high blood pressure, heart attacks, or infection in the heart (Jarvik Heart, Inc., 2016). There are drugs in place created to help with these diseases, but once the heart reaches a certain stage, there is only so much medication can do. If heart failure reaches an advanced stage “60-94%” of patients will die within 1 year (Khan & Jehangir, 2014).
The first total artificial heart, called the Jarvik 7, was made out of aluminum and polyurethane, which is a plastic like material. Similar to the human heart, the total artificial heart has four mechanical valves that work to control blood from the upper chambers of the heart called the atrium, to the lower chambers and major arteries. The first artery being the aorta which brings blood from the entire body to the heart, and the other being the pulmonary artery which sends deoxygenated blood to the lungs to get oxygenated. Tubes called pneumatic drive lines go through holes in the stomach to connect to the machine called the driver that sits outside of the body and powers the heart (How Does It Work?, 2022). The artificial heart is distinct from other cardiac technologies such as the cardiopulmonary bypass machine which came before it. The cardiopulmonary bypass machine is different as it is an external device used to function for the heart and lungs, for only a few hours at a time during surgery.
Figure 11.2 The image shows the ventricular assist device, and the direction of blood flow through the heart.
“Ventricular Assist Device “ by Bruce Blaus is licensed under CC BY-SA 4.0
11.3 History of the Artificial Heart
Key Takeaway(s)
The first artificial heart was first created for patients suffering from heart failure, and was a way to bridge the gap of waiting for a transplant.
As imagined there were many small progressions that brought forward the creation of the total artificial heart. Before the finalization and release of this technology, models had been tested on in animals as early as 1957, and by the mid-1970s, several artificial heart designs had already come into existence (Ryan et al., 2015). In 1969, Dr. Denton Cooley executed the first total artificial heart transplantation in a human. The 47- year old patient who received this heart, only lived for 32 hours before he died due to rejection of the heart and pneumonia. Although the patient died. Dr. Cooley recognized that human circulation by a mechanical device had the potential to be successful. At the time of its invention, implantation of a total artificial heart had similar significance to landing on the moon. The artificial heart played a major role in advancing medical technology, as it pushed biological and engineering boundaries.
When someone has severe heart damage they are oftentimes placed on a transplant list. The total artificial heart was created for patients who were waiting on the transplant list, so that they could sustain their lives until they were able to receive a new heart. In 1982, Dr. Robert Jarvik became renowned for his work on the first permanent artificial heart which proved to be successful. Jarvik was first inspired during his undergraduate years as student when his father needed to have surgery for his failing heart. Dr. Jarvik first practiced the permanent total artificial heart on cows and made sure that it could pump at least 100,000 times a day (The First Artificial Heart, 30 Years Later, n.d.). The first human implantation of the Jarvik- artificial heart was in 1982 on Barney Clark, by the medical university of Utah. Clark survived the surgery for 112 days, where he later passed away from multiple-system organ failure due to other complications from infection. After Clark’s operation, the Jarvik-7 model was implanted many more times (Kiger, 2010). Although, this technology was first recognized as permanent because the patient could survive on it for an extended amount of time; it was later deemed to not be permanent due to the fact that patients had to be connected to a large pneumatic console.
11.4 Impact of the Artificial Heart on the Social Generation
Key Takeaway(s)
At the time of the implantation of the first artificial heart, a lot of the world was captivated. However, one of the unintended consequences of the artificial heart is that some compared the technology with Frankenstein-like aspects, raising bioethical questions and concerns. The openness of this medical experiment facilitated by the University of Utah fueled heated public debate on a variety of medical research. Issues like the involvement of the medical profession in Nazi war crimes, unethical experiments on minorities in the Unites States, and the development of oral contraceptives all caused major discussion within society. States began to negotiate the roles of medical and scientific professions, as well as the risks and limits associated with scientific research (Jansen, A., & Roesch, C. 2022). Another unintended consequence were the drawbacks to its design, not only was the heart itself expensive, costing around 125,000 dollars, it also generated a noise that was disturbing to patients. The total artificial heart is not fully implanted within the body so in a way it limits mobility and convenience of patients. Lastly, another major unintended consequence was the increased chance for secondary complications after the procedure like infections (Gray & Selzman, 2006).
The implementation of the artificial heart technology involved making life-or death decisions. Many questioned its reliability, success, and if it actually gave the patient any quality of life. An Intended consequence of the artificial heart is that it gives patients who had no other options a chance to hopefully have more time to live. It also brought more awareness to heart disease and its possible outcomes. A positive unintended consequence is that other cardiac technologies were further developed like the electrocardiogram, which helped to increase the recognition of coronary heart disease before it was too late (Dalen et al., 2014). Primary health care also increased at this time as more technological studies were done, and investigation of the social causes of disease also increased (Cueto, 2004). Overall, the artificial heart was revolutionary to the medical field, and its success surprised the public.
11.5 How the Artificial Heart Evolved
Key Takeaway(s)
The total artificial heart is still being used today. Scientific research continues to be made on how to improve the device and quality of life of patients with heart failure.
The total artificial heart is one of the most prominent medical inventions of the 20th century, especially due to the increasing population with end-stage heart failure. As the artificial heart progressed, not only did its engineering design develop but also the post-operative knowledge that was critical to the well being of the patient. Since 1982, when the first total artificial heart was placed, more than 1,000 Jarvik-7 types have been implanted. The number of annual implants has steadily increased overtime, with 161 implants being done in the year 2013 alone (Ryan et al., 2015). Today, research continues to push the boundaries for what is possible. In 1994, the FDA approved the left ventricular assist device, and in 2000 the first recipient of the Jarvik-2000 was implanted. In 2001, implant of the first self- contained mechanical heart replacement was made. The device called the AbioCor, is battery powered and the size of a softball (Khan & Jehangir, 2014). Advanced heart failure programs have been established over the nation and are actively studying devices that can support a failing heart.
Overtime, researchers have accumulated knowledge on the functioning of the artificial heart, and have materialized this knowledge. Now, researchers are trying to make the technology more biologically based instead of mechanical. The device has been mechanically refined over the years. For example, the artificial heart now only weighs ten ounces, and has increased the comfortability and quality of life the patient has while on the machine. The end goal of the research is to create a pump that could avoid transplantation altogether. With each implant more knowledge is gained on how to make the heart better, and the technology helps decrease the number of patients on the transplant list (Cueto, 2004).
Figure 11.3 A more recent image of an artificial heart exhibited at the London science museum.
“Artificial Heart London” by Rick Proser is licensed under CC BY 3.0.
Case Study: Interview with Dr. William DeVries and his Experience in Completing the First Total Artificial Heart Implantation.
The University of Utah conducted an interview with the surgeon who implanted the the first Jarvik-7 into patient Barney Clark in 1982. Surgeon William DeVries was asked a series of questions, the first being “Did you think the Jarvik-7 heart would work?”. DeVries answered; “Absolutely”. He would not have done the surgery if he felt otherwise. He states that the Jarvik-7 is very similar to the total artificial heart being used today. He was then asked “How was success defined?” and answered that the IRB (Institutional Review Board) defined success as Clark coming out of the surgery alive, which shocked him because he was devoted to ensuring Clark had some quality of life. Next, he was asked “Why Barney Clark?” , he answered that Barney was a dentist and understood some of the medical science behind the surgery. He explained that he allowed him to watch him implant the heart into a cow, and that he wanted Clark to see the cow be able to walk around after the surgery. He also noted that Barney really had no other choice, without the surgery he was expected to die very soon.
When asked “ What was Barney’s reaction after he awoke from the surgery?” DeVries answered, by quoting Clark who said to his wife “Although I have no heart I still love you.” DeVries states that Clark remained in the hospital until his death so that he could be studied. He believed the research was important and wanted to make a difference for others in the same situation. Lastly, when asked “What was the most valuable result?” DeVries stated that because of the success of the implantation, there was a jump in technology and progression of the research leading to the artificial implants that are used around the world today.
Chapter Summary
In conclusion, the total artificial heart provides an example of a creative, and ahead of its time technology discovered by a generation deemed technologically deficient. The baby boomer generation had many technological advancements during its time that helped navigate future generations research. The heart is a vital organ needed for human survival, and with an increase in heart failure disease the creation of the artificial heart was significant. The goal of the heart was to give patients time to live as they patiently waited for a donor. The pioneers of the artificial heart dedicated many years to developing the technology, and faced the public’s lack of confidence in its creation. There were some unintended consequences that impacted the progression of the technology such as, increased cost in healthcare, and unpredictable secondary complications post surgery, but overall the total artificial heart met its goal of prolonging life.
Review Questions
1. What was the first authorized total artificial heart called?
- a. VAD
- b. Jarvik- 7
- c. EKG
- d. Ventricular Assist Device
2. How did the public view the total artificial heart implant at the time?
- a. No one noticed
- b. Some viewed it as revolutionary
- c. Both B and D
- d. Some were skeptical and questioned the ethics of the operation
3. Which was NOT an unintended consequence of the total artificial heart?
- a. It increased the cost of health care for patients who had heart failure.
- b. It increased awareness of heart disease and increased primary care.
- c. It increased knowledge of other cardiac medical technologies.
- d. It completely stopped anyone from ever having to receive a transplant.
Answers:
-
- b.
- c.
- d.
Food For Thought
- How ethical was the emergence of the artificial heart? Is it ethical to take medical risk when someone may die to help save them and others?
- Is it important to study last resort technologies such as the artificial heart? Should more effort and focus be placed on prevention?
- Can you think of a similar technology that at first received negative feedback from the public?
References
Cueto, M. (2004). The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care. American Journal of Public Health, 94(11), 1864–1874. https://doi.org/10.2105/ajph.94.11.1864
Dalen, J. E., Alpert, J. S., Goldberg, R. J., & Weinstein, R. S. (2014). The Epidemic of the 20th Century: Coronary Heart Disease. The American Journal of Medicine, 127(9), 807–812. https://doi.org/10.1016/j.amjmed.2014.04.015
Gray, N. A., & Selzman, C. H. (2006). Current status of the total artificial heart. American Heart Journal, 152(1), 4–10. https://doi.org/10.1016/j.ahj.2005.10.024
How Does It Work? (2022, March 24). NHLBI, NIH. https://www.nhlbi.nih.gov/health/total-artificial-heart/how-it-works
Huyler, D. D., & Ciocca, D. J. (2016). Baby Boomers: The use of technology to support learning.
Jansen, A., & Roesch, C. (2022). Introduction: Biomedicine in Contemporary History. Journal of Contemporary History, 57(4), 843–858. https://doi-org.libproxy.clemson.edu/10.1177/00220094211039547
Jarvik Heart, Inc. (2016, April 26). Heart Failure | Jarvik Heart Inc. Jarvik Heart Inc. |. https://www.jarvikheart.com/heart-disease-overview/causes/
Khan, S., & Jehangir, W. (2014, October). Evolution of artificial hearts: An overview and history. Cardiology research. Retrieved December 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358116/
Kiger, P. J. (2010, December 22). Baby Boomer Inventions That Changed the World. U.S. https://www.reuters.com/article/idUS182429596720101222
Ryan, T. D., Jefferies, J. L., Zafar, F., Lorts, A., & Morales, D. L. (2015). The Evolving Role of the Total Artificial Heart in the Management of End-Stage Congenital Heart Disease and Adolescents. ASAIO Journal, 61(1), 8–14. https://doi.org/10.1097/mat.0000000000000156
The First Artificial Heart, 30 Years Later. (n.d.). University of Utah Health. https://healthcare.utah.edu/healthfeed/postings/2012/12/120212ArtificialHeart30YearsLater.php