August 1st was the 30th day of survival for the first human to receive a self-contained artificial heart.
He's doing great. His surgeons yesterday held the third press conference since the operation in Louisville, Kentucky, to give a progress report. The patient, a married man in his 50s, remains in intensive care at Jewish Hospital in Louisville, but the heart has improved his condition considerably and he is walking, talking, and gaining strength.
There has been criticism of Abiomed (the maker of the device), the surgical team, and hospital for keeping important information from the public. The doctors' response has been that "updates too often take away from caring for the patient. We are trying to preserve and protect the patient and his family. There are no secrets: We are disclosing everything about the patient."
Doctors say the patient has "exceeded expectations." He is up every day, talking and walking short distances and moving himself around in his wheelchair. He is still weak and breathing through a tracheotomy. Occasionally he goes on a ventilator for short periods when he becomes exhausted. He has had some solid food but gets most of his nutrition through a tube.
But he is joking with and teasing the nurses and hospital staff, and cardiac surgeon Dr. Robert Dowling said it was "hard to describe him very ill" with that sort of behavior. He has said that "Life is wonderful," but Dowling says he is not out of the woods yet. He remains in intensive care, but Dowling is looking at scenarios for moving him out of there. The patient is still malnourished and that can make him more prone to infection and breathing problems.
Prior to the surgery the patient was in the end stage of heart disease. He could only walk 10 to 15 feet without assistance and his weight slipped to 140 pounds from his normal 200 pounds. He also suffered from diabetes and kidney problems. He had a 9% chance of surviving more than 30 days without the heart--hence the significance of the 30-day milestone.
He has been doing upper-body exercises, gripping a ball in his hand, and lifting light weights. He is getting stronger. There was a minor procedure a few days after surgery to drain fluid from around the heart's internal battery. He is sleeping 4 to 6 hours a day.
The heart is still working "flawlessly" and is estimated to have beaten somewhere in the neighborhood of 6 million times since implantation. Most of the settings are on automatic--most importantly the ones that regulate balance and blood pressure.
The patient has clear lungs, and his kidney and liver are functioning well. Because blood clots are a big threat, he is on blood-thinning medications. He has experienced intermittent stomach bleeding, or gastritis. They are trying to find a balance and edge him up to the ideal blood-thinning medication dose.
There have been no signs of infection and the patient has had a positive mental outlook. He has tanked the manufacturer and apparently says that he'd like to do it in person someday.
Dowling describes the last month as "intense and exhausting."
Four more implantations are planned this year at other sites around the country. Although the Louisville surgeons held a private informational teleconference last week with the patient and the other surgical teams, to date no other candidates have been chosen for future transplants. The candidate has to have a chest cavity large enough to hold the AbioCor heart, which only comes in one size. Someone with a small chest cavity would not be eligible for surgery. The makers of the heart, Abiomed, will only say that the time between the first and second implantations will be significantly longer than the time between the second, third, fourth, and fifth implantations.
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