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Doctors Achieve Milestone1 Using Artificial Heart With No Beat
In March, two doctors at the Texas Heart Institute in Houston achieved what medical experts call a major milestone by implanting a continuous-flow artificial heart in a human patient. The mechanical heart worked flawlessly. But the patient, who suffered from other grave illnesses, eventually died after he and his family decided3 not to prolong treatment. The success of the artificial heart used in that case has opened the way to greater use of the device in other cardiac patients.
Since the first artificial heart was implanted in a human here in Houston in 1969, the field has advanced steadily4. But it hasn't kept pace with the need for devices that can keep patients alive until they can get a real organ transplant. Heart disease remains5 the number one killer6 of Americans each year. Of the estimated 5 million people in the United States with failing hearts, only around 2,000 are likely to get a transplant this year.
That is where various types of artificial pumps have come into play. Last month, at the Texas Children's Hospital here in Houston, Jordan Merecka, 17, became the first patient in a U.S. pediatric hospital to have his congenitally deformed7 heart removed and replaced with an external mechanical heart pump. Meeting with reporters a few days ago, he told how he almost ran out of time, waiting to have the procedure.
"This is just a godsend. A couple months earlier and I would not be here right now," said Merecka.
Merecka, who now awaits a transplant, has limited mobility8 in the hospital as he remains tethered to the artificial heart beating loudly beside him.
But nearby, at the Texas Heart Institute, doctors and researchers are working with another type of artificial heart, one that is much smaller, much more efficient and does not beat.
Lead researcher Dr. Bud Frazier explained its advantages over devices like the one keeping Jordan Merecka alive at Children's Hospital.
"It is a good life-saving pump, but the limitation of it is that it is externally powered and externally driven, and it requires a large console," said Frazier. "So, if we are really going to impact the premature9 death from heart failure, we have to have a pump that is implantable and can replace the heart."
The artificial heart Frazier and his colleague, Dr. William Cohn, developed is small enough to be implanted in the human chest. But, unlike an animal or human heart, it produces no pulse because it is a continuous-flow mechanism10. It uses a small spinning turbine to keep blood flowing at a steady rate rather than a pump that mimics12 the action of the heart found in humans or in the calves13 the doctors have used for trials.
To provide the blood flow of a natural human heart, vibrating pumps must beat 100,000 times a day, 35 million times a year, leading to mechanical breakdowns14. The continuous-flow pumps are much more durable15 and can last years without a problem.
These continuous-flow devices have been used for some time to assist the left ventricle of the heart, which is the part that sends blood throughout the body and is the part that most often fails. But the doctors at Texas Heart Institute use a device that is essentially16 two such pumps put together to replace the functions of both sides of the heart.
Doctors Frazier and Cohn carried out the first successful implant2 of a continuous-flow artificial heart in a 55-year-old man here in Houston in March. The patient later died because of conditions unrelated to the heart operation, but Cohn says the implanted heart worked well.
"He went five weeks and his blood pressure and the flow through his body and his oxygenation was beautiful throughout that interval," recalled Cohn.
Cohn says the work he and Frazier have done shows that such a device can function much like the natural heart, even though it has no pump action to increase the pulse.
Normally when a person works or exercises, the heart beats faster so that more blood can flow to the muscles in need of energy and to the lungs where the blood is oxygenated. But Cohn says the continuous-flow heart does the same without the pulsation17.
"If the conditions change so that the amount of blood arriving to the pump increases, the flow through the pump will increase," added Cohn. "It sort of has the ability to automatically increase its flow like the mammalian heart, which is, perhaps, the biggest advantage of all."
One of the biggest problems with this kind of small, implantable device is powering it without having the patient tethered to an external source of electricity. The device Doctors Frazier and Cohn developed uses small externally connected batteries that can be easily replaced without interrupting the machine's operation. But they are investigating the use of new highly efficient batteries, even ones using a tiny amount of plutonium as a power source.
Frazier says that while this may sound exotic and dangerous, the use of plutonium for such medical devices goes back to the 1970s, when they were used in heart pacemakers and studied closely.
"The thing we were concerned about was increased instance of malignancies, but we followed over a thousand of those patients over 20 years and there was no increased instance," Frazier explained. "It is bulky, though, and expensive. We came out for pacemakers with lithium-powered batteries."
Cohn says they are studying batteries that may be able to mimic11 the human body's natural power system. "There is a lot of other research looking at biological cells, cells that are actually powered by oxygen and glucose18, much in the way the human body is," Cohn noted19. "So there is a lot of battery technology that is in the works."
Since the continuous-flow artificial heart is so efficient and durable, might some future version actually work better than the heart nature has provided? Science fiction writers have speculated that one day there might be "bionic" humans, partially20 made up of artificial components21 that make them more powerful than normal people. That is something Doctors Frazier and Cohn also debate.
FRAZIER: "I don't think so."
COHN: "Well, you never know. Never try to second guess progress and human innovation. I always joke that in the 2090 Olympics there will be 'stock and modified.' You never know where it is all going to end up."
FRAZIER: "Well, we are also.. I think we are limited in time. You know, nature has had a million years or so on us in designing these things."
Doctors Bud Frazier and William Cohn are continuing their work with artificial hearts at the Texas Heart Institute in hopes of helping22 prevent at least some of the more than 300,000 heart disease-related deaths in the United States each year. Support for the research was provided by the National Institutes of Health as well as engineers at NASA and researchers from the University of Houston and Rice University.
1 milestone | |
n.里程碑;划时代的事件 | |
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2 implant | |
vt.注入,植入,灌输 | |
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3 decided | |
adj.决定了的,坚决的;明显的,明确的 | |
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4 steadily | |
adv.稳定地;不变地;持续地 | |
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5 remains | |
n.剩余物,残留物;遗体,遗迹 | |
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6 killer | |
n.杀人者,杀人犯,杀手,屠杀者 | |
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7 deformed | |
adj.畸形的;变形的;丑的,破相了的 | |
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8 mobility | |
n.可动性,变动性,情感不定 | |
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9 premature | |
adj.比预期时间早的;不成熟的,仓促的 | |
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10 mechanism | |
n.机械装置;机构,结构 | |
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11 mimic | |
v.模仿,戏弄;n.模仿他人言行的人 | |
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12 mimics | |
n.模仿名人言行的娱乐演员,滑稽剧演员( mimic的名词复数 );善于模仿的人或物v.(尤指为了逗乐而)模仿( mimic的第三人称单数 );酷似 | |
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13 calves | |
n.(calf的复数)笨拙的男子,腓;腿肚子( calf的名词复数 );牛犊;腓;小腿肚v.生小牛( calve的第三人称单数 );(冰川)崩解;生(小牛等),产(犊);使(冰川)崩解 | |
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14 breakdowns | |
n.分解( breakdown的名词复数 );衰竭;(车辆或机器的)损坏;统计分析 | |
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15 durable | |
adj.持久的,耐久的 | |
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16 essentially | |
adv.本质上,实质上,基本上 | |
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17 pulsation | |
n.脉搏,悸动,脉动;搏动性 | |
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18 glucose | |
n.葡萄糖 | |
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19 noted | |
adj.著名的,知名的 | |
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20 partially | |
adv.部分地,从某些方面讲 | |
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21 components | |
(机器、设备等的)构成要素,零件,成分; 成分( component的名词复数 ); [物理化学]组分; [数学]分量; (混合物的)组成部分 | |
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22 helping | |
n.食物的一份&adj.帮助人的,辅助的 | |
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