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Evolution of Artificial Hearts: an Overview and History

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Evolution of Artificial Hearts: an Overview and History Elmer ress Review Cardiol Res. 2014;5(5):121-125 Evolution of Artificial Hearts: An Overview and History Sanna Khana, Waqas Jehangirb, c Abstract on a donor list but some will not make it waiting to receive a transplant. Additionally, there are approximately a little over The heart is a muscular organ which pumps blood through blood ves- 2,000 hearts available for patients per year but there are more sels to different organs of the body. It is the most significant and vital than 3,000 patients waiting for a transplant [2, 3]. Throughout organ in the human body. Without this organ, life is unimaginable. the last century, many doctors have materialized their theories Doctors and scientists have been trying for a long time to create some- concerning the heart into new life-saving technologies. These thing similar or equivalent to the heart. The purpose is to develop a theories culminated over the years into what is known as the temporary machine or pump for a person who has a disease of the artificial heart today. heart and their survival without transplant is impossible. These tem- porary devices can provide enough time for the patient until a donor heart is available. The purpose of this review is to provide an over- Review of Literature and Discussion view and history of how man has developed an artificial heart for survival. The theory of “mechanical circulatory support” was first hy- pothesized by Julien Jean Cesar LeGallois in 1812 [4]. How- Keywords: Heart; Artificial Heart; Evolution ever, his hypothesis would not become a reality until the 21st century. Nearly a century after LeGallois’ theory, the unfore- seen pairing of Charles Lindbergh and Alexis Carrel joined forces to advance mechanical circulatory support in the 1920s. Introduction Lindbergh was an inventor who is mainly known today as an aviator who flew over the Atlantic whilst Carrel was a sur- geon who won the Nobel Prize for his innovations in organ The heart is the most important organ in the human body. It transplantation [5]. Carrel was uncertain that while performing transports blood to various parts of our body and most im- heart surgery, an external blood pump could support the human portantly keeps us alive. The leading cause of death today is body. Lindbergh reviewed the issues that Carrel was having heart disease and around 600,000 people die from this yearly and went on to create several of his own blood pumps which [1]. Furthermore, heart failure is affecting around 20 million turned out to be unsuccessful. It took him a few years but he people exclusively in the United States and Europe [2]. Ap- eventually created a blood pump that actually worked. Lind- proximately 100,000 people are diagnosed with progressive bergh also went on to create a centrifuge that could securely heart failure every year [2]. If the heart failure has reached an separate blood plasma. After this innovation, Carrel and Lind- advanced stage, “60-94%” of patients will die in 1 year [2]. bergh went on to create an “in vitro artificial heart-like” device Due to these statistics, the heart has become a concern for doc- to keep organs alive when removed from the body [6]. Some tors and scientists alike. There are many drugs in the market organs they removed were kidneys, hearts, thyroid glands, and to treat heart disease but once the disease has reached a cer- ovaries. These organs were monitored after removal to observe tain phase, the drugs can only do so much. The only option their development and function [6]. Early innovations such as left after drugs is transplantation. Patients are then left to wait an external blood pump and device similar to that of an arti- ficial heart set into motion the desire to create a total artificial heart. Manuscript accepted for publication September 17, 2014 Subsequently in 1937, Dr. Vladimir P. Demikhov devel- oped a total artificial heart (TAH) device and executed the first a Drexel University College of Medicine, Philadelphia, PA, USA coronary artery bypass surgery and intrathoracic transplanta- bRaritan Bay Medical Center, Perth Amboy, NJ, USA cCorresponding Author: Waqas Jehangir, 530 New Brunswick Ave, Perth Am- tion in the world [7, 8]. The TAH he developed was made up boy, NJ 08861, USA. Email: [email protected] of two pumps, besides each other which were driven by an “external motor with a transcutaneous drive shaft” [8]. This doi: http://dx.doi.org/10.14740/cr354w device was transplanted into a dog that went onto live 5.5 h Articles © The authors | Journal compilation © Cardiol Res and Elmer Press Inc™ | www.cardiologyres.org This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction 121 in any medium, provided the original work is properly cited Evolution of Artificial Hearts Cardiol Res. 2014;5(5):121-125 after the operation. His experiments were the first of this kind Dr. Sewell began his research, no heart operations using a and he mainly tested on dogs. In 1946 Dr. Demikhov simulta- pump-oxygenator had been produced [11]. He thought that the neously transplanted a heart and lung, which proved success- patient’s lungs could be used to oxygenate the blood during a ful. He was able to do these operations without using a cardio- heart operation and as a result only a single or a pair of pumps pulmonary bypass. In lieu of the cardiopulmonary bypass, Dr. would be required in place of the heart. Dr. Sewell designed Demikhov performed surgery quickly and used his own meth- his pump so that it would go around the right side of the heart od to preserve organs during transplantation. In June 1946, he [11]. In his early trials, he was not successful. His experiments performed a heterotopic heart-lung transplant on a dog for 9.5 failed because he could not push blood through rubber tubing h, which was a landmark in his experiments. The animals Dr. using a roller pump. He then decided to use pressurized gas to Demikhov experimented on usually survived 30 days post op- create force. Dr. Sewell also studied the methods which dif- eration. Dr. Demikhov’s donor’s heart-lung preparations were ferent researchers had used but they also did not move blood preserved during transplantation by utilizing “closed-circuit through a pumping chamber [11]. Dr. Sewell then designed circulation” [7]. “Blood from the left ventricle was pumped a “pneumatically-powered pump” [11]. This pump was made into the aorta; then, through the coronary vessels that sup- up of “tubular glass pumping chamber with a side arm con- plied the myocardium, it passed into the right atrium, the right nected to a compressed air and vacuum source and a rubber ventricle, and the lungs, where the blood was reoxygenated bladder made of reinforced Penrose tubing held in place by and returned to the left atrium” [7]. In July 1953, he reached a perforated rubber stoppers” [11]. The pumping chamber was milestone by performing the first successful coronary bypass protected by rubber-flap valves and suctioned blood from the surgery on a dog. The International Society for Heart and Lung right atrium into the pulmonary artery via a cannula. Eccentric Transplantation awarded the “first Pioneer Award” to Dr. De- cams and weighted arms with blades controlled the timing of mikhov in 1989 for “the development of intrathoracic trans- compressed air and suction since the blades stopped and re- plantation and the use of artificial hearts” [7]. In summation, leased the small rubber tubes which all resulted in compressed Dr. Demikhov was a pioneer who developed his ideas about air and vacuum sources [11]. This method proved successful the heart into reality which are now regularly used in medicine. for Dr. Sewell’s pump and he went on to win the thesis prize A few years after Dr. Demikhov in 1939, Dr. John H. Gib- from his medical school for this achievement. bon, Jr. of the United States was assisting another physician in Following in the footsteps of their predecessors, Dr. Tetsu- an emergency pulmonary embolectomy where a patient lost zo Akutsu and Dr. Willem Kolff from the Cleveland Clinic in consciousness due to blood clots being removed in open-heart the United States were the first to successfully implant a TAH surgery. He thought that if there was some device which can in an animal that went on to live for 1.5 h in 1957. Both of these eliminate blood from the patient’s body while avoiding the doctors were experts in developing TAHs and received many lungs, oxygenate the body, and then return to the heart, the accolades [12]. A few years later in 1952, Domingo Liotta of patient would still be alive. This event fueled his passion to Argentina created his own models similar to that of Dr. Tet- create the heart-lung machine [9, 10]. Over the next several suzo and Dr. Kolff. His models increased survival time up to years, Dr. Gibbon went on to develop an apparatus which was 13 h [8]. Liotta then went to work with Dr. Michael DeBakey studied on laboratory rats. The lab rats survived total body per- of Baylor University in the United States, who in 1983 went on fusion experiments and this research went on to be published to develop a device using a roller pump which could transfuse in 1939. Years later, Dr. Gibbon went on to work for Jefferson blood constantly [4]. In 1963, Liotta carried out the “first clini- Medical College where he teamed up with IBM to work on cal implantation of a pulsatile left ventricular assist device” his device which after development was introduced as IBM [8].
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