The Quest to Create an Artificial Heart
By Mimi Swartz
Crown. 317 pp. $27.
Reviewed by Chris Patsilelis
Dramatic and dense with fascinating medical information, Mimi Swartz's Ticker will astonish you. Swartz, executive editor of Texas Monthly and coauthor of Power Failure (2003), recounts the 50-year saga of the major developments in the world of cardiac technology.
This book is no highly specialized, academic/medical work à la the New England Journal of Medicine. No. This is a dramatic adventure story on the level of Tom Wolfe's The Right Stuff (1979). The colorful characters here, nearly all renowned surgeons and frequently contentious rivals, are all too human, and beyond, with egos and eccentricities on glaring display.
Swartz is excellent at describing medical procedures in all their vivid peril. As of the 1950s, she says, "heart surgery … would continue to be brutal, coarse, and rudimentary." Once the surgeon began to cut," she writes, "he was essentially flying blind. Just getting to the heart was something of an ordeal. During an operation, a surgeon would break a rib with the retractor, which might cut the heart itself.
Many advances in heart surgery were of almost unbelievable down-home inventions. Frustrated at the difficulty of holding the heart still during operations, one innovative surgeon, Billy Cohn, bought a common metal ladle at a local Stop & Shop and slightly modified it — cutting a little square window in the flat surface — to construct a simple surgical instrument that did the trick.
The author introduces us to the brilliant, thoroughly likable, Oscar "Bud" Frazier of the Texas Heart Institute. A former high school football star and flight surgeon in Vietnam, by 2015 Frazier had spent 55 years at the institute hospital. He roamed the halls in his black cowboy boots, perpetually reading worn paperbacks — Shakespeare, Dickens, Dostoyevsky — as he checked on his patients. Those patients included Dick Cheney, Bono, Olivia de Havilland, and assorted Eastern and European royalty. Frazier was considered perhaps the best cardiac surgeon in the world. And he had long been interested in developing a sustainable artificial heart.
Swartz acquaints us with the obsessive, driven coronary innovator Michael DeBakey, who, starting in the 1950s, established himself as one of the greatest inventors and surgeons in the field. In the 1950s, he found a way to use a common synthetic fabric, Dacron, as a replacement for the heart's weak blood vessels.
DeBakey ran Baylor University's surgery department when Frazier was a medical student there, and the latter soon discovered that the former was a tyrant. Students were terrified to ask questions for fear of DeBakey's lacerating responses. The author tells us that DeBakey "made experienced residents stand in the corner if they displeased him in the operating room."
Meantime, DeBakey was extending the frontiers of cardiovascular surgery. He developed new heart transplant techniques, a continuous-flow pump for an artificial heart, and also the left-ventricular assist device (LVAD).
One of DeBakey's colleagues was Denton Cooley, a quick-moving risk-taker who "was so handsome," Swartz writes, that he "could make the wives of patients momentarily forget their husbands' dire circumstances." In the operating room, she writes, "he was fast, dexterous, and inventive," and, strangely, "he loved the unexpected disaster." In the 1950s, when Cooley arrived at Baylor, the heart was an organ that was considered off-limits for any reputable surgeon. Surrounding tissue was operated on, such as blood vessels, but not the heart itself. But then Cooley was presented with a patient who had an aneurysm of the aortic arch, "a dangerous weakening of the arterial wall where it curves just above the heart," as Swartz describes it, and a very perilous condition associated with catastrophic surgical failures.
To prepare for this hazardous operation, Cooley raced across town to a VA hospital, bought a chisel and special mallet, and proceeded to accomplish a groundbreaking aneurysmectomy. His stern, skeptical overseer, Michael DeBakey, was thunderstruck.
Of course, the holy grail of cardiac surgery was, and still is, the creation of a sustainable artificial heart. Many of the aforementioned surgeons had tinkered with the idea; some had placed various models into their patients. No patient lived very long.
In March 2011, Cohn and Frazier fitted two Heart Mate IIs — continuous flow pumps — into the chest of 55-year-old Craig Lewis, who was suffering from amyloidosis, a disease in which fat deposits overwhelm the organs. The surgeons had used individual LVADs to take over for failing ventricles and created a dual pump designed to take over for the whole heart.
The next morning, Craig's wife, Linda, was allowed to listen to her recuperating husband's chest. Swartz recounts that Linda Lewis heard no "thump, thump; just a faint whirring somewhere way down deep inside. She was hearing the sound of the first non-pulsatile artificial heart ever put inside a human." Lewis lived for six weeks with his dual-pump arrangement; he died from his underlying disease and not from failure of the machine. Another man, in the Czech Republic, lived for six months after a similar operation. The astonishing story continues.