While watching the various artificial heart experiments in the basement of the Texas Heart Institute, I sometimes wondered if I was experiencing something like Thomas Edison’s housekeeper: a person with only the slightest reason to be in a place where history was being made. Or today, the Texas Heart Institute announced that a new total artificial heart, the BiVacor TAH, had kept a Houston man alive for several days. As one of its developers likes to say, this is the cardiac equivalent of a successful moon landing, a medical breakthrough that could change the way millions of people currently suffer from heart failure are treated. If the device proves to last, it could bring freedom to people around the world whose damaged hearts make it difficult for them to even walk across a room or get out of bed.
The news came to me last week in a text message from Dr. Bud Frazier, a renowned Houston cardiac surgeon, who informed me that he couldn’t make it to lunch because “I’m with a patient right now, and no one knows the physiology of pulseless blood flow better than he does.”
“If I can save him from the doctor, you should see the patients,” he joked. After a few seconds, I froze. Frasier spoke so indirectly that I suddenly understood what he was telling me. With trembling hands, I posed the question back to him. “Is this a Viva Call?” I asked. It was.
I have been waiting for this day, my hair turning gray. In 2013, I started writing a book about the 50-year effort to develop the world’s first artificial heart. As a friend well-meaningly pointed out, the book was, at the time, about failure. In 1963, Dr. Michael DeBakey, the world’s most famous surgeon at the time, who built Houston’s renowned Baylor College of Medicine into a medical powerhouse through sheer force of will, promised that within 10 years, more than 100,000 people would be walking around with artificial hearts in their chests. His plan coincided with that of then-President John F. Kennedy. Kennedy promised in 1962, at Rice Stadium, that he would put a man on the moon within eight years. We all know what happened after that. In 1969, the United States landed on the moon. But decades passed, and the artificial heart remained one of medicine’s holy grails, along with a cure for cancer.
One horrific failure after another followed, some of which became national television sensations, like poor Barney Clark’s experiment in 1982. The problem with the artificial heart was that a real organ beats 60 to 80 times a minute, about 115,000 times a day, or more than 2.5 billion times over its average lifespan. The artificial heart is like a perpetual motion machine, but it’s not. Until recently, no one could come up with a machine that could stand up to it. They broke. The patient, or victim, had to be hooked up to giant machines that pumped with noises that drove him close to insanity.
But now, Frazier tells me, a team in Houston is working on a really promising artificial heart, a quest to which he’s dedicated much of his life. At that point, Frazier’s most successful attempt had been to implant two left ventricular assist devices together. The single LVAD was a fairly successful machine that helped a weak heart pump more blood. The dual LVAD is a kind of heart replacement that even made it onto our cover in 2010. Popular Science Although the device was developed in 2012 and helped keep a man alive for a time after fatal organ failure, it felt like the kind of makeshift device Rube Goldberg would come up with as a heart surgeon.
Before Frazier, previous iterations of the artificial heart, including the one built in DeBakey’s lab in the 1960s (and later implanted in one of his patients by his nemesis, Dr. Denton Cooley, without his permission), had always tried to mimic the pumping action of an organ. Frazier often told me that as long as inventors continued to mimic the pumping action of the heart, he didn’t think total heart replacement was possible, because the pump would wear out. Patients in that situation would need either replacement or transplant surgery, which comes with its own problems. Frazier wondered if something like the rotating action of a turbine was the answer. He often said that the Wright brothers didn’t fly by imitating birds.
The stakes of his work couldn’t have been higher: heart failure currently kills 6.2 million adults in the United States and 26 million worldwide. These figures, I thought, indicated there was considerable interest in a book about heart disease. And finally, Mattress Mack emerged as a financier; he’d lost his brother to heart disease, despite Frasier’s life-saving efforts. The result was a core cast of characters: West Texas philosopher and Vietnam veteran Bud Frasier; his partner, heart surgeon Dr. Billy Cohn, an eccentric inventor who can sell ice to Eskimos; and finally, an ultra-rich furniture salesman who keeps pet tiger cubs.
And then there was another one. In 2011, a young Australian named Daniel Timms showed up in Houston with a replacement device he carried in a backpack. His device had one moving part and was about the size of a Rio Grande Valley sweet orange. Timms managed to get a meeting with Cohn, who at first wasn’t particularly interested in talking to a kid who needed a shave and clean clothes and had wrapped his invention in a rag and put it in a flimsy backpack. But then Cohn saw what Timms had. It was the precursor to what is now described in a Texas Heart Institute press release as a “titanium, biventricular rotary blood pump with a single moving part that uses a magnetically levitated rotor to pump blood and replace both of the failing ventricles.” At that moment, the dual LVAD that Cohn had been developing with Frazier was consigned to the shelf of a museum exhibiting the evolution of ideas, if not to the dustbin of history. With Tim’s invention, Billy Cohn and Bud Frazier could say they had the Holy Grail.
Perhaps much to their chagrin, Cohn, Frazier, and Timms left me there while they refined the original BiVacor. One day in 2014, I was in the animal lab in the basement of Texas Heart. There was a healthy-looking calf on a treadmill. Timms stood at the control panel, and everyone else was staring at the calf. Nobody in the room seemed to be breathing except the calf. The calf started to move along the treadmill, and Cohn fed it a carrot. The calf kept on walking, trying to reach the treat, looking like it was trying to figure out what the big deal was. And then it was all over. Frazier told me to put my head against the animal’s chest, which I did dutifully and quickly, because I had a hunch that no one would be too happy to have a journalist in the room.
I pressed my ear to the soft skin of the calf and heard nothing. There was no thumping sound we are accustomed to, no pulsating rhythm in my ears. Just a very soft whining sound that I heard after someone handed me a stethoscope. I then realized how Thomas Edison’s housekeeper must have felt walking into a dark room with only one light bulb on.
The book was due in 2018, and I met it with the best ending I could come up with at the time. This was not a story of failure, but of persistence. Frazier dedicated his life to one pursuit. In fact, so did Timms, and I never doubted the team would succeed. Yet, now in his 80s, with gray hair and worn-out knees, Frazier often told me he worried he wouldn’t be on the ground long enough to see the end. And yet, he kept the faith. In the years that followed, whenever I saw Frazier, he told me he was six months away from implanting his “pump” in a person (perhaps force of habit explains why he called the BiVacor a pump, even though it’s not a pump).
Frasier lived to see it. There were FDA hoops to jump through, lots of funding to raise, and many calves to die so humans could live. But for the first time, BiVacor’s heart was placed in the chest of a local man who would have died of heart failure. He subsequently underwent a heart transplant and is still alive today.
The device is still experimental, initially being used as a “bridge to transplant.” More human trials are to come, but perhaps one day BiVacor will sit on hospital shelves waiting to be put to use in hospitals around the world. In the meantime, Frazier will be keeping a watchful eye at the bedside of every BiVacor patient.
Pumps wear out, some don’t.
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