How Artificial Hearts Work

The Seven-hour Surgery

Surgeons implanting the AbioCor heart
Surgeons implanting the AbioCor heart
Photo courtesy Abiomed

The surgery to implant a AbioCor artificial heart is extremely delicate. Not only are the surgeons cutting off and extracting the natural heart's right and left ventricles, but they are also placing a foreign object into the patient's chest. The patient must be placed on, and later removed from, a heart-lung machine. The surgery requires hundreds of stitches, to properly secure the heart to artificial ventricles. Grafts connect the AbioCor to remaining parts of the natural heart. Grafts are a kind of synthetic tissue used to connect the artificial device to the patient's natural tissue.

Due to the complexity of the surgery, there are lots of medical personnel on-hand during the operation. The surgery on July 2, 2001, which was the first of its kind in the world, included a team of the two lead surgeons, 14 nurses, perfusionists, anesthesiologists and other support staff.

Here is the procedure, as described by University of Louisville surgeon Robert Dowling:

  1. Surgeons implant the energy-transfer coil in the abdomen.
  2. The breast bone is opened and the patient is placed on a heart-lung machine.
  3. Surgeons remove the right and left ventricles of the native heart. They leave in the right and left atria, the aorta and the pulmonary artery. This part of the surgery alone takes two to three hours.
  4. Atrial cuffs are sewn to the native heart's right and left atria.
  5. A plastic model is placed in the chest to determine the proper placement and fit of the heart in the patient.
  6. Grafts are cut to an appropriate length and sewn to the aorta and pulmonary artery.
  7. The AbioCor is placed in the chest. Surgeons use "quick connects" -- sort of like little snaps -- to connect the heart to the pulmonary artery, aorta and left and right atria.
  8. All of the air in the device is removed.
  9. The patient is taken off the heart-lung machine.
  10. The surgical team ensures that the heart is working properly.

Since this first transplant, another 11 procedures have been done. The most recent one took place on February 20, 2004. As part of a clinical trial, patient number 12 underwent surgery at St. Luke's Episcopal Hospital in Houston at the Texas Heart Institute.

Originally, Abiomed officials cautioned against overly-optimistic results; the most optimistic predictions were that a patient could live up to six months with the AbioCor heart. The device is only designed to double life expectancy for patients who had only about 30 days to live prior to the operation.

Robert Tools, the patient who received the heart transplant on July 2, 2001, at Jewish Hospital in Louisville, has passed away. Ten other patients have also died, but the recipients of the AbioCor heart have lived an average of five months after their transplants.