In 1984, University of Louisville physicians performed Kentucky’s first-ever heart transplant; in 2001, they were the ones to implant the world’s first AbioCor artificial heart; and last week they made history once again – by successfully performing the world’s first Aeson bioprosthetic total artificial heart implantation in a female patient.
“About three and a half thousand patients in the country are awaiting a heart transplant at each moment,” explained Siddharth Pahwa, M.D., one of two lead cardiothoracic surgeons in the procedure, in a CARMAT Artificial Heart News Conference. “Due to the paucity of donor heart availability, we’re unable to transplant most of them, so there is a constant need to innovate and push and find heart transplant substitutes.”
The Aeson is one such substitute. Currently part of an Early Feasibility Study (EFS) sponsored by French medical device company CARMAT, the device is a potential game-changer for thousands of patients. This includes the 900 or so female patients waiting for a heart transplant in the US. Despite being the leading cause of death for American women, heart disease is often seen as a “male” disease – one that has often had distinctly “male” solutions.
“For the other half of the world’s population, completion of this procedure by the Jewish Hospital team brings new hope for extended life,” said Mark Slaughter, M.D., also a lead cardiothoracic surgeon for the procedure, to UofL News. “Size limitations can make it harder to implant artificial hearts in women, but the Aeson artificial heart is compact enough to fit inside the smaller chest cavities more frequently found in women, which gives hope to a wider variety of men and women waiting for a heart transplant and increases the chances for success.”
Jewish Hospital is one of just four programs in the US approved to perform this procedure. While last week’s procedure was the third Aeson heart to be transplanted in North America, there are already around 20 of the devices walking around inside European recipients. All of the previous implantations, however, have been in male patients – until this one.
“You all know we like being first,” joked Slaughter.
However, women aren’t the only patients who could benefit from this improvement in implantation options. Heart care has faced a dichotomy for some time now: most of those afflicted by heart disease suffer from biventricular failure, where both the left and right sides of the heart are failing to pump blood properly – yet it’s these patients who have had fewer treatment options available.
“The left ventricular assist device […] has been approved [for] years and has done really well,” Pahwa explained. “Unfortunately, as the name [suggests] it’s a left ventricular device, and it supports the left side of the heart. For patients with biventricular failure, which is the more common lot, it’s not as effective.”
“The Aeson device that we’ve just implanted is designed to help patients with biventricular failure, and thus it opens up a wide spectrum of patients that we can help with it,” he said.
One innovation that gives the Aeson an edge is the inclusion of pressure sensors, which, Pahwa explained, “sense the amount of blood that the body needs and delivers that much cardiac output.” While other devices could be set at a fixed rate of flow, he said, “CARMAT has developed the Aeson to automatically adjust the flow, creating an improved performance to meet the body’s changing blood flow needs.”
The Aeson artificial heart is not intended as a permanent fixture, but a bridge to transplant: a temporary measure to keep patients alive while they wait for a new heart. The patient who received the device was referred to the Advanced Heart Failure Therapies Program at Jewish Hospital earlier this year with end-stage heart failure. She is recovering well from the surgery, the physicians reported.
“This world-first artificial heart implant into a female patient is another demonstration of UofL Health’s commitment to provide both the world-class care of today and develop the world-class standards of tomorrow,” said John Walsh, chief administrative officer of Jewish Hospital, to UofL News. “We celebrate this first as a milestone and recognize the hard work of Drs. Slaughter and Pahwa and the entire team. The true impact of their work will be measured in the dozens, hundreds and thousands of lives improved in the years to come.”