Helping Out a Heart in Texas

By Denise Grady

Doctors have long suspected that the heart could heal itself even when damaged by a heart attack or during surgery -- if only there were a way to let it rest. For more than 20 years, researchers have been trying to develop implantable pumps that temporarily take over part of the heart's job. Some half a dozen such devices are now available, most of them experimental, bulky and requiring risky open-heart surgery. But at a medical conference last week in Reno, O. Howard Frazier, director of the transplant program at the Texas Heart Institute in Houston, described the first successful use of a radically different newcomer. It is a tiny, disposable pump that can handle most of the heart's workload and that can be inserted in 20 minutes without major surgery.

Frazier first tried the device last month on a patient who was near death after a heart transplant. Working from an incision in the patient's groin, the surgeon threaded a 7-in. assembly made of a tube connected to a miniature, propeller-like pump through the patient's arteries and into his left ventricle, the main pumping chamber of the heart. The stainless-steel pump, driven by a slender cable linked to a motor outside the body, took on the work of the ailing ventricle. Spinning 25,000 times a minute -- about four times as fast as a sports-car engine -- the pump drew a steady stream of blood out of the chamber and into the aorta, the main vessel carrying blood to the body. Afterward, Frazier exulted, "This is really an astonishing device."

Within days, the patient's condition improved, and his transplanted heart began to beat strongly on its own. The dramatic case marked the debut of the Hemopump, an experimental device just 1/4 in. wide and 1/2 in. long, manufactured by Nimbus Medical Inc., of Rancho Cordova, Calif. Although a second patient given the pump died, the cause was apparently unrelated to the device.

Allan Lansing, director of Humana Heart Institute International in Louisville, expects to begin further tests soon on the Hemopump, which was approved for human trials by the Food and Drug Administration last March. "I'm impressed," says Lansing. "If this pump does work, it could be of enormous benefit to many patients." Eventually, he says, it could be available in coronary-care units and emergency rooms to treat heart attacks immediately after they occur. "It won't replace anything that is now available," says Heart Surgeon Jack Copeland of the University of Arizona Health Sciences Center in Tucson. "But it will add a dimension to what we can do for patients."

The pump's inventor, Richard Wampler, 39, a California physician, took his inspiration from pumps he saw in deep wells ten years ago in Egypt. The pump's spinning motion and the resulting continuous flow of blood from the heart represent a departure from the natural pulsating action that most other devices try to mimic. Some researchers at first feared that the whirling blades would destroy blood cells and that the body would be unable to tolerate the nonpulsating blood flow. So far, the problem has not materialized. Another potential drawback: small as the pump is, it may be too large to use in women and children or in patients with narrowed arteries.

If the device works in future tests, Wampler and Frazier estimate, it might eventually be used in as many as 150,000 people a year. With a $3,000 price tag, the whirring little pump may be the ultimate rarity in medical technology: a bargain.

With reporting by Andrea Dorfman/New York and Richard Woodbury/Houston