When Dr Christian Barnard accomplished the world's first human heart transplant in the Groote Schur hospital in South Africa on December 3rd, 1967, it made headlines around the world. Even though that first patient died a mere 18 days later, a radically new treatment modality for what was known as end-stage heart failure had arrived and, with further advances in the understanding and treatment of the unwanted rejection of transplanted tissue by the recipient's immune system, heart transplantation is now available in most countries in the "developed" world as a fairly safe and even routine treatment for end-stage heart disease.
But it became apparent very quickly that transplantation could never become a standard treatment for all cases of terminal heart disease. Quite apart from its financial costs, there would never be enough hearts available for transplantation to meet the needs of those whose hearts were in terminal failure. So the cardiologists and the surgeons and the biomedical engineers began casting around for a more effective and universally applicable means of dealing with end-stage heart failure - a means of providing a substitute for the human heart. Research continues to try to find an animal replacement (a pig, perhaps) for a human heart. But this would bring a battery of new tissue rejection problems. Genetically modified animal hearts have been considered.
Above all, the search for a mechanical replacement has been vigorously pursued now for the past 40 years, with the first artificial mechanical heart being implanted in Utah in December 1982. The inventor of those early cumbersome mechanical hearts, Dr Robert Jarvik, kept working and eventually devised a much smaller and simpler device which did not try to mimic the elaborate pumping mechanism of the heart muscle, but supplemented the heart's own pump with a tiny pump surgically implanted into the muscular wall of the heart, yet delivering blood to the aorta, the main artery carrying blood from the heart around the body.
As described in the current issue of The Lancet, it is a "thumb-sized, silent, titanium, axial-flow impeller pump weighing 90 grams and with a displacement volume of 25 cubic centimetres". It has been used already in a small number of cases to provide a "bridge" for the patient with a failing heart who is lucky enough to be awaiting the arrival of a human heart for transplantation. It is featured in The Lancet now because a team of surgeons in the John Radcliffe hospital in Oxford, led by Mr Stephen Westaby, have implanted it into Mr Peter Houghton who was reckoned to have only six weeks to live with his own failing heart. Mr Houghton, a hospital psychotherapist who, ironically, worked a great deal with terminally ill patients, had his Jarvik 2000 pump implanted on June 20th and was successfully discharged to his home two months later with every sign that his damaged heart muscle was recovering already.
All of which means that this new technique is feasible and probably effective. It is early days yet, of course, but there is a real hope here of a successful and widely available means of treating end-stage heart failure. That it why it is worthy of all the financial support and development that it can get.