Artificial heart surgeon discusses patient, operation

Dr. Robert Dowling

LOUISVILLE, Kentucky (CNN) -- Earlier this week, surgeons sewed an artificial heart inside a patient's body, along with a battery pack and controller. CNN's Colleen McEdwards talked with Dr. Rob Dowling, one of the surgeons who implanted the artificial heart, about the surgery, the patient and future of such procedures.

MCEDWARDS: So the patient was put back on a respirator this morning, we understand. How big a setback is that?

DOWLING: Actually, I don't consider that a setback at all. He's very weak from before the surgery. He just got tired, and we didn't want him to work all that hard. We just did it in a routine non-urgent fashion, to just to make it easier on him.

We'll have him on (the respirator) for … a few more days, let him get his strength back up, and we'll have him right back off.

VIDEO CNN Medical Correspondent Elizabeth Cohen talks with Dr. Robert Dowling (July 4) Play video (QuickTime, Real or Windows Media) CNN's Rhonda Rowland goes through the history of the artificial heart (July 3) Play video (QuickTime, Real or Windows Media) (More)     MORE STORIES AbioCor latest innovation in crowded field     EXTRA INFORMATION Explainer: See a diagram of how the heart is implanted and powered   Timeline: What research led to the implantation of the artificial heart?     RESOURCES On The Scene: Elizabeth Cohen: Ethics of the artificial heart     KEY FACTS: What is it? The AbioCor is a totally implantable artificial heart made of titanium and plastic. It weighs about 2 pounds. What does it do? The device pumps blood through the heart to the lungs and the rest of the body, simulating a living heartbeat. Who is it for? The AbioCor is designed for heart failure patients who have failed all existing therapies. If it is successful, about 100,000 patients a year could benefit. What does it cost? The AbioCor is estimated to cost about $70,000. Why is it important? Manufacturer Abiomed says AbioCor could be a viable alternative for patients with no other options. It could give them more freedom of movement, because they would not need to be tethered to large machines the way recipients of the first artificial heart were. It could also reduce the risk of infection because it is completely implanted -- no wires or tubes stick out of the patient's body.

MCEDWARDS: How much has he been able to do since the surgery?

DOWLING: He's able to fully move all his extremities. When the breathing tube was out, he was able to talk with his family members, he was able to communicate with the doctors and nurses. We were able to have him sitting up in bed, so he's coming along very nicely.

MCEDWARDS: Doctor, how sick was he when he agreed to this operation? I think a lot of people want to know why he agreed to have this done.

DOWLING: He's a very, very intelligent man, and he understood his own mortality. In other words, he had a very good understanding of how sick he was and what his prognosis was.

We have all types of statistical ways to look at his condition, and we can put that into computer models to determine someone's chance -- his chance, anyone's chance -- of surviving. All our predictors indicated that his chance of not being alive in 30 days was 80 percent.

MCEDWARDS: Can you explain … what's different about this artificial heart, different from others that have been used in the past?

DOWLING: The other artificial hearts were developed 15 years ago. So if you can just imagine, all the differences in technology in the last 15 years have been incorporated into this device -- miniaturization, all the advances in electronics.

So what used to be a controller that was almost the size of a refrigerator is now a controller that can fit in the palm of your hand -- extremely sophisticated. And the other major difference between the old devices, and even some of the devices used today, is everything's internal. So there are no wires, cables or lines coming through the skin, and that's a major advantage. We think that that's going to markedly decrease the risk of any infection or any bacteria getting inside the body, if there's nothing crossing the skin.

MCEDWARDS: Even some of the people who have been involved in this incredible achievement have talked about some of the ethical concerns that they have -- and I'm wondering, for you, what the ethical issues are.

DOWLING: To me, it's pretty straightforward: This man, without this therapy, was not going to survive. And he understood it all; his family understood it all. We explained it to him in great detail. We explained every possible risk that we could possibly conceive of in detail. We showed it to him in writing. We read to him word for word the consent form that had been approved by all the appropriate IRBs (Institutional Review Boards).

We even went out of our way to get approval from the ethics committee, who understood the nature of the illness and the fact that this type of experimental surgery is justified, I think, rather easily in someone that we know, with a very high degree of certainty, has a very small chance of living in the short term.

MCEDWARDS: Do you foresee a point in the future when this type of heart is widely used, is widely implanted in people in this country?

DOWLING: This is the first step toward answering that question. I guess my short answer to the question is yes, that's what we think. We have the potential for that, and this is the first step in answering that question, and our initial result is very positive.