A Year Later, The Beat Goes On

When Gom Christerson entered Jewish Hospital in Louisville, Ky., last September, he was willing to do almost anything to save his life from his failing heart. "I'll try anything but that," he told cardiac surgeon Laman Gray Jr., nodding to a model of the shiny new AbioCor artificial heart on Gray's desk. But over the next 10 days the AbioCor turned out to be his only option, and Christerson reconsidered--after he learned that the new heart would allow him to abandon his hated low-sodium, low-fat diet and go back to eating seafood and barbecued ribs. Nine months later, Christerson, 71, is home in Central City, Ky., enjoying the best quality of life that he's had in a long time. He plays cards with his friends, visits the local barbershop to catch up on news and chows down on ribs. And best of all, on May 16 he saw the birth of his first great-grandchild, a girl named Ellen Thomas in his honor.

A year ago NEWSWEEK put the AbioCor on its cover. Since then, seven terminally ill men have received the heart as part of a clinical trial. Of those, only two are still alive, including Christerson. And three of the patients have had strokes, apparently related to a design problem that has now been corrected. As a result of the strokes, the trial was briefly suspended. To the layperson, that record may not appear impressive. But doctors point out that no new medical invention performs flawlessly in its first trials. Heart-assist devices, to name just one, have now been implanted with great success in thousands of patients. "But of the first 10 we did here, maybe two worked," says Gray. The AbioCor did more than just work. Within five months of becoming its first recipient, patient Robert Tools had enough energy to talk of starting a new job. (He died in November.) It sustained another patient through gallbladder surgery and a third through lung problems that his natural heart could not have endured. "Its performance has been truly remarkable," Gray says, "and will only improve over time."

For now, doctors are still on a steep learning curve, refining surgical techniques and perfecting regimens for postoperative care. But their greatest challenge has been preventing strokes. Abiomed, the heart's manufacturer, halted implantations in January to ferret out the source of the problem. It turned out to be four plastic struts that crisscrossed over the heart's left in-take valve. The designers had added these struts for technical reasons when the heart was still being tested in calves. But in people, the struts merely provided a static component on which blood could potentially clot, with the clots later breaking off and traveling to the brain to cause strokes. It was a simple decision to take them out, and in April, Abiomed resumed the clinical trial.

The heart has now beat 1.5 billion times in its various recipients without a single mechanical malfunction. "When the software geniuses at Microsoft design a new program, they can't claim that kind of reliability," says Dr. Rob Dowling, who helped Gray implant Christerson's AbioCor. The real goal, though, is to restore functional life, and that has actually been achieved in one patient. Because the heart is self-contained with only an external battery pack, patients can go about their daily routines without being tethered to a large console, as with previous artificial hearts. And because it has no wires penetrating the skin, it does not carry the same risk of infection as earlier devices. When Christerson went home, the doctors were anticipating calls for help. But neither he nor his family called once in that first week. "We finally called them," says Dowling.

To transplant chief O. H. Frazier at the Texas Heart Institute, Christerson's experience proves that the heart will work. If other patients have not done as well, he says, that's because they were so sick at the outset, with liver, lung and kidney problems in addition to longstanding heart failure. His own AbioCor patient, Bobby Harrison, was an oil-rig fireman with Red Adair whose firefighting days came to an end with a massive heart attack in 1992. Harrison was doing well on the AbioCor and was almost ready to go home when he suffered a stroke. "It was a bitter pill for us," says Frazier. "But he was unable to tolerate a full dose of anticoagulant drugs. If he could have, I'm sure he would be alive today." The main improvement that Frazier still wants to see in the heart is a reduction in its size. "It's still a big pump," he says, fitting only 50 percent of men and 20 percent of women. A second-generation heart is expected to be smaller.

Despite the early setbacks, surgeons are still very impressed. When Dr. Louis Samuels at Philadelphia's Hahnemann University Hospital removed James Quinn's dying heart last November and watched the AbioCor begin pumping blood, he says, "it was the closest I will ever experience to the exhilaration of childbirth. To take a person who is essentially lifeless and restore life is miraculous." Today Quinn is the other surviving AbioCor patient.

Though doctors say it takes a hero to receive such an experimental device, Christerson denies it. "The only other option was going home and letting Joe Ben [the undertaker] stuff me with cotton," he told his daughter Patti Pryor. But on April 16 he went home to a hero's welcome anyway, complete with the fire engine he'd never gotten to ride as a child. He headed into town with the sirens wailing. But the real surprise was what he saw when he got there. "We expected a few friends outside our house," says Pryor. Instead the streets were clogged with well-wishers. "People were coming out of the restaurants hollering," she says. "There were big signs on all the marquees and banners reading welcome home, tom." It was a triumphal moment for Christerson. No homecoming is as sweet as one that seemed impossible.