| Man with Artificial
Heart
man with artificial heart
dies 5 months after implant
device beat flawlessly in pioneering patient
by lawrence k.altman
robert tools
the first recipient
of a self contained
artificial heart
died yesterday
at jewish hospital in louisville, ky.
where he had
received
the device
nearly five
months
before
1
mr. tools
who was 59
had remained in the hospital
since his surgery
on july 2
he died
from complications
following bleeding
in his abdomen, which began
early thursday
his kidneys
and liver
failed
and his blood pressure
dropped
leading
to
his death
in the early afternoon
dr. roberts d. dowling
one of his doctors
said
in a brief interview
2
the hospital
said
that mr. tool’s death
was not due to
malfunction
of
the AbioCor artificial heart
that dr. dowling implanted with his partner
dr. laman a. gray jr.
3
in mr. tools’s final hours
doctors
could not
maintain
his blood pressure
even with strong drugs
mr. tools suffered
a severe stroke
on nov. 11 and
his
remaining
brain function
ceased
shortly after noon
yesterday
4
with the agreement of mr. tools’s wife
carol
and a retired
anesthesiologist
who had been appointed
as an advocate for mr. tools, dr. dowling
instructed engineers to override
safety commands
in
a computer
to
stop
the AbioCor mechanical heart
until then
the device had beat flawlessly
more
than
20
million
times
inside
mr. tools
5
before receiving the implant
mr. tools was nearly bedridden
from end-stage heart failure
he had lost more than
50 pounds
mostly muscle
and had difficulty
even raising his head
heart attacks
had left such extensive scarring
that the two main pumping chambers of
his heart
were failing badly
and his lungs
were full
of fluid
a formula used to predict survival
in heart failure patients
showed that
statistically, mr. tools
had an 80 percent
chance of dying
within 30 days
6
mr. tools
became the first
AbioCor recipient
after another medical
center had rejected
him as a candidate
for a heart
transplant
because
he had
significant
kidney failure
diabetes
and
other
medical
problems
7
in august
mr. tools said
he knew
instantly
after awakening
from the implant surgery
that he was getting better
8
the device
and other equipment
in his chest
weighed more than
four
pounds
and made a constant
whirring sound
but
as long
as I can hear
the sound
I know
that
I am here
mr. tools said
adding
that he preferred it
to the alternative
death
9
mr. tools
who was black
sought
in the interview
to dispel
rumors
that he had been
used
as
a
guinea
pig
he said
he volunteered
for the experiment
because
I knew
I had one more
chance
to survive
10
but mr. tools also
said
I
realize
that
death
is
inevitable
11
by late september
mr. tools had recovered
sufficient strength to be-
gin making trips
from the hospital to
ice cream parlors
a comedy club
and a park
12
earlier this month
mr. dowling told
a meeting
of the american
heart association
that the
hospital
was working
with the food and drug
administration on plans
to discharge
mr. tools from the
hospital
the doctors
had expressed
hope that mr. tools might be
able to go to his home
in franklin, ky
by christmas
13
four other patients
are living
with
AbioCor hearts
which are made
by Abiomed Inc.
of danvers, mass.
public information
about their recoveries
though limited
has indicated
that they
have
had
mixed
success
14
one recipient
tom christerson 70
who
received his implant
on sept. 13
at jewish hospital
remains
on a ventilator
in recent weeks
he devel-
oped a fever
to 170 degrees
fahrenheit
but recovered no infection
was found and the cause of
the fever was not determined
dr. gray said
15
the three others
who had not been identified
are at the texas
heart institute and st. lukes epis-
copal hospital in houston; the uni
versity of california at los angeles
medical center; and hahnemann
university hospital in philadelphia
16
on monday
Abiomed said
that the f.d.a. had reviewed
the progress
of the first
five patients
and had given
the company
permission to
implant the
device in
another
five patients
17
the next day
the sixth AbioCor implant
was performed in an uniden-
tified man
at the texas heart insti-
tute
18
but
the man
did not survive
surgery
because
he
developed
uncontrolled
bleeding
19
the condition
was related to
the man’s longstanding
heart
failure and
to earlier
heart surgery that re-
quired
anticoagulat therapy
his surgeon
dr. o.h. frazier
said
20
in mr. tool’s case
from the out-
set, dr. gray
had warned
that unex-
pected
complications
could happen
at any time they did several times
21
a few hours
after the operation
mr. tools
was taken back
to the operating room
to stop
bleeding
in his chest
which doctors
attributed
to one
or two
loose
stitches
22
mr. tools
went on to suffer
a num-
ber of episodes
of bleeding
from his
nose and stomach
and required
many blood transfusions
the cause
was not determined
but becuase
of the bleeding
the doctors
could
not
prescribe adequate amounts of anti-
coagulant drugs to
prevent forma-
tion
of
blood
clots in the device
pieces of such
clot can break off
and be carried
by the blood to lodge
in the brain
and cause
a stroke
23
dr. gray, who was away
at a scientific meeting
when mr. tools died
said earlier
this week
that his team
could
not
give
mr. tools
adequate doses
of anicoagulants
about 80 per-
cent of the time
during
the first
two months
after
the implant
24
thereafter
they tried to juggle
the amounts of anticoagulants
but
the bleeding
problem
persisted
25
on Thursday
while mr. tools was
taking an anticoagulant
he bled
spontaneously
into the area
behind the lining
of the stomach
and intes-
tines
dr. dowling said
the second major setback
mr. tools experi-
enced
in the last
three weeks
26
on nov. 11
mr. tools suffered
a major stroke
that paralyzed
the right side of
his body
and impaired
his speech
the stroke was due
to a blood clot that may
have come from
the AbioCor heart
the AbioCor was removed
in an autopsy yesterday
and a detailed
examination
may pro-
vide clues to the origins
of the stroke
27
mr. tools was born
in mobile, ala.
and graduated from
high school in tampa, fla.
during the vietnam
war, he was a member
of the ma-
rines
special forces
mr. tools’s last job
had been with
us west communications in denver
yesterday
his wife
daughter
and son
expressed their gratitude to the public
for their prayers
and support
28
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