Pulse: A Message from Dean Joel A. Kaplan

On July 2, the entire world turned to Louisville, Ky., to learn of the first operation to place a totally implantable artificial replacement heart in a patient dying of chronic congestive heart failure.

Dr. Laman Gray, professor and chief of cardiothoracic surgery at the University of Louisville School of Medicine, and Dr. Robert Dowling, associate professor of surgery (cardiothoracic), successfully replaced the patient's failing heart with the AbioCor heart at Jewish Hospital.

For the previous three years, the entire surgical team, along with ABIOMED engineers, had been perfecting its techniques and the AbioCor device in a series of 40 calves operated on in the School of Medicine's animal laboratories. These animals had excellent survival rates and were up and walking shortly after the operations. Other teams that may join UofL in implanting future devices are from Houston, Boston, Los Angeles and Philadelphia.

The AbioCor is a tremendous advance over previous artificial hearts used in the 1980s since it resists clotting and, thus, reduces the chances for stroke; has no external wires or tubes, lowering the risk of infection; has the latest computer and monitoring capabilities built into it; and has internal and external batteries, enabling the patient to be mobile with a good quality of life.

The first human implant was a daring and exciting procedure for this cardiac anesthesiologist to watch. The surgeons made it look easy as they cut out the patient's ventricles and sewed in the four connectors to the right and left atria, pulmonary artery and aorta. Watching the insertion of the AbioCor heart and its subsequent perfect function, allowing the patient to be taken off cardiopulmonary bypass with ease, was amazing.

Having removed thousands of patients from cardiopulmonary bypass during cardiac operations over the past 25 years, I can say it was eerie to see so little motion in the chest while there were normal hemodynamics and a cardiac output of six liters per minute. Even the surgeons seemed awed.

But this was really the easy part for all involved. Following the operation, the major public issues became how much information to disclose about the patient, and the ethical questions of informed consent, cost, psychological risks for the family, the length of time the heart would function in a human, and the ultimate questions of how to handle his eventual death.

These areas had been anticipated, and it was decided to try to protect the patient's privacy for as long as he wished. He and his family had been fully informed of all the risks and had a knowledgeable patient advocate with them who participated in the medical and personal decisions.

Of course, everyone hopes this patient and others in the experimental procedures will live extended periods of time with a good quality of life.

In the weeks immediately following surgery, the AbioCor heart continues to "purr like a kitten" on physical examination, and the patient is making strides toward regaining strength.

When I arrived in Louisville and started to expand our translational research program at the School of Medicine, I was quoted in Modern Healthcare as saying the UofL School of Medicine is a fast-rising star-and the world will see it soon.

To date, the world has seen the first two successful hand transplants and now the AbioCor replacement heart. The latter hit the front pages around the world and the cover of Newsweek. Soon, there will be exciting advances in other areas featured in this magazine, including proteomics, tissue engineering, drug design and information technology.

We are continuing to build the school's research program with new recruits from other leading academic health centers, new research facilities, a General Clinical Research Center in the University of Louisville Hospital, and a phenomenal growth in research funding coming from private and public sources.

Among these sources of funding is an $8.5 million grant from the National Institutes of Health to fund five research projects at the Kentucky Spinal Cord Injury Research Center, which is supported by Norton Healthcare. The grant was, in fact, the largest NIH award ever given to UofL.

The Association of American Medical Colleges recently featured the School of Medicine on the cover of its newsletter, highlighting the rapid emergence of research at this distinguished school best known for its teaching and clinical care.

As we hoped, many of the research projects are also leading to technology transfer and spin-offs of new biotechnology companies in our growing BioPark around the Louisville Medical Center.

The city and region are basing their economic growth around health care, which is now the No. 1 industry in Louisville. We are truly the "architects of the future" of the city due to our faculty "creating the knowledge to heal" -- the advertising slogan of UofL Health Care.

Joel A. Kaplan, M.D.
Executive Vice President for Health Affairs
and Dean, School of Medicine