In the spring of 1974, my fifty-five-year-old father had a heart attack. He was rushed to a small community hospital in Queens. I was living in Manhattan, studying medicine at Columbia. By the time I arrived at the hospital, he was in shock, gasping for breath, his heart unable to pump forcefully. The hospital had no intensive care unit or cardiologist in attendance, no effective measures to compensate for his damaged heart. He died before my eyes.
Over the ensuing decades, although I am not a cardiologist, I’ve followed with interest the evolving treatment of heart disease. The incidence of fatal heart attacks has fallen dramatically since I lost my father. This is attributable in part to preventative measures like quitting smoking, healthier diet, exercise, and statin medicines, all of which reduce the risk of atherosclerosis—the buildup of plaque inside the arteries. Treatment of heart attacks also has improved with the advent of drugs that help dissolve clots in blocked coronary arteries. In addition, technology has advanced to the point that diseased coronary arteries can be mechanically opened with angioplasty and stents.
But with the improved survival rate from a heart attack has come a striking increase in the number of people with congestive heart failure. Damage to cardiac muscle may not be immediately fatal, but over time the weakened heart struggles to pump blood effectively. The circulatory system backs up, filling the lungs with fluid and starving the body of needed oxygen and nutrients. Debility and ultimately death ensue.
The greatest cost of congestive heart failure, of course, is the suffering and demise of patients. But society as a whole also bears a substantial economic burden: the direct and indirect costs of care in the United States, including hospitalization and medications, have risen to about $31 billion a year. This has spurred a search for more effective treatments.
The best option for people with severe congestive heart failure when medications stop working is a heart transplant. With current surgical techniques and potent drugs to prevent rejection, transplantation is often successful. But there is a dearth of donors. So what is the alternative? Patients look to devices to sustain them. This has been viewed as a straightforward engineering problem with an engineering solution: the body’s natural pump replaced with an artificial one. But unalloyed success has largely proven elusive for nearly half a century.
A month after my father died, I finished my courses in the classroom and began my training in the hospital. That included scrubbing in on open heart surgery, where I was exposed not only to techniques of bypassing diseased coronary arteries with grafts but also the argot of the surgical residents. Notable was the term “cowboy,” lauding a heart surgeon (typically a man…
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