7 ms·

He lasted 2 months. For reference, artificial hearts generally do 130 days - (2018) https://syncardia.com/patients/media/blog/2018/08/seven-things-about-artific

He lasted 2 months. For reference, artificial hearts generally do 130 days - (2018) https://syncardia.com/patients/media/blog/2018/08/seven-things-about-artificial-hearts/ https://syncardia.com/patients/media/blog/2018/08/seven-thin... with some notable outliers that live for years, and human to human transplant is about 9 years. Usually it's some related systemic problem that kills you under these conditions eg consistent brain clotting causing stroke or organ failure due to drug cocktails.

ryeights 5y ago
Wow, that's not great. I take it these are meant to be used as a stopgap before an actual transplant?
- Stevvo 5y ago
  Yea; it's a stopgap solution. The pump is in a backpack so it's not perfect for mobility.
  - deleted 5y ago
    [deleted]
  - deleted 5y ago
    [deleted]
  - hwillis 5y ago
    LVADs are implanted in your chest. Blood doesn't leave your body, but do they have external batteries. You have a wire coming out of your chest (or neck/head, sometimes) which is a constant infection worry. AFAIK the only external pumps are like, countertop kind of things. They're ideally a stopgap, but even still it's typically a massive change in quality of life. The left ventricle is what feeds your entire body blood; the right ventricle only feeds the lungs. When the left ventricle fails, blood backs up and starts overflowing into the lung space. It's exceptionally unpleasant. The right ventricle is usually in much better shape so an LVAD can be almost like having a functioning transplant except for the risk of infection.
    - faeyanpiraat 5y ago
      Well, half of your hearth failing being "exceptionally unpleasant" is not a surprise. Anyways, wouldn't it be feasible to use wireless power transfer?
      - hwillis 5y ago
        It is, and it has even been done. One large limitation is that it's not a great idea to have batteries inside the body. An LVAD is intrinsically liquid-cooled; batteries are not. Ruggedly encapsulating a battery means it is fairly well-insulated and can get warm. Batteries also fail pretty unpredictably- they're fundamentally dozens of square feet of very thin film, and it's very difficult to ensure that every battery is perfect. But again, it has been done. Implanting a couple medium-size batteries and the circuitry+magnet for wireless charging is pretty robust to failure, but consider actually making that decision for yourself. You're already accepting huge restrictions, so is the wire that much of an extra burden? Realistically, if the LVAD loses power, you're dead. It's not like suffocating; without bloodflow (even blood without oxygen!) your brain will die in about two minutes. Chest compressions probably won't even help. You got the LVAD because your heart couldn't pump, and chest compressions will not force blood through the LVAD. Even if this happens in the emergency room your odds are not good. Cutting open a chest to hand-crank a human is not easy. Pulling an ECMO machine and inserting the massive catheters is not easy. You might die while the machine is still rolling towards you.
        rmak 5y ago
        I thought your real heart kind of recovered a bit since it wasn't going through the workload.
- throwthere 5y ago
  Not always, some are”destination” therapy meaning no transplant planned in the immediate future. https://my.clevelandclinic.org/health/treatments/17192-left-ventricular-assist-devices-mechanical-circulatory-support-mcs https://my.clevelandclinic.org/health/treatments/17192-left-...
  - rootusrootus 5y ago
    That's an LVAD, though -- isn't that an entirely different beast than an artificial heart, with a different use case?
    - sagarun 5y ago
      LVAD goes for 5 years
      - iancmceachern 5y ago
        More like 10 and more now, 5 years was the stuff we were making in the 90s and early 2000s.
    - throwthere 5y ago
      Artificial heart is kind of a non-specific term. It covers anything from LVAD, LBAD and RVAD together, ECMO or biventrivular vad. So depends on what you’re specifically referring to but lvad is the most common of those.
      - rootusrootus 5y ago
        Fair enough. I'm in no way experienced in the medical field. I would have told you I thought an artificial heart was a complete heart replacement, just like a full transplant but with a mechanical device instead. TIL.
    - hwillis 5y ago
      It's still typically a massive change in quality of life. The left ventricle is what feeds your entire body blood; the right ventricle only feeds the lungs. When the left ventricle fails, blood backs up and starts overflowing into the lung space in addition to the rest of your body slowly suffocating. It's exceptionally unpleasant. The right ventricle is usually in much better shape so an LVAD can be almost like having a functioning transplant, except that there's a big wire going out of your chest/neck (which is a constant infection risk and can't really get wet) and you're now battery-powered. Any kind of heart transplant comes with huge problems, even besides the immunosupressants etc. The nerves don't reconnect, so the heart doesn't respond to commands to speed up. It makes any kind of exertion difficult and unpleasant. Diet is critical, clots are a constant fear, etc. By the time you get a transplant you've usually spent a while with insufficient bloodflow, and your organs have been slowly dying. It's nothing short of incredible that people can get 20+ years out of transplants. The deck is stacked against us hard.
- iancmceachern 5y ago
  Yes, syncardia is primarily used as a bridge to transplant.
sebazzz 5y ago
> He had already been bedridden for six weeks leading up to the surgery, attached to a machine which was keeping him alive. Slightly less.
momenti 5y ago
Heart transplant recipients survive 15 years on average: https://en.wikipedia.org/wiki/Heart_transplantation https://en.wikipedia.org/wiki/Heart_transplantation
- msrenee 5y ago
  The Wikipedia page cites a documentary as the source, which may be correct, but doesn't seem like an appropriate source. Here's a paper that I skimmed the abstract of claiming ~9 years: https://pubmed.ncbi.nlm.nih.gov/15280687/ https://pubmed.ncbi.nlm.nih.gov/15280687/
  - MPSimmons 5y ago
    I don't know what the documentary source is, but this paper is from 2004, and it's likely that procedures have improved reliability since then.
    - maewsa 5y ago
      Documentary cited is from 2007 so that's a marked improvement for 2-3 years... I'd personally lean towards trusting published medical journal.
  - sobren 5y ago
    Here's a 2015 article from the Journal of Thoratic Disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387387/.It https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387387/.It doesn't calculate the exact average, but 21% of patients are alive after 20 years. Survival rates have definitely rapidly increased over the last two decades. > Survival after heart transplantation is excellent, particularly if it is compared with the natural course of end-stage HF. The most recent data of the registry of the International Society of Heart and Lung Transplantation indicates a current 1-year survival of 84.5% and a 5-year survival of 72.5% (5). This has significantly improved as compared to the 76.9% 1-year survival and 62.7% 5-year survival in the 1980s. The development of new immunosuppressive drugs which allow a variety of immunosuppressive regimens, tailored to the individual patient, has contributed to this success, since rejection and the adverse effects of immunosuppression could be better controlled. After 20 years, ca. 21% of patients are still alive, according to the international registry (5). In some experienced centers, long-term survival is reported to be even higher (6-9). The University Hospital Zurich has achieved a 20-year survival rate of 55.6% (10). >The improvement in outcome over the decades is related mainly to an increase in survival over the first year. After this period, the attrition rate of ca. 3-4% per year has remained similar over the different eras. This might be attributable to the fact that it was not possible to reduce the incidence of long-term complications after heart transplantation, such as chronic allograft vasculopathy (CAV) and malignancies, which account for ca. 35% of all deaths after 10 to 15 years (5).
dekhn 5y ago
Artificial hearts are artificial hearts- mechanical plumbing. This is far more akin to human heart transplantation (which is a mature operation that has excellent outcomes).
Guereric 5y ago
I found extra information for those curious about statistics involving human heart transplantation [1]: "The most recent data of the registry of the International Society of Heart and Lung Transplantation indicates a current 1-year survival of 84.5% and a 5-year survival of 72.5%. This has significantly improved as compared to the 76.9% 1-year survival and 62.7% 5-year survival in the 1980s. The development of new immunosuppressive drugs which allow a variety of immunosuppressive regimens, tailored to the individual patient, has contributed to this success, since rejection and the adverse effects of immunosuppression could be better controlled. After 20 years, ca. 21% of patients are still alive, according to the international registry. In some experienced centers, long-term survival is reported to be even higher. The University Hospital Zurich has achieved a 20-year survival rate of 55.6%. The improvement in outcome over the decades is related mainly to an increase in survival over the first year. After this period, the attrition rate of ca. 3-4% per year has remained similar over the different eras. This might be attributable to the fact that it was not possible to reduce the incidence of long-term complications after heart transplantation, such as chronic allograft vasculopathy (CAV) and malignancies, which account for ca. 35% of all deaths after 10 to 15 years." [1] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4387387/ https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4387387/
dpierce9 5y ago
Survival rate commensurability across time and procedure is quite complicated when you also have fairly strict/different/evolving selection criteria.
blagie 5y ago
... seems like a genetically-engineered pig's heart could avoid eventually be engineered to avoid some of those problems. It's science fiction, but quickly heading towards science, to engineer hearts which don't require quite the same cocktail of hearts. Cells would need to present the same way as the patient, so the engineering would need to be specific to each patient (which also means the patient needs to wait for the pig to grow old enough).

ryeights 5y ago

Wow, that's not great. I take it these are meant to be used as a stopgap before an actual transplant?

Stevvo 5y ago
Yea; it's a stopgap solution. The pump is in a backpack so it's not perfect for mobility.
- deleted 5y ago
  [deleted]
- deleted 5y ago
  [deleted]
- hwillis 5y ago
  LVADs are implanted in your chest. Blood doesn't leave your body, but do they have external batteries. You have a wire coming out of your chest (or neck/head, sometimes) which is a constant infection worry. AFAIK the only external pumps are like, countertop kind of things. They're ideally a stopgap, but even still it's typically a massive change in quality of life. The left ventricle is what feeds your entire body blood; the right ventricle only feeds the lungs. When the left ventricle fails, blood backs up and starts overflowing into the lung space. It's exceptionally unpleasant. The right ventricle is usually in much better shape so an LVAD can be almost like having a functioning transplant except for the risk of infection.
  - faeyanpiraat 5y ago
    Well, half of your hearth failing being "exceptionally unpleasant" is not a surprise. Anyways, wouldn't it be feasible to use wireless power transfer?
    - hwillis 5y ago
      It is, and it has even been done. One large limitation is that it's not a great idea to have batteries inside the body. An LVAD is intrinsically liquid-cooled; batteries are not. Ruggedly encapsulating a battery means it is fairly well-insulated and can get warm. Batteries also fail pretty unpredictably- they're fundamentally dozens of square feet of very thin film, and it's very difficult to ensure that every battery is perfect. But again, it has been done. Implanting a couple medium-size batteries and the circuitry+magnet for wireless charging is pretty robust to failure, but consider actually making that decision for yourself. You're already accepting huge restrictions, so is the wire that much of an extra burden? Realistically, if the LVAD loses power, you're dead. It's not like suffocating; without bloodflow (even blood without oxygen!) your brain will die in about two minutes. Chest compressions probably won't even help. You got the LVAD because your heart couldn't pump, and chest compressions will not force blood through the LVAD. Even if this happens in the emergency room your odds are not good. Cutting open a chest to hand-crank a human is not easy. Pulling an ECMO machine and inserting the massive catheters is not easy. You might die while the machine is still rolling towards you.
      - rmak 5y ago
        I thought your real heart kind of recovered a bit since it wasn't going through the workload.
throwthere 5y ago
Not always, some are”destination” therapy meaning no transplant planned in the immediate future. https://my.clevelandclinic.org/health/treatments/17192-left-ventricular-assist-devices-mechanical-circulatory-support-mcs https://my.clevelandclinic.org/health/treatments/17192-left-...
- rootusrootus 5y ago
  That's an LVAD, though -- isn't that an entirely different beast than an artificial heart, with a different use case?
  - sagarun 5y ago
    LVAD goes for 5 years
    - iancmceachern 5y ago
      More like 10 and more now, 5 years was the stuff we were making in the 90s and early 2000s.
  - throwthere 5y ago
    Artificial heart is kind of a non-specific term. It covers anything from LVAD, LBAD and RVAD together, ECMO or biventrivular vad. So depends on what you’re specifically referring to but lvad is the most common of those.
    - rootusrootus 5y ago
      Fair enough. I'm in no way experienced in the medical field. I would have told you I thought an artificial heart was a complete heart replacement, just like a full transplant but with a mechanical device instead. TIL.
  - hwillis 5y ago
    It's still typically a massive change in quality of life. The left ventricle is what feeds your entire body blood; the right ventricle only feeds the lungs. When the left ventricle fails, blood backs up and starts overflowing into the lung space in addition to the rest of your body slowly suffocating. It's exceptionally unpleasant. The right ventricle is usually in much better shape so an LVAD can be almost like having a functioning transplant, except that there's a big wire going out of your chest/neck (which is a constant infection risk and can't really get wet) and you're now battery-powered. Any kind of heart transplant comes with huge problems, even besides the immunosupressants etc. The nerves don't reconnect, so the heart doesn't respond to commands to speed up. It makes any kind of exertion difficult and unpleasant. Diet is critical, clots are a constant fear, etc. By the time you get a transplant you've usually spent a while with insufficient bloodflow, and your organs have been slowly dying. It's nothing short of incredible that people can get 20+ years out of transplants. The deck is stacked against us hard.
iancmceachern 5y ago
Yes, syncardia is primarily used as a bridge to transplant.

sebazzz 5y ago

> He had already been bedridden for six weeks leading up to the surgery, attached to a machine which was keeping him alive. Slightly less.

momenti 5y ago

Heart transplant recipients survive 15 years on average: https://en.wikipedia.org/wiki/Heart_transplantation https://en.wikipedia.org/wiki/Heart_transplantation

msrenee 5y ago
The Wikipedia page cites a documentary as the source, which may be correct, but doesn't seem like an appropriate source. Here's a paper that I skimmed the abstract of claiming ~9 years: https://pubmed.ncbi.nlm.nih.gov/15280687/ https://pubmed.ncbi.nlm.nih.gov/15280687/
- MPSimmons 5y ago
  I don't know what the documentary source is, but this paper is from 2004, and it's likely that procedures have improved reliability since then.
  - maewsa 5y ago
    Documentary cited is from 2007 so that's a marked improvement for 2-3 years... I'd personally lean towards trusting published medical journal.
- sobren 5y ago
  Here's a 2015 article from the Journal of Thoratic Disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387387/.It https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387387/.It doesn't calculate the exact average, but 21% of patients are alive after 20 years. Survival rates have definitely rapidly increased over the last two decades. > Survival after heart transplantation is excellent, particularly if it is compared with the natural course of end-stage HF. The most recent data of the registry of the International Society of Heart and Lung Transplantation indicates a current 1-year survival of 84.5% and a 5-year survival of 72.5% (5). This has significantly improved as compared to the 76.9% 1-year survival and 62.7% 5-year survival in the 1980s. The development of new immunosuppressive drugs which allow a variety of immunosuppressive regimens, tailored to the individual patient, has contributed to this success, since rejection and the adverse effects of immunosuppression could be better controlled. After 20 years, ca. 21% of patients are still alive, according to the international registry (5). In some experienced centers, long-term survival is reported to be even higher (6-9). The University Hospital Zurich has achieved a 20-year survival rate of 55.6% (10). >The improvement in outcome over the decades is related mainly to an increase in survival over the first year. After this period, the attrition rate of ca. 3-4% per year has remained similar over the different eras. This might be attributable to the fact that it was not possible to reduce the incidence of long-term complications after heart transplantation, such as chronic allograft vasculopathy (CAV) and malignancies, which account for ca. 35% of all deaths after 10 to 15 years (5).

dekhn 5y ago

Artificial hearts are artificial hearts- mechanical plumbing. This is far more akin to human heart transplantation (which is a mature operation that has excellent outcomes).

Guereric 5y ago

I found extra information for those curious about statistics involving human heart transplantation [1]: "The most recent data of the registry of the International Society of Heart and Lung Transplantation indicates a current 1-year survival of 84.5% and a 5-year survival of 72.5%. This has significantly improved as compared to the 76.9% 1-year survival and 62.7% 5-year survival in the 1980s. The development of new immunosuppressive drugs which allow a variety of immunosuppressive regimens, tailored to the individual patient, has contributed to this success, since rejection and the adverse effects of immunosuppression could be better controlled. After 20 years, ca. 21% of patients are still alive, according to the international registry. In some experienced centers, long-term survival is reported to be even higher. The University Hospital Zurich has achieved a 20-year survival rate of 55.6%. The improvement in outcome over the decades is related mainly to an increase in survival over the first year. After this period, the attrition rate of ca. 3-4% per year has remained similar over the different eras. This might be attributable to the fact that it was not possible to reduce the incidence of long-term complications after heart transplantation, such as chronic allograft vasculopathy (CAV) and malignancies, which account for ca. 35% of all deaths after 10 to 15 years." [1] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4387387/ https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4387387/

dpierce9 5y ago

Survival rate commensurability across time and procedure is quite complicated when you also have fairly strict/different/evolving selection criteria.

blagie 5y ago

... seems like a genetically-engineered pig's heart could avoid eventually be engineered to avoid some of those problems. It's science fiction, but quickly heading towards science, to engineer hearts which don't require quite the same cocktail of hearts. Cells would need to present the same way as the patient, so the engineering would need to be specific to each patient (which also means the patient needs to wait for the pig to grow old enough).