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Artificial Heart Recipient Suffers Serious Stroke

Medicine: Patient is paralyzed on right side. Plans to implant hearts in 10 more people will go forward.


Robert Tools, the first patient to receive a totally implantable artificial heart, suffered a stroke on Sunday and remains in serious condition, surgeons at Louisville's Jewish Hospital said Wednesday.

The cause of the damage was a blood clot that lodged in an artery on the left side of Tools' brain, said Dr. Laman Gray, one of the surgeons. "There's no question about it," he said. "It's been confirmed by a CT scan."

Tools' right arm and leg were paralyzed by the stroke and he was still not able to speak by Tuesday, Gray said, adding that his patient had recovered some movement in his leg.

"We can't really predict how much he is going to recover and how long it is going to take," Gray told a press conference. "We just have to wait and see."

The other four patients who have received the AbioCor artificial heart, including one at UCLA, are all doing well, according to a spokesman for the manufacturer, Abiomed Inc. of Danvers, Mass.

Tools, 59, received the device, which is powered by a small battery under the skin, on July 2. Until Sunday, he had been doing quite well, making 20 excursions outside the hospital, said another of his physicians, Dr. Robert Dowling. In the last two weeks, Dowling said, Tools was beginning to gain weight--a sign of recovery from his pre-implant condition.

Tools "started out with a life expectancy of only a matter of a few days" when the implant was performed, Gray said. "He was as sick a person as I have ever seen."

Unfortunately, Tools has developed a bleeding problem in his stomach that prevented surgeons from giving him drugs that inhibit blood clots during much of his hospital stay.

"A patient with an artificial heart valve needs [blood] thinning or he will have a stroke," Dowling said, because blood in contact with metal or plastic surfaces clots readily. The artificial heart "has four artificial valves, so it is crucial to have the blood thinned. But you can't thin the blood and let someone bleed to death" in his stomach.

The fact that Tools has "had the device running for two months" without blood-thinning drugs and had not experienced a stroke already is "remarkable," Gray said. "That speaks well to the design of the heart."

The other four patients with the artificial hearts--in Louisville, Los Angeles, Houston and Philadelphia--have received the drugs, he added.

Tools was sitting up in bed Sunday afternoon when the stroke hit. There is no evidence to suggest that any of his activities may have been involved in causing it. He had had a brief episode last week when he had difficulty talking. "That may have been a precursor to the stroke," Gray said.

Tools is currently on a respirator with a tube in his throat, so surgeons are not sure if he is able to speak yet. He is also mildly sedated because of the treatment, so they are not sure how aware he is.

"We're very disappointed," Gray said. "We have become very good friends, and we consider him more of a friend than a patient. We are very sorry to see he has had a problem."

The team said the stroke will not affect the next stage of the project, in which surgeons will implant the device in 10 more patients as soon as they receive permission from the Food and Drug Administration.

Tom Christerson, the second artificial heart patient at Jewish Hospital, who received the device 62 days ago, had also encountered some difficulties, running a temperature as high as 107 degrees and suffering partial kidney and liver failure. But Gray said Wednesday that Christerson's temperature has returned to normal and that both organs are now working properly.

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