Doctors hail courage of first recipient of self-contained artificial heart

Saturday, December 1st 2001, 12:00 am
By: News On 6

LOUISVILLE, Ky. (AP) _ When Robert Tools was wheeled into Jewish Hospital this summer, he was so weak he could barely lift his head. He was too ill to qualify for a heart transplant, and he said he could feel his life ebbing away as doctors prepared to implant the world's first self-contained artificial heart.

That was July 2. By the end of August, Tools was walking into a news conference in a button-down shirt and slacks and talking to the world about his new lease on life.

``I realize that death is inevitable, but I also realize if there's an opportunity to extend it, you take it,'' Tools, 59, said at the time. ``I had a choice to stay home and die or come here and take a chance.''

He had been expected to survive only a month without the heart. He lived for 151 days with it until his death on Friday of internal bleeding and organ failure.

His nearly five months of life as the first recipient of a self-contained mechanical heart left doctors hopeful Friday that such artificial hearts could someday become a routine option for survival.

``He did not go through this in vain,'' said Dr. Hillel Laks, chief of cardiothoracic surgery at the UCLA School of Medicine.

``This device has functioned extremely well. If one could use the device in not such desperately ill patients, the recoveries would be much quicker and the outcome better,'' Laks said.

During the clinical trial phase underway, the AbioCor heart can only be implanted in patients who, like Tools, are too ill to qualify for a heart transplant and are given little chance of surviving more than 30 days.

Four other patients are now living with AbioCor hearts. Another underwent the surgery in Houston this week but didn't survive the operation.

One of Laks' patients, a 74-year-old man who received the softball-size mechanical heart in October, continues to slowly recover. He is able to stand and walk from a chair to his bed, and he can spend time off the ventilator, the doctor said.

Laks said doctors are constantly learning more about the device, and that the credit goes to the initial patients.

``Mr. Tools and his family members are heroes,'' said Dr. Robert Dowling, one of Tools' surgeons. ``Their willingness to be the first to participate in the AbioCor clinical trial could potentially pave the way for a revolutionary treatment option for advanced heart disease.''

Dowling and fellow Louisville surgeon Laman Gray Jr. said Tools' death was not caused by any problem with the plastic-and-titanium heart. After Tools' brain function stopped on Friday, doctors had to override commands in a computer to turn off the heart, The New York Times reported.

Before surgery, Tools suffered from congestive heart failure, diabetes and kidney disease, and his doctors said those previous health problems led to severe abdominal bleeding that started Thursday and caused Tools' organ to fail that night.

The AbioCor heart is made by Abiomed Inc. of Danvers, Mass. Unlike earlier artificial hearts, it has no wires or tubes that stick out of the chest and connect to a big compressor. Abiomed hopes to have its device on the market within the next few years.

Doctors and officials at Abiomed had been pleased with Tools' steady progress over four months.

In early November, Tools was able to eat a cheesesteak during an outing with Louisville's mayor. He had recovered enough to make trips outside the hospital, including a fishing trip, and doctors had said they hoped he could be home for Christmas.

That changed when he suffered a stroke Nov. 11. Blood-thinning drugs are often given to patients to prevent clots that can cause strokes, but Tools could not be given high doses because such drugs can also cause internal bleeding.

Doctors had said early on that strokes were among the risks for the artificial heart patients. The AbioCor was designed with a smooth plastic lining to decrease the chance of blood clots forming. The hospital said Tools' death was unrelated to the stroke, although the Times reported that the heart would be examined for clues to what caused it.

Among all artificial heart recipients, William Schroeder of Jasper, Ind., lived the longest, surviving 620 days with a Jarvik-7 heart until his death in 1986. The first artificial heart recipient, Barney Clark, a Seattle-area dentist, lived 112 days after receiving a Jarvik-7, which is not self-contained, in 1982.

Tools lived in the small down of Franklin, 140 miles south of Louisville. Carlin Tools, one his two adult children, said his father exhibited great strength and courage while fighting for his life. Carol Tools said her husband would have ``faded away slowly at home'' without the surgery.

``After our decision to participate in this experimental procedure, he has been able to make a difference for mankind, enjoy some of his favorite things in life, and experience a bit of notoriety,'' Carol Tools said. ``For Bob, nothing could have been better.''