The hearts on wheels that are saving lives

10:13am Friday 14th March 2008

A North-East hospital is pioneering the use of a portable artificial heart. Health Editor Barry Nelson reports

IMAGINE lugging your own beating heart around with you on what looks like a small suitcase on wheels. Sounds frightening, like something out of science fiction, but that is effectively what some teenage patients at a North-East heart unit have been doing since the introduction of a remarkable piece of new technology three years ago.

Its full name is the EXCOR Ventricular Assist Device, but it is better known as The Berlin Heart.

Since it was developed by German scientists at the Berlin Heart Institute, this sophisticated artificial heart has helped to save the lives of desperately-ill children around the world.

Youngsters whose own hearts are failing are plumbed in' to the Berlin Heart, which takes over the pumping action of the heart. Connected by transparent tubes to the chest, the computer-controlled, twin-chambered pump mimics the action of the child's heart, buying precious time to allow the organ either to recover from illness or allow a suitable donated replacement heart to be found.

It is available in either a photocopiersized bedside version on wheels for babies and younger children, or a much smaller, battery-powered version on a trolley which older children can wheel behind them.

Remarkably, apart from the Berlin Heart Institute itself, the centre which has used the EXCOR VAD more than any other heart unit in Europe or America is the Freeman Hospital in Newcastle.

Since it was first used on a child patient in November 2005, the Freeman Hospital team, led by consultant cardiac surgeon Mr Asif Hasan, has fitted the devices to 13 children. The Berlin team is currently doing about 80 a year.

Paediatric intensive care specialist Dr Jane Cassidy, who accompanied Mr Hasan to Germany in September 2005 to see the Berlin Heart in action for the first time, says the device has proved to be extremely valuable.

"The main advantage is that it can be used for longer periods of time compared with earlier ventricular assist devices,"

she says.

This is important at a time when children who need a heart transplant are waiting significantly longer than they were a few years ago.

One of the main differences between the Berlin Heart and earlier devices is its more manageable size and portability - even the bedside version is on wheels - and doctor-friendly features.

"It is connected to the patient via two or four tubes, depending on whether we are supporting both sides of the heart.

The transparent tubes are also coated with an anticoagulent called Heparin to prevent blood clots," says Dr Cassidy.

"One of the major differences is that it is much easier to see clots forming in the tubes and valves of the Berlin Heart because they are transparent. We are never relaxed when we have a child on a Berlin Heart because you know you are one blood clot away from disaster. They can form and go up to the brain," she adds.

The portability of both versions of the Berlin Heart has also improved the quality of life for young patients, while doctors have seen fewer complications.

"A child can be connected to the Berlin Heart and still move around. They can even go to the gym or the hospital shop.

It is more normal, instead of being on a ventilator and being sedated for weeks on end," she adds. The tubes are "very securely" stitched in and the devices themselves are "very robust", she says.

Mr Hasan has installed most of the Berlin Hearts at the Freeman and the unit has an enviable survival rate of around 70 per cent.

"We did the first in November 2005 with the help of a surgeon who came over from Berlin. We supported the patient on the Berlin Heart for five months but he died waiting for a donor heart,"

says Dr Cassidy.

So far ten out of 13 patients fitted with Berlin Hearts have had successful transplants at the Freeman Hospital and nine have survived to date. The average age of the patients is two years, the youngest was two and a half months and the oldest 15.

Notable successes have included 13- month-old Jack Vellam from Pitsford, Northamptonshire. Jack broke records after he become the youngest patient to stay on an artificial heart for 120 days while he recovered from myocarditis, an inflammation of the heart muscle. He was discharged last August.

More recently, the life of three-yearold Abigail Hall, from Lenzie, near Glasgow, was saved. Abigail was born with a severe heart abnormality, which meant she only had one pumping chamber instead of two. The Berlin Heart kept her alive for long enough for a donor heart to become available and she was discharged in January.

At the time, Dr Richard Kirk, a consultant paediatric cardiologist and a member of the Freeman team which saved Abigail's life, described her situation as "enormously challenging".

Fittingly, it was a North-East baby, Louisa Jane McGregor-Smith, from Middlesbrough, who became the youngest patient in the world to survive thanks to an artificial heart. A Berlin Heart kept her alive for five critical weeks until a suitable heart could be found in Northern Ireland.

Two days before Christmas, Mr Hasan flew to Belfast in a private jet to collect Louisa's new heart and last month she was back with her parents on Teesside.

Despite the success, Dr Cassidy stresses that danger is ever-present until a transplant is completed. "Patients may look incredibly well on a Berlin Heart,"

he says, "but you are never relaxed until they are successfully transplanted."

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