Story transcripts

The Ultimate Bypass

Friday, September 24, 2010

Reporter: Charles Wooley
Producers: Jonathan Harley and Hugh Nailon

It's a terrible irony. Heart disease is Australia's biggest killer, yet we have one of the lowest organ donation rates in the world.

The wait for a transplant can be agonisingly long.

Often it's fatal.

But there's been some remarkable progress in recent times. Doctors can now keep their patients alive for months, even years, by hooking them up to artificial pumps.

It's amazing stuff. And that's just the start of it. In the future these machines will be so small that they'll actually replace the human heart.

Story contacts:

To find out more about the Total Artificial Heart, go to:
www.syncardia.com

To find out more about the world-first mechanical heart being developed by Dr John Fraser and his team at Brisbane’s Prince Charles Hospital go to:
www.bivacor.com

Their research and development is supported by The Prince Charles Hospital Foundation:
www.findingcures.com.au

Full transcript:

STORY -

EBONY GRIFFIN: Do they have to put you open and put the heart in it with cords coming out?

WAYNE GRIFFIN: Yeah.

CHARLES WOOLEY: At 35, Wayne Griffin's heart is failing, and there's no hope it will ever recover. Now he has to explain to his 9-year-old daughter Ebony how he's going to survive without it.

EBONY GRIFFIN: How do they cut it open?

WAYNE GRIFFIN: Um, with a saw.

EBONY GRIFFIN: Yeah, but how do you cut it open without killing you?

CHARLES WOOLEY: It's a hard story to tell a kid, because in the coming months Dad will be kept alive not by a donor heart, but by a machine.

EBONY GRIFFIN: Who's heart is it?

WAYNE GRIFFIN: It's not a real heart.

EBONY GRIFFIN: What is it?

WAYNE GRIFFIN: It's a special heart that does the same job as your heart, but...

EBONY GRIFFIN: So how can you use it?

WAYNE GRIFFIN: It plugs into me.

CHARLES WOOLEY: Ebony's not the only one coming to terms with all of this. It's a procedure so new to Australia this is only the second time the heart surgery team here at Sydney's St Vincent's Hospital has performed it. SURGEON: Everything's set to go. Wayne's fast asleep. We'll go in and open the chest and remove Wayne's heart.

CHARLES WOOLEY: Wayne's heart might look to be pumping vigorously, but a congenital condition has weakened it beyond repair and unceremoniously, unsentimentally, it's removed. That most emotive, most powerful, dare we say it, the most romantic of human organs, is all but completely replaced by pumps and tubes, valves and bolts. It may look and sound like a small swimming pool filter, but the Total Artificial Heart keeps patients like Wayne alive for those precious months when their old heart has given up and a live transplant is still on the way.

DR JACK COPELAND: It's just a pump and you take out the pump and throw it in a bucket and replace it with two plastic ventricles. We're just plumbers, you know - we cut, we sew, we put in artificial hearts. And, you know, if our plumbing breaks down - like mine did this morning - and you don't have any hot water, you're in trouble!

CHARLES WOOLEY: Dr Jack Copeland is the father of this little lifesaver, ensuring more than 700 patients around the world have made it to the top of heart transplant waiting lists.

DR JACK COPELAND: Now, the pneumatic idea is a pretty easy one. You just (BLOWS).

CHARLES WOOLEY: It even sounds like a human heart.

DR JACK COPELAND: So you could probably keep yourself alive by blowing in the thing or having a little squeeze...

CHARLES WOOLEY: Sounds like a perpetual motion machine to me.

DR JACK COPELAND: That's right, you just don't want to get tired.

CHARLES WOOLEY: But implanting the device is no simple procedure. The left and right ventricles of the damaged heart must be removed and the artificial chambers attached to take their place. They take on the job of pushing and pulling blood throughout the body, all driven by an external pneumatic pump.

DR JACK COPELAND: It's just down to blood pumping. All it does is pump blood.

CHARLES WOOLEY: In a world where donor hearts are in desperately short supply, it buys time. A lot of people die waiting for transplants?

DR JACK COPELAND: It's somewhere between 15 percent and 25 percent of people per year that are waiting for transplant actually die while they're on the waiting list. We just don't have the donor hearts available.

CHARLES WOOLEY: Vanessa Cirillo wouldn't be climbing the steep, barren hills of Arizona today were it not for the three vital months she was sustained by the Total Artificial Heart.

CHARLES WOOLEY: My understanding is that if you've had a heart transplant your heart is behind your body in terms of responding to exertion?

VANESSA CIRILLO: Yes, it does. Mine takes a little while for it to get going.

CHARLES WOOLEY: But it does kick in? I'm not going to have to carry you back down?

VANESSA CIRILLO: No, I hope not!

CHARLES WOOLEY: Vanessa's a picture of health, a transplant triumph. But in 2007 she faced a deadly countdown - a crippling virus was shutting down her heart. A donor was her only hope.

VANESSA CIRILLO: I couldn't sleep at night because I couldn't breathe. I couldn't eat. I was mobile, but I was totally fatigued because all the fluid in my lungs, it was hard for me to breathe.

CHARLES WOOLEY: So in fact your life was in danger?

VANESSA CIRILLO: Yes.

CHARLES WOOLEY: The Total Artificial Heart saw her through. The wait for a transplant was no longer a death sentence.

VANESSA CIRILLO: It was a miracle. I mean, that machine and the ideas behind it is just an absolute miracle, and I felt instantly better.

DR JACK COPELAND: Vanessa was dead, essentially, when she came in. She was a young person who was going to die.

CHARLES WOOLEY: What is wonderful is when you can help someone young like Vanessa - more so than someone like myself who has had a reasonable innings.

DR JACK COPELAND: I wouldn't count you out!

CHARLES WOOLEY: The perennial problem with medical technology is how to replicate evolution's time-tested designs, especially matching what nature manages in such a tiny space. SURGEON: As you can hear, it's not the quietest thing, but it's better than the alternative, which is no noise at all.

CHARLES WOOLEY: Wayne's artificial heart is up and running but he has a long way to go to recovery and a full-heart transplant. But he's feeling the best he has in years. It's bloody noisy in here, though.

WAYNE GRIFFIN: Yeah. Beggars can't be choosers, can they?

CHARLES WOOLEY: The only catch - his stop-gap heart is a little noisy and a bit unwieldy.

WAYNE GRIFFIN: At this point, the next stage is a real heart and normal life. Before, the next stage was death - nothing to look forward to.

CHARLES WOOLEY: There's still many a slip ahead. For surgeon Paul Jansz, the focus now is on getting Wayne a heart transplant. That means finding a suitable donor and then hoping that Wayne's body won't reject the new organ.

PAUL JANSZ: We're halfway there with Wayne. He's still on a journey.

CHARLES WOOLEY: And it's not just any heart, but one that is tissue type more to his type.

PAUL JANSZ: We have to match the blood type and the tissue type and we also have to match the size.

FIONA COOTE: I can remember being taken off the life support system.

CHARLES WOOLEY: As Australia's first pin-up patient of heart transplants, Fiona Coote is a living reminder of those pioneering days when a donor heart had to be found straight away or the patient faced certain death. And 26 years later, you're looking terrific!

FIONA COOTE: Yeah, yeah. Look, I'm well.

CHARLES WOOLEY: And feeling good.

FIONA COOTE: Yeah, well, and yeah, very few dramas, so I'm really lucky.

CHARLES WOOLEY: Back then, in 1984, finding a transplant heart for this 14-year-old farm girl was the first problem, but fooling her body into letting it stay would be a lifelong challenge. FIONA COOTE (1984): It stops the body rejecting the heart. REPORTER: In other words, this is keeping you going?

FIONA COOTE: Yep. These are all the anti-rejection ones.

CHARLES WOOLEY: It's quite a cocktail! Even today, every morning, every night, Fiona must take anti-rejection drugs. Are they expensive?

FIONA COOTE: Some of them are very expensive, but thankfully it's all subsidised for me.

CHARLES WOOLEY: It's all on national health. As it should be. I don't mind paying for you, by the way.

FIONA COOTE: Well, thank you!

CHARLES WOOLEY: But this tiny device may relegate traditional transplants and their many complications to the medical history books.

DR JOHN FRASER: So the blood without the oxygen comes to the right side, gets spun around, pumped to the lungs, picks up the oxygen, comes back to the left side of the heart, spun back around and ejected to the rest of the body.

CHARLES WOOLEY: Here at Prince Charles Hospital in Brisbane, researchers are designing a world-first mechanical heart, small enough and reliable enough to do away forever with donor heart transplants.

DR JOHN FRASER: Look, it's a brilliant design.

CHARLES WOOLEY: At the helm of this grand medical adventure is a native Scot turned patriotic Australian, Dr John Fraser.

DR JOHN FRASER: And the really clever piece is the spinning impellor inside, which spins like the front doors of a hotel, spins the blood out, spurts it out, at around 2,000 to 3,000 revs per minute.

CHARLES WOOLEY: People come in, people go out?

DR JOHN FRASER: People come out, red cells go in, red cells come out, without oxygen, with oxygen.

CHARLES WOOLEY: How bloody clever are you blokes?

DR JOHN FRASER: (In Australian accent): Bloody clever, mate, bloody clever!

CHARLES WOOLEY: You've got a good Australian accent there.

DR JOHN FRASER: We know we don't need anti-rejection drugs. We know that it's on the shelf. We know we don't have to wait for a donor to come available where you might die whilst waiting for the donor.

CHARLES WOOLEY: Now it's simple demographics, isn't it, that as the Australian population ages the more heart attacks we're going to have?

DR JOHN FRASER: The incidence of heart failure is doubling every 10 years and the number of donors is staying static. So as the problem gets bigger and the donor pool stays the same there's a huge increasing unmet need.

CHARLES WOOLEY: The next step - John Fraser and his team will later this year implant their mechanical heart into a sheep and if that works, the next scientific leap will be to trial it in a human being.

DR JOHN FRASER: It will charge across the skin - there'll be no wires, there'll be no breach in the skin, The patient will be totally wire-free.

CHARLES WOOLEY: So like charging or recharging your mobile phone without using a socket?

DR JOHN FRASER: Without any wire, without any wire.

CHARLES WOOLEY: Just in close proximity?

DR JOHN FRASER: Wire free. They can go swimming, go surfing.

CHARLES WOOLEY: Does it speak to you when you're running low so you remember to charge it?

DR JOHN FRASER: It'll speak boldly in a Scottish accent.

CHARLES WOOLEY: And yet, for all this amazing science, one can't help but feel some mysteries of the heart remain. Such as why Vanessa, whose donor was an amateur boxer, is now herself a convert to that sport. Even for the experts some matters of the heart defy science.

DR JACK COPELAND: It's hard to say that couldn't happen, because when you do transplant a solid organ you do transplant a huge amount of DNA.

CHARLES WOOLEY: So you keep your mind open?

DR JACK COPELAND: Yeah, I mean, I'm sceptical to the max, but it's just possible that that crazy theory might be true!

CHARLES WOOLEY: Well, if you have an artificial heart, anything's possible.

DR JACK COPELAND: Well, it's a pretty dramatic and miraculous thing.

CHARLES WOOLEY: A miracle not just for patients like Wayne...

EBONY GRIFFIN: That's good!

WAYNE GRIFFIN: What's it sound like?

EBONY GRIFFIN: It sounds like a horse running.

CHARLES WOOLEY: ..but also for those they hold closest to their heart.

EBONY GRIFFIN: But you're not going to be sick anymore?

WAYNE GRIFFIN: Not going to be sick anymore.

EBONY GRIFFIN: Only a little bit?

WAYNE GRIFFIN: No. Not sick anymore. Then we can go and play and swim, have fun. And I'll be alive.

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