An artificial heart with real freedom

It was too damaged to keep him alive, so surgeons decided it had to come out. On Feb. 6, in a six-hour operation, surgeons did just that and then implanted an artificial heart in its place. On Wednesday, Marshall left the University of Washington Medical Center to begin what likely will be a long wait for a heart transplant. Leaving the hospital is not something any total artificial-heart patient in Washington has been able to do before. Previously, such patients were tethered to the only FDA-approved mechanical "driver" for the fake heart - a 418-pound machine - which meant they had to stay in the hospital until a donor heart became available. That can mean a wait of one to two years or more. Marshall, 51, Wasilla, Alaska, got his first taste of freedom Saturday, leaving the hospital to visit the Ballard Locks. He took with him a backpack-size pneumatic machine and batteries - an experimental portable driver system made by SynCardia, now being tested by the University of Washington and other centers. "I was very glad to feel the BTUs from the sun," Marshall said. Visitors at the Locks didn't ask why he was toting around a machine making a loud blappety-blappety-blappety sound. "I got a few looks," he mused. After 10 years of trials, the artificial heart in 2004 was approved by the FDA as a bridge until a transplant could be performed. The artificial heart now used is a refined version of the Jarvik 7 Total Artificial Heart implanted in 1982 into a 61-year-old dentist from the Seattle area, Dr. Barney Clark, who lived for 112 days. In the 10-year trial, 79 percent of the patients with the artificial heart survived until a transplant - for one patient, that was more than four years. By contrast, 46 percent of similar patients without the heart survived to get a transplant. The demand for donor hearts is increasing much faster than the number of available hearts, which has dwindled in recent years, according to the New England Journal of Medicine. Marshall is one of 40 patients enrolled in this trial at medical centers around the country. Instead of returning to Wasilla, the Marshalls will be staying in a temporary residence in Bothell, Wash., while they wait for a heart - the kind that doesn't need batteries. John Capps, administrator of the UW Medicine Regional Heart Center, said being able to use the portable machine is very likely to be less expensive than having a patient spend a year or two in the hospital. But there are also physical risks. Marshall has tubes coming out of his body, and that always poses the risk of infection, Mokadam said. The heart and the driver are mechanical, and could have mechanical problems. But for patients awaiting a transplant, he said, being able to leave the hospital is incredibly important. "It's not just their physical health that patients have to get through, it's their mental state as well," Mokadam said. As for Marshall, he was upbeat. He smiles at the nurses and thanks them for everything, his wife said. "He has an attitude I've never seen in anybody else," she said. "He's actually my hero." As for the noise, Marshall said he now sleeps with earplugs. Otherwise, he and Kathy are beginning to be sort of fond of it, he said. "We decided that's the sound of life - absolutely."