The persistence of medical technology development

Today I learned that David Lederman, a pioneer of the total artificial heart, passed away. Dr. Lederman founded AbioCor with the objective to develop and market a fully implantable total artificial heart. While the AbioCor device that was ultimately developed, which differed from the famed Jarvik 7 device implanted in dentist Barney Clark in that it was self contained (i.e., no external tether), was only implanted in 14 patients between 2001 and 2004, its technologies led to important advances in hemodynamics and engineering that were embodied in bridge-to-transplant devices and left ventricular assist devices that are common in use today.

Dr. Lederman had noted in a 2003 CBS interview, “There is no reason a person should die when their heart stops. If the person’s brain and the rest of the body is in good shape, why should people die?”. While there is no question that Dr. Lederman would have preferred that the AbioCor device or its descendants would lead to widespread adoption as a total artificial heart, the development of the device with its ambitious goals generated a presumption that medical technology could intervene in providing the functions normally and naturally provided by a vital organ.

My father, who passed away some years ago, was a general surgeon with expertise in chest/thoracic procedures. When we once discussed technologies like the artificial heart, he was eminently skeptical that the technology would soon be practical, since there were fundamental challenges with the technology. First and foremost, he was concerned with the problem of hemolysis — synthetic heart valves incorporated in such a device were inevitably going to be too rough on red blood cells, ultimately causing their rupture and leading to potentially lethal clot embolisms. He believed the technology was possible but its practical limitations represented a hurdle that would take many years to surmount.

As a surgeon trained over 50 years ago, my father had a perspective based in an era before many modern technologies — he was highly proficient in surgical technique that relied predominantly on precision with a scalpel and sutures.  But, to his credit, with the advent of laparoscopic surgery in the late 1980s, he not only adopted this technology in his practice but also advanced its use through training of his colleagues at hospitals in New England. (He also pioneered the development of a subclavicular IV.) He recognized the persistence of medical technology in advancing what was possible in surgery.  Therefore, even though he was not able to see widespread adoption of artificial heart technologies or their evolution into left ventricular assist devices and others, I have to believe that both he and Dr. Lederman would fully expect that it was only a matter of time before such technologies would reach the leading edge and eventual routine clinical practice.

Posted via email from medmarket’s posterous

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