Andy Buczek, Hartford Hospital's first heart transplant patient, with his family and his surgeon, Dr. Henry B.C. Low, right, in 2004. He received his transplanted heart in 1984
In December, 1967, Dr. Christiaan Barnard successfully transplanted a heart from a young head trauma victim into a dying fifty-four-year-old man with ischemic cardiomyopathy. News of the transplant electrified the world – physicians and the lay public alike.
A frenzy of international activity followed, with over one hundred transplants performed in almost fifty centers over the next year. However, the initial results were discouraging, to say the least. Nearly sixty patients were dead by the eighth postoperative day.
The mean survival was less than thirty days, and seventy one of the first one hundred patients were dead within a year. While problems of immune suppression and rejection were addressed, heart transplantation remained largely an experimental procedure, performed in only a handful of centers worldwide after 1969.
Around 1980, the introduction of cyclosporine A
revolutionized postoperative immune suppression, making solid organ transplantation of all types feasible. Heart transplantation hospital mortality fell to less than ten percent, and five year survival improved to better than seventy five percent. The Food and Drug Administration approved heart transplantation for end-stage heart failure in the early 1980s. Today, over two thousand transplants are performed in more the one hundred twenty centers in the United States alone.
Inspired by the early reports of 1968, Dr. Henry B.C. Low began a series of experimental canine heart transplants at Hartford Hospital. As the dismal outcomes in humans became apparent, enthusiasm for the procedure waned and Dr. Low halted his experimental work.
This quiescent period ended in 1979, when Dr. Lee Ellison revived interest locally. Dr. Robert Schweizer, then Director of Transplantation at Hartford Hospital, suggested that he work with Dr. Low on a series of animal transplants. Ultimately, concerns about viral infections ended that series, but by that time Dr. Low was confident in his technique. By 1980, Dr. Ellison decided to concentrate on his congenital cardiac surgical practice, and Dr. Low was assisted in the operating room by Dr. David Drezner.
The FDA approved cyclosporine for use in transplantation in 1981. Even before that, the drug’s salutary clinical effects were evident and it appeared that heart transplantation would be a clinical option for the treatment of end-stage congestive heart failure. With the encouragement of Dr. Schweizer ("You sew in the heart, Henry, I'll keep them alive afterwards," Dr. Low remembers him saying), Dr. Low asked the Hartford Hospital administration for permission to go ahead. Interestingly, at about that time, the board of the Massachusetts General Hospital had refused to allow their program to go forward. The president of Hartford Hospital at the time was reluctant to bring the matter to the board.
Presumably he was concerned about the negative backlash were such a high-profile procedure to fail; he also said he was afraid the publicity might bring too much business to Hartford Hospital. In the face of persistent persuasion by Dr. Low, Dr. Jack Reed (Chief of Surgery), and Bernadette Warren, the matter was brought before the board and Dr. Low was allowed to proceed. Heart transplantation is a multi-disciplinary effort, requiring not only surgeons but also transplant medicine and cardiology. In addition to Drs. Low, Drezner, and Schweizer, Drs. Michael Rossi, James Dougherty, and Alfredo Nino of the Division of Cardiology at Hartford Hospital were instrumental in getting the program off the ground.
Dr. Low observed his first human heart transplant in 1982, flying to the Medical College of Virginia with a heart donated from a patient at Mt. Sinai. Trips to Columbia-Presbyterian Medical Center and Stanford University by the whole team not only completed their training but also convinced them heart transplantation was feasible at Hartford Hospital.
Buczek and Dr. Low in 1984
A heart from a young trauma victim became available, and in November 1984, amidst intense interest (thirty two people passed through the operating room), the first successful heart transplant in the state of Connecticut was performed. Nearly twenty years, two hip operations, a colon resection and two children later, that patient remains alive and well.
Heart transplantation is inherently dramatic because one is transplanting the organ traditionally seen as the seat of the emotions and the soul into a person who is by definition totally debilitated and near death.
Over the years several particularly dramatic episodes stand out. On Valentine's Day in 1987, two United States Air Force F 111 fighter-bombers flew supersonic across country to bring a heart from Oklahoma City to a dying man at Hartford Hospital. Another man was bought to the operating room from the cardiac catheterization laboratory after a failed angioplasty attempt in the setting of a profound ischemic cardiomyopathy. He was placed on cardiopulmonary bypass with CPR underway. When he couldn't be weaned after four bypasses, a heart became available from another hospital. After ten hours on pump, fourteen hours in the operating room, and four weeks in the hospital, he walked out with his new heart. He is now the guiding energy behind the Park Road Playhouse.
Sometimes the new heart just doesn't work. One patient was re-transplanted the same day; one sixteen year old boy was re-transplanted after a week of mechanical circulatory support and one patient's new heart recovered completely. Every life saved is precious and every extra day lived is a little miracle.
Since November of 1984, about two hundred fifty transplants have been performed at Hartford Hospital. Dr. Low realized from the start that this had to be a team effort and the success of the program is testimony to the skill of all involved. Over the years, the Hartford Hospital team has included Drs. David Drezner, Hiroyoshi Takata, James Gallagher, Robert Lowe, Robert Gallagher, David Underhill, Paul Preissler, and Jonathan Hammond (surgeons), Drs. Robert Schweizer, Stanley Bartus, and David Hull (Hartford Transplant Associates), Drs . Michael Rossi, James Dougherty, Alfredo Nino, the late David Lawrence, Jeffrey Walden and Carol Campbell, APRN (cardiology), Dr. Martin Berman and colleagues (pathology), the Infectious Disease and Nephrology staff at Hartford Hospital, as well as the physicians, mid-level practitioners, and nurses of the Cardiothoracic Surgery Intensive Care Unit and the Postoperative floor.
About five hundred thousand new cases of congestive heart failure are diagnosed each year in the United States, but only about two thousand transplants are performed. Clearly, the overall contribution of transplantation to the treatment of congestive heart failure is “epidemiologically trivial,” in the words of Dr. Eric Rose of Columbia University. New developments in medical therapy, including ACE inhibitors, ARBs, beta blockers and diuretics, advances in ICDs and biventricular pacing, surgical alternatives to transplantation (including mitral valve repair, left ventricular remodeling and long-term ventricular assist devices), as well as chronic donor shortages, mean that heart transplantation will never be an everyday occurrence.
Yet for those few with no other options, debilitated and dying a slow agonizing death, the heart transplant program at Hartford Hospital has given – and will continue to provide – a major source of comfort and hope.