Medical Staff Pulse Newsletter

Cedars-Sinai successfully implants its first total artificial heart

Michelle Johnson has helped make Cedars-Sinai history.

Over a six-hour operation in mid-January, surgeons removed the 39-year-old San Diego woman's failing heart and implanted an FDA-approved artificial one made of polyurethane, carbon and titanium. Manufactured by SynCardia Systems, the 5.6-ounce device gives patients with end-stage biventricular failure such as Johnson a new lease on life. She was discharged from Cedars-Sinai in mid-March, her new heart pumping a steady 130 beats per minute.

"I'm looking forward to taking my son to Legoland for his 7th birthday and just spending time with my family," she said.

Previously, patients like Johnson couldn't leave the hospital - they had to be tethered to "Big Blue," a 418-pound machine that powers an artificial heart. But she is part of a group of patients in an FDA study testing a 13.5 pound, backpack-sized pneumatic machine and batteries. The so-called "freedom portable driver" connects to the artificial heart via two external tubes. The small machine gives recipients full mobility, allowing them to go about their daily lives as they wait for a donor heart - the kind that doesn't need batteries.

"They can't run marathons or swim, but the quality of life is pretty good," said Jaime Moriguchi, MD, medical director of the Mechanical Circulatory Support Program in the Cedars-Sinai Heart Institute.

The surgery went smoothly, said one of her surgeons, Fardad Esmailian, MD, surgical director of Cedars-Sinai's Heart Transplantation and Ventricular Assist Device Program. Cedars-Sinai is one of only 60 medical centers worldwide certified to perform artificial-heart implants.

"Everything went extremely well from a technical standpoint," Esmailian said. "If we find the right candidates, we will do more."  

The medical center's first artificial heart implant was one year in the making. Dozens of medical personnel were trained to deal with the device and its pneumatic machines. That included emergency first responders such as local paramedics and fire departments, who were trained not to perform CPR or an EKG on artificial-heart recipients such as Johnson.

In addition, a core team that included cardiologists, surgeons and nurse practitioners traveled to SynCardia's headquarters in Tucson, Ariz., to see how the device is made, perform surgery simulations, and receive other training.

"We worked out all the kinks, so we were well prepared," said Lawrence Czer, MD, medical director of the Heart Transplant Program and transplantation cardiology at the Heart Institute. "This was a team effort and everyone pulled together. Now, many more patients can be helped."

Johnson is one of the lucky ones. Diagnosed with idiopathic cardiomyopathy in her late 20s, her condition gradually deteriorated so much that she underwent a human-heart transplant at Cedars-Sinai in December 2010.

At first, all went well. She exercised at the gym, ferried her kids to school and work, and took classes for an associate's degree in social work at San Diego City College.

But after nine months, her body began rejecting the heart. This is not an uncommon occurrence - nearly 25 percent of heart transplant recipients show signs of rejection within a year of transplant. However, powerful immunosuppressant drugs and other therapy such as plasmapharesis did not improve Johnson's condition.

The artificial heart was her only option. The man-made heart, which pumps up to 9.5 liters of blood a minute, does not require immunosuppressants. And unlike donor hearts, the device has no risk of rejection since it's made out of biocompatible materials.

"You can't reject plastic or titanium" Moriguchi said and "We anticipate that she will become a more suitable candidate for a second heart transplantation once her antibody levels have been reduced."

Pictured from top: (l-r) Fardad Esmailian, MD, Rotch Delos Santos, RN, patient Michelle Johnson and Jaime Moriguchi, MD; Johnson visits with her caregivers in the Saperstein Critical Care Tower.

 At left: After being discharged, Johnson pushes the backpack-sized pneumatic machine that is connected to her artificial heart.