heart transplant

Groundbreaking procedure allows heart repairs to grow with children, new study shows

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Owen Monroe was born with a rare heart heart defect called truncus arteriosis. He was the first person in the world to get a partial heart transplant to repair it.

Owen Monroe was born with a rare heart heart defect called truncus arteriosis. He was the first person in the world to get a partial heart transplant to repair it.Nick and Tayler Monroe CNN  — 

Owen Monroe was 18 days old when he made history, becoming the first person in the world to receive a partial heart transplant.

His groundbreaking surgery, performed in 2022, even captured the attention of Hollywood scriptwriters, who wove his story into a recent episode of the long-running medical drama “Grey’s Anatomy.”

In a study published Tuesday in the journal JAMA, his doctors will document another milestone: For the first time, the tissue used to fix Owen’s heart has grown, a long-sought goal of this type of repair.

At the time of his first operation, Owen’s heart was the size of a strawberry. Today, at 20 months of age, it’s about the size of an apricot – and the new valves and blood vessels have kept up with his growth, which means unlike most children born with the same defect, he may not need to have more risky heart surgeries throughout his life.

Researchers have been working to make growing heart valves a reality through tissue engineering, germinating them from cells in a lab. That approach has worked in animals, but it has not yet panned out in humans.

“This is a huge advance,” said Dr. Kathleen Fenton, chief of the Advanced Technologies and Surgery Branch of the National Heart, Lung, and Blood Institute. She wrote a recent editorial about the potential of partial heart transplants, but she was not involved in this research.

At 20 months of age, Owen Monroe's heart repair is growing with him.

At 20 months of age, Owen Monroe’s heart repair is growing with him.Nick and Tayler Monroe

“It’s one child, right? So you have to do research,” Fenton said. “You have to follow these children in the long term and see what really happens. But there is, I think, every reason to hope that it’s really going to be a groundbreaking advance for a subset of children that don’t otherwise have good options.”

The procedure is catching on quickly. Since Owen’s surgery, 12 other partial heart transplants have been performed in children, including nine at Duke Health, the hospital that developed the operation.

The technique has also enabled “domino transplants” and split-root transplants, which allow a single donor heart to save the lives of two critically ill infants.

In a domino transplant, the first child, born with a weak heart muscle that can’t adequately pump blood, gets a whole donated heart while the second baby gets the healthy blood vessels and valves from the first infant. In a split-root transplant, the functioning parts of a heart are donated to two infants.

“What’s a big leap is to be able to potentially make use of donor parts that otherwise couldn’t be used,” Fenton said.

Dr. Joseph Turek, chief of pediatric heart surgery at Duke Health and the surgeon who created the partial heart transplant, said he believes that it could help hundreds of children every year in the US.

“I think that that, ultimately, it will be limited by the number of donors,” said Turek, who is the lead author of the new study.

“There are 500 pediatric heart transplants that we do a year in this country, and so for the vast majority of those kids getting hearts, they would have available their old hearts. We could use their valves. So my guess is, this could help over a thousand kids a year, hopefully,” he said.

A tiny pioneer

Nick and Tayler Monroe, Owen’s parents, learned that he had a serious heart defect when they went for an in-depth ultrasound exam at his 20th week of development.

Owen had a rare birth defect called truncus arteriosis.

Normally, people have two major blood vessels coming out of the tops of their hearts. One, the pulmonary artery, sends blue blood that’s depleted of oxygen to the lungs to pick up more while the other, the aorta, sends oxygen-rich red blood to fuel the rest of the body.

Owen Monroe shortly before having a procedure to fix his heart in 2022.

Owen Monroe shortly before having a procedure to fix his heart in 2022.Nick and Tayler Monroe

With truncus arteriosis, which affects about 250 babies born in the US each year, these two vessels are fused, allowing oxygenated and deoxygenated blood to mix. They are also lacking a valve needed to keep blood from flowing backward, and many with this condition are born with a hole between the bottom two pumping chambers of their hearts.

Babies with truncus arteriosis are often in distress soon after birth. Too much blood flows into their lungs, straining the tiny air sacs. Because their blood isn’t well-oxygenated, they may look blue and work harder to breathe.

“So even before he was born, we were going in knowing that he was going to have open-heart surgery very young and then was probably going to have a handful of surgeries before he was a teenager and then a couple more after that throughout his life,” Nick Monroe said.

But Owen’s case was even more serious, Turek explained.

Normally, when a child has truncus arteriosis, surgeons need to replace only the pulmonary heart valve they weren’t born with. They’re often able to save and use the single valve the child does have to serve as their aortic valve.

In Owen’s case, even the one valve he had didn’t work well. A doctor who saw his first post-birth ultrasound thought Owen would need a full heart transplant.

But the next day, Turek approached Owen’s parents and presented an alternative: He had been practicing a new technique that could replace just the defective parts of Owen’s heart with living vessels and valves from a recently deceased donor.

Tayler Monroe, Owen’s mom, asked the doctor how many times he had done the procedure.

“He said, ‘I’ve done it five times – on piglets,’ ” Nick Monroe said.

Making the decision to be first

Turek told them that if everything went well, Owen wouldn’t need any more open-heart surgeries. If he repaired Owen’s heart using frozen valves harvested from cadavers, their son had only a 50% chance of survival.

Monroe says that they realized it was risky, but they also knew that their son might not survive any other way. He was already in heart failure. The hospital couldn’t give him a lifesaving heart-lung bypass called ECMO because his damaged heart wouldn’t have been able to handle it.

“So they had no emergency care they could give him, any more than they already were,” Monroe said.

“Everybody always says to us, ‘it must have been such a hard decision,’ but when your backs are against the wall and then your surgeon says, ‘well, here’s a lifeline,’ you take the chance,” he said. “We saw it as the best opportunity for our son to have a chance of survival.”

Owen Monroe

Owen MonroeNick and Tayler Monroe

They agreed to try the partial transplant, and then they waited.

“Every day, he was looking so jaundiced, and you could feel the tension on the floor. Every time we had rounds. How it was weighing on everybody,” Monroe said. “The entire staff of that unit – all the nurses, all the fellows and all the doctors – every time, they’re like, ‘there’s no change. No good news.’ ”

Owen’s mom is a pediatric ICU nurse. She knew all too well what was happening, and Monroe said she coped by separating her emotions from her clinical understanding.

“When we were at the hospital, she was in nurse mode, so she was very analytical and logical and knew what all the numbers did on all the pumps and was really good about asking the doctors questions,” Monroe said.

But when she got back to their room at the Ronald McDonald House at night, Monroe said, he could hear her crying in the shower “because it’s so emotionally draining and you can only separate yourself so far.”

After more than two weeks, they got their first jolt of hope: The hospital had found a matching heart. The donor’s heart muscle wasn’t suitable for transplant, but the valves and blood vessels might help Owen.

Staff relayed the good news the morning of April 22, 2022. By 3 p.m., Owen was in surgery.

“And so we’re just sitting there in the waiting room for the intensive care unit, and hours are going by, and you don’t really want to watch TV or do anything,” Monroe said. “We’re just sort of staring off into space, just waiting for the next phone call.”

Finally, around midnight, Turek came out to tell them the procedure was finished. Everything had gone well.

Since then, there’s been no stopping Owen, who is now a happy, active toddler who is meeting his developmental milestones.

“The most amazing thing about this whole experience is, it’s almost as if his body was ready to go and was like, ‘this is the only thing that’s wrong with me. Just fix my heart, and I’m good to go,’ ” Monroe said.

Weighing the risks

There are tradeoffs with partial heart transplants. Owen still needs medication to suppress his immune system so it won’t reject the transplanted parts of his heart, but he needs only a low dose.

Typically, when the immune system rejects a donor heart as foreign, it is rejecting the heart muscle. There aren’t as many markers in the tissue that makes up blood vessels and valves, so it’s not as reactive.

“Normal heart transplant patients go on two agents to manage their rejection issues. And Owen is on one of those two agents, at basically half a dose,” Turek said.

Turek says they’re still studying how the body responds to this type of transplant to see whether they may be able to refine his regimen even further.

Drugs that suppress immune function can be life-sustaining, but they also make people more vulnerable to infections and cancer. So the goal is to find a long-term fix that won’t require any.

Another child who’s gotten a partial heart transplant hasn’t needed any anti-rejection medication and is doing well

“He’s on no immunosupression, and his valve continues to grow very well,” Turek said, “I suspect thathis donor was very well-matched with him.”

The Monroes are grateful they got to help Owen and ultimately other children, too.

If Owen had gotten the older kind of repair for his heart, Nick Monroe said, they would be planning his third surgery by now.

“When we made the decision, of course, we were only thinking about what was best for our son,” he said. “But at the end of the day, being able to be sort of a pioneer to help other children improve their lives and sort of advance treatment for other sick kids with congenital heart disease … we’re very proud we took the risk.”

101 Year Old David Rockefeller Just Received 7th Heart Transplant.

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The 101 heir to the Rockefeller fortune, David Rockefeller, just successfully completed his 7th open heart transplant after the last one failed earlier this week. This would mark more heart transplants than any other human being that’s ever existed.

david-rockefeller-800x445

David’s net worth is estimated at only $3 billion, a small number compared to the many new tech startup billionaires that make the exclusive forbes list. However he is the most wealthy billionaire of old money in the Forbes Billionaires club. David stared as an American banker who served as chairman and chief executive of Chase Manhattan Corporation. He is the oldest living member of the Rockefeller family and family patriarch since July 2004. Rockefeller is also the only surviving child of John D. Rockefeller, Jr. and Abby Aldrich Rockefeller, and the only surviving grandchild of John D. Rockefeller and Laura Spelman Rockefeller.This would make David Rockefeller

Rockefeller was born in New York City, New York, in 1915 and grew up in a nine-story house at 10 West 54th Street, the tallest private residence ever built in the city. The home contained rare, ancient, medieval and Renaissance treasures collected by his father—with some, such as the Unicorn Tapestries, held in an adjoining building at 12 West 54th Street. On the seventh floor was his mother’s private modern art gallery. The house was subsequently donated by David’s father as a site for a sculpture garden that is now part of the Museum of Modern Art. He spent much time as a child at the family estate Kykuit, where, in his memoirs, he recalls visits by associates of his father, including General George C. Marshall, the adventurer Admiral Richard Evelyn Byrd (whose Antarctic expeditions had been funded by the family), and the aviator Charles Lindbergh. Summer vacations were spent at the Eyrie, a 100-room house in Seal Harbor on the southeast shore of Mount Desert Island, in Maine. The house was demolished by the family in the early 1960s to make way for Museum of Modern Art. This was conceived and planned for by his mother Abby.

In 1946, Rockefeller joined the staff of the longtime family-associated Chase National Bank.

Rockefeller started as an assistant manager in the Foreign Department. There he financed international trade in a number of commodities, such as coffee, sugar and metals. This position also maintained relationships with more than 1,000 correspondent banks throughout the world. He served in other positions and became president in 1960. He was both chairman and chief executive of Chase Manhattan from 1969 to 1980 and remained chairman until 1981. He was also, as recently as 1980, the single largest individual shareholder of the bank, holding 1.7% of its shares.

 In 1954, Rockefeller became chairman of the committee charged with deciding the location of the bank’s new headquarters. The following year his decision to erect the building in the Wall Street area was accepted; it was subsequently seen as a decision that directly revived the City’s downtown financial district. In 1960 the headquarters was completed under his direction at One Chase Manhattan Plaza, on Liberty Street in downtown Manhattan, directly across from the Federal Reserve Bank of New York. At 60 stories, it was at that time the largest bank building in the world; it also had, five floors below ground, the largest bank vault then in existence.

In the 1960s, Rockefeller and other businessmen formed the Chase International Advisory Committee (IAC) which by 2005 consisted of twenty-eight prominent and businessmen from 19 nations throughout the world, many of whom were his personal friends. Rockefeller subsequently became chairman until he retired from that position on the IAC in 1999. After the Chase’s merger with J. P. Morgan, this committee was renamed theInternational Council, and contains prominent figures such as Henry Kissinger, Riley P. Bechtel (of the Bechtel Group), Andre Desmarais, George Shultz, Tony Blair, the current chairman.  Historically, prominent figures on the IAC have included Gianni Agnelli (a longtime associate, who spent thirty years on the Committee), John Loudon (Chairman of Royal Dutch-Shell), C. Douglas Dillon, David Packard, Lee Kuan Yew and Henry Ford II.

.Under his term as CEO, Chase spread internationally and became a central pillar in the world’s financial system; Chase has a global network of correspondent banks that has been estimated to number about 50,000, the largest of any bank in the world. In 1973, Chase established the first branch of an American bank in Moscow near the Kremlin, in the then Soviet Union. That year Rockefeller traveled to China, resulting in his bank becoming the National Bank of China’s first correspondent bank in the United States.

In November 1979, while chairman of the Chase Bank, Rockefeller became embroiled in an international incident when he and Henry Kissinger, along with John J. McCloy and Rockefeller aides, persuaded President Jimmy Carter through the United States Department of State to admit the Shah of Iran, Mohammad Reza Pahlavi, into the United States for hospital treatment for lymphoma. This action directly precipitated what is known as the Iran hostage crisis and placed Rockefeller under intense media scrutiny (particularly from The New York Times) for the first time in his public life.

In a private capacity Rockefeller has met with and advised every American President since Eisenhower and has even at times served as an unofficial emissary on high-level diplomatic missions. Additionally, he serves as the only member of the Advisory Board for the Bilderberg Group.

As of September 2015, his net worth is estimated to be US $3.0 billion, ranking him among the 200 richest people in the world. Initially, most of his wealth had come to him via the family trusts that his father had set up, which were administered by Room 5600 and the Chase Bank.

 Though David’s body continues to age, the ability to replace body parts that fail with young and youthful ones could hypothetically keep Mr. Rockefeller running for a very long time

The Heart Consciousness – a Neurological Perspective

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Heart Consciousness - a Neurological Perspective

 

During organ transplantation there have been numerous reports of emotions, memories and experiences being transferred along with the organ which is being transplanted, from the donor to the recipient.  Dr. Paul Pearsall has collected the cases of 73 heart transplant patients and 67 other organ transplant recipients and published them in his book, “The Hearts Code” (1). Here is a sample of a case that has been reported.

Transplant recipient develops desire for chicken nuggets and green peppers.

On May 29, 1988, an American woman named Claire Sylvia received a heart transplant at a hospital in Yale, Connecticut. She was told that her donor was an 18 year-old male from Maine who had just died in a motorcycle accident.

Soon after her operation, Sylvia declared that she felt like drinking beer, something she hadn’t particularly been fond of before. Later, she observed an uncontrollable urge to eat chicken nuggets and found herself drawn to visiting the popular chicken restaurant chain, KFC.  She also began craving green peppers which she hadn’t particularly liked before. She started behaving in an aggressive and impetuous manner following the surgery. Sylvia also began having recurring dreams about a mystery man named Tim, whom she felt was the organ donor.

She searched for obituaries in newspapers published from Maine and was able to identify the young man whose heart she had received. His name had indeed been Tim. After visiting Tim’s family, she discovered that he used to love chicken nuggets, green peppers and beer. These experiences are documented in her book, A Change of Heart: A Memoir  (2).

The Heart Brain

In 1974, the French researchers Gahery and Vigier, working with cats, stimulated the vagus nerve (which carries many of the signals from the heart to the brain) and found that the brain’s electrical response was reduced to about half its normal rate when stimulating the vagus nerve (3).  The heart appeared to be sending meaningful messages to the brain that it not only understood, but also obeyed (4).  Later, neurophysiologists discovered a neural pathway and mechanism whereby input from the heart to the brain could inhibit or facilitate the brain’s electrical activity (5).

Dr. Armour introduced the idea of functional “heart brain.” His research revealed that the heart has a complex intrinsic nervous system that is sufficiently refined to qualify as a “little brain” in its own right, due to its independent existence.

The heart’s nervous system contains around 40,000 neurons, called sensory neurites. The heart’s brain is an intricate network of several types of neurons, neurotransmitters, proteins and support cells similar to those found in the brain proper. Its elaborate circuitry enables it to act independently of the cranial brain to learn, remember, and even feel and sense (6).

Information from the heart, including feeling sensations, is sent to the brain through several afferents. These afferent nerve pathways enter the brain at the area of the medulla, and cascade up into the higher centers of the brain, where they may influence perception, decision making and other cognitive processes (7).

When heart rhythm patterns are coherent the neural information sent to the brain facilitates cortical function. This effect is often experienced as heightened mental clarity, improved decision making and increased creativity. Additionally, coherent input from the heart tends to facilitate the experience of positive feeling states (8).

States of increased heart rhythm coherence are associated with improvements in cognitive performance (9). The brain’s alpha wave activity is synchronized to the cardiac cycle. During states of high heart rhythm coherence, alpha wave synchronization to the heart’s activity significantly increases (10).

The heart’s afferent neurological signals directly affect activity in the amygdala and associated nuclei, an important emotional processing center in the brain. The amygdala is the key brain center that coordinates behavioral, immunological, and neuroendocrine responses to environmental threats. It compares incoming emotional signals with stored emotional memories, and accordingly makes instantaneous decisions about the level of perceived threat.

Due to its extensive connections to the limbic system, it is able to take over the neural pathways, activating the autonomic nervous system and emotional response before the higher brain centers receive the sensory information (11).

The heart communicates information to the brain and throughout the body via electromagnetic field interactions. The heart generates the body’s most powerful and most extensive rhythmic electromagnetic field. The heart’s magnetic component is about 500 times stronger than the brain’s magnetic field and can be detected several feet away from the body.

It was proposed that, this heart field acts as a carrier wave for information that provides a global synchronizing signal for the entire body (12). There is now evidence that an influential electromagnetic communication system operates just below our conscious awareness. Energetic interactions possibly contribute to the magnetic attractions or repulsions that occur between individuals, and also affect social relationships.

It was also found that one person’s brain waves can synchronize to another person’s heart (13). When people touch or are in proximity one person’s heartbeat signal is registered in the other person’s brainwaves (14). When two people are at a conversational distance, the electromagnetic signal generated by one person’s heart can influence the other person’s brain rhythms.

When an individual is generating a coherent heart rhythm, synchronization between that individual’s brainwaves and another person’s heart-beat is more likely to occur (15).

Individuals capable of generating high ratios of heart coherence were able to alter DNA conformation according to their intention. Intending to denature (un-wind) or renature (wind) the DNA had corresponding effects on the UV spectra (16). As people learn to sustain heart-focused positive feeling states, the brain can be brought into entrainment with the heart (17). The conclusion is the need of pointing to the heart as the center of consciousness.

Carmat fits 2nd patient with artificial heart

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French company Carmat confirmed on Monday that it had fitted a second patient with one of its artificial hearts and would continue its clinical trials on two more patients.

Carmat’s device, which mimicks nature’s work using biological materials and sensors, is designed to serve not as a bridge to a heart transplant but as a permanent implant, extending life for terminally ill patients who cannot hope for a real organ, because they are too old or donors are scarce.

Shares in Carmat rose as much as 19 percent on Friday after French media reported that doctors had implanted an artificial heart made by the company for a second time. The stock was up 2.6 percent at 0737 GMT (3.37 a.m. EDT).

The clinical trial will be considered a success if Carmat’s first patients survive with the implant for at least a month. The patients selected suffer from terminal heart failure – when the sick heart can no longer pump enough blood to sustain the body – and have only a few weeks, or even days, to live.

Carmat said it does not plan to publish any information on the results of this feasibility study until it is completed.

If the results of these first safety tests are positive, Carmat has said it would fit the device into about 20 patients with less severe heart failure, with an aim to request the right to market its device in Europe by 2015.

Patient enrollment had been put on hold in March after the first person to be implanted with the device, a 76-year-old man, died two and a half months after his operation.

Carmat’s device, developed by a team of engineers from Airbus parent company EADS, weighs about 900g (around 2 lb)- nearly three times more than an average healthy human heart. It mimics heart muscle contractions and contains sensors that adapt the blood flow to the patient’s moves.

It is powered by external, wearable lithium-ion batteries. Inside the heart, surfaces that come into contact with human blood are made partly from bovine tissue instead of synthetic materials such as plastic that can cause blood clots.

Among Carmat’s competitors for artificial heart implants are privately-held SynCardia Systems and Abiomed, both of the United States.

First Patient Implanted With Carmat Total Artificial Heart Dies.

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A 76-year-old man with end-stage heart failure who was the first person implanted with the world’s first permanent, biosynthetic artificial heart has died 75 days after receiving the device. The patient died March 2, 2014, physicians at European Hospital Georges-Pompidou (EHGP) in Paris announced Monday night.

Assistance Publique — Hôpitaux de Paris (APHP) released a statement saying that the cause of death is being investigated but will not be known until a thorough analysis of medical and technical data is conducted.

“The doctors directly involved in postoperative care wish to emphasize the importance of the first lessons they have learned from this first clinical trial regarding patient selection, postoperative care, treatment, and prevention of complications,” says APHP.

The device manufacturer, Carmat, said it is “of course premature to draw conclusions from a single patient, either before or, in this case, beyond the 30-day postimplantation survival period.”

The patient was the first in a feasibility study aiming to enroll four patients suffering from irreversible end-stage, biventricular heart failure (LVEF <30%) who were not eligible for transplantation. The study is examining patient survival at 30 days, prosthesis function, and patient quality of life.

“We are currently recruiting the other three patients,” explained Prof Christian Latrémouille (EHGP) at a French cardiology society meeting in January. “The total artificial heart bioprosthesis, Carmat, is now [officially] in clinical trials.”

Carmat is not expected to communicate the results of the study until implantation and 30-day follow-up is completed in all four subjects.

The patient, whose name has not been made public, was implanted with the device in mid-December; in February, an update from the hospital indicated that the patient had been taken off anticoagulants on January 10; and as of February 18, it reported he was able to walk without respiratory assistance. French newspaper Le Parisien reported today that no signs of thrombosis were seen on the device after postmortem explantation.

By way of comparison, the first patient to receive a heart transplant in 1967, Louis Washkansky, aged 55, survived the operation and lived for just 18 days before succumbing to massive bilateral pneumonia induced by the immunosuppressive regimen.

 

Fully Implanted Artificial Heart Mimics Cardiac Physiology

 
Carmat total artificial heart.

The brainchild of renowned cardiologist Prof Alain Cribier, the Carmat pump was designed with a morphology similar to that of the human heart, with two separate ventricles and four bioprosthetic valves. Unlike left ventricular assist devices (LVADs) approved for use in end-stage heart-disease patients, either as destination therapy or as bridges to transplantation, the Carmat, weighing 900 g, is designed to fully reproduce heart function, using biomaterials, including bovine valves.

The device consists of two ventricular cavities with two volume spaces separated by a flexible biomembrane: one for blood and one for the “actioning fluid,” the company website explains. A flexible, external bag contains this actioning fluid and beats at the same rate as a native heart, displacing the biomembrane and mimicking the movement of the native ventricle wall during heart contraction: that motion admits and ejects the blood. A sensor monitors and regulates prosthesis operation according to patient’s needs.

At present, the investigational device is powered either by a hospital-based console or by an external battery with a battery life of four to six hours. An internal backup battery operates the artificial heart for 20 minutes. The company is currently developing a fuel cell that would increase device autonomy to 16 hours.