事件记录
Dr. 米勒: 大约32年前, Barney Clark had the first artificial heart implanted here at the 犹他大学. We're going to talk about how things have changed since then on 范围 Radio. 这是 Dr. 汤姆米勒.
播音员: Medical news and research from the 犹他大学 physicians and specialists you can use for a happier and healthier life. 您正在收听的是范围.
首例人工心脏移植手术
Dr. 米勒: 我和 Dr. 克雷格Selzman. 他是一名副教授 心胸外科手术 in the Department of Surgery here at the 犹他大学, 克雷格也是心脏移植专家 心室辅助装置这是一种新型人工心脏.
大约32年前, Barney Clark was the first man to undergo an artificial heart implantation, 那是在大发娱乐 犹他大学. 我认为，从那以后发生了很多变化. Dr. Selzman, can you talk to us about what's new with artificial hearts?
Dr. Selzman: 从那时起，发生了很多事情. It's been in two or three different areas, and the first area is just the technology.
Dr. 米勒: 这已经发生了巨大的变化.
Dr. Selzman: 它是巨大的.
Dr. 米勒: 我记得巴尼·克拉克的照片. 水泵很大. 他们不得不和巴尼·克拉克一起转悠. 很吵. 声音很大. 太可怕了.
Dr. Selzman: 这是Zamboni机器. We still have one here in the hospital, if necessary, to clean the ice outside. But the deal now is that we have these pumps so small and they're very patient-friendly so that the patients can actually go home. 他们可以做任何事. 他们可以打18洞的高尔夫球，走路. You name it; they can do it.
The one thing that is a little bit difficult is there's electricity going through this; they're not going for a swim any time soon, 但这种情况甚至正在改变. We have pumps now that allow people to have artificial heart support that can actually go swimming with internal batteries and stuff. 所以这是巨大的.
心室辅助装置（VAD）结果
Dr. 米勒: So are the pumps still external to the body, or are they within the body now?
Dr. Selzman: 它们都在体内. 大发娱乐还有一些是外部使用的. Those are used for really the sickest of patients that we're really just trying to do whatever we can to save their lives. But in terms of folks that you want to actually go home and regain life, the thing about a lot of this field is that the chances of you having a long life with advanced 心脏衰竭 is low. Probably the patients we're talking about, less than 10% are alive at two years.
Dr. 米勒: 我是说，这和很多癌症一样糟糕.
Dr. Selzman: 这是转移性癌症. 基本上是一样的. 我经常用类比, and the one thing that the VADs have done in this artificial technology is that it's the therapy that is so much better than chemotherapy, meaning that you can put somebody on with an advanced cancer, 你可能会再买两个, 三年, 四个月. 大发娱乐说的是购买5到10年的债券. 不仅是年份，而且是质量年份. 这些病人回到了他们的家人身边. 他们要回去工作了. 他们在生活. 令人惊奇的.
人工心脏移植vs. 心脏移植手术
Dr. 米勒: 克雷格，这是否意味着拥有一个 心脏移植手术 可能会过时?
Dr. Selzman: Ah, 这是个好问题, and it's one of the current debates within our community because the life expectancy, the one year survival rate for patients that are getting these machines is almost as good as getting a 心脏移植手术. 心脏移植的问题是：伟大的治疗. 只是数量不够而已.
在过去的25年里, 大发娱乐已经做了2个,000-2,在美国每年有500颗心脏, 但大概有80到100个,今天需要大发娱乐的1000人. 所以这些泵真的填补了这个缺口. Early on, because the pump technology wasn't quite so good, you'd have complications. But now the complication rates are actually very manageable and the survival is quite good. 目前一年存活率超过90%.
Dr. 米勒: I remember in the Barney Clark days that that clots arising from the use of that type of pump were a real problem. 现在已经基本消除了，对吗?
Dr. Selzman: Whenever you have blood that goes through a washing machine or a Kenmore or a Maytag, 这是不正常的. And so we still are faced with this complex problem of hemostasis, thrombosis, and anti-coagulations. For the most part for these pumps, you will be taking some blood thinner medicines.
Dr. 米勒: 但发生血栓的风险较低?
Dr. Selzman: 它要低得多. 我的意思是, it hearkens back to the old heart valve days where we used to have that had a ball that would go up and down, 旧的比约克-希利阀门之类的. We don't use those any more, and so the whole field is new.
Dr. 米勒: 整个技术.
Dr. Selzman: 是的.
人工心脏技术的未来
Dr. 米勒: 这些设备的未来会是什么样子? 我的意思是, do you see these devices becoming smaller, like calculators becoming smaller and smaller?
Dr. Selzman: 是的. I think there are two or three things that are going to really make a difference here, 你可以追溯. 如果你看一下心脏起搏器除颤器领域, defibrillators used to be these big giant things that you used to put in the abdominal cavity, 现在它们是你锁骨下面的这些小东西.
同样的事情也发生在VAD领域. 它们变得越来越小, 因为它们越来越小, 并发症越来越少, you're actually going to start putting these things in patients that are less sick to try to get them off this spiral of decline that happens with 心脏衰竭. 体积更大，并发症更少. And then the main thing that's coming from an industrial standpoint is power. 就像你想给波音747装电池一样, 或者是什么？, 757年, 锂电池是唯一不好的东西.
Dr. 米勒: 完全.
Dr. Selzman: 所以他们开始用vad做同样的事情. And so a lot of the original DeBakey pump, believe it or not, was a collaboration with N.A.S.A. 来大发娱乐做这些事情.
Dr. 米勒: 剥离技术.
Dr. Selzman: 是的，大发娱乐有很多交叉合作. The interesting thing I think really where the field is going, it's not so much about the pump because the pumps are getting better and better. 但这是关于病人和病人的生物学. And our goal is not to actually put the pump in to have them have it for the rest of their life or for them to get a transplant, 但实际上是为了好起来，这样大发娱乐就可以移除泵.
那么大发娱乐怎么做呢? Well, we're going to recondition the heart, probably use other biologic therapies to help us. So the main thing that I see the field going in the next five to 10 years is not so much about a pump, 而是关于一个心脏不好的病人. How do you make that heart better with the assistance of a heart pump so that you can actually remove it so that patients can live long lives that way?
播音员: We're your daily dose of science, conversation and medicine. 这是Scope. 大发娱乐是犹他大学健康科学广播.