One Man, Two Hearts

South African Surgeon Christiaan Neethling Barnard is a hard act to follow. Seven years ago this week, he performed history's first transplantation of a human heart. Last week he staged a surgical spectacular of about the same order: Barnard gave a patient a second heart and left the old one, or most of it, in place. For a while, at least, both hearts were working.

The patient was Ivan Taylor, 58, an engineer who entered Cape Town's Groote Schuur Hospital early in November. "He was in a hell of a mess," says Barnard. "Absolutely a desperate man." The problem was that the patient's heart was not all of a piece. Of its two heavy-duty pumping chambers, the right ventricle was strong and driving blood efficiently to the lungs; it was the left ventricle, which propels oxygenated blood to the arterial system, that was diseased and failing. Christiaan and his surgeon brother Marius decided that what Taylor needed was an assistant left heart. Then they waited for one to become available.

Desperate Condition. The source, as usual, was the victim of a traffic accident. Ten-year-old Jennifer Schrikker was killed by a car, and her mother gave permission for the surgeons to use the child's heart. During the transplant-implant operation, which began at midnight and lasted five hours, Taylor was on the heart-lung machine, which maintains the patient's circulation, allowing his own heart to be stopped during the delicate operation. Only then did Barnard discover how desperate his condition had been: "His left ventricle was nothing but a bag of fibrous tissue." Barnard cut away 45% of this diseased heart muscle, partly to make room for the implant. He placed the donor heart piggyback on Taylor's own, left side to left side, and cut silver-dollar-size holes in the left atrium (upper chamber) of each. Then he stitched the two hearts together and shunted the aorta from the donor heart into Taylor's aorta.

The rationale was clear: oxygenated blood from the lungs would flow naturally into the patient's left atrium, and some from there to his repaired left ventricle for. pumping to the rest of his body. Some would also flow into the donor heart's left atrium and its left ventricle, where the child's young, muscular pumping chamber would give the patient's heart a boost. No artificial pacemakers were used, so the two hearts kept beating at their own rates; the child donor's, without connections to the nervous system, pulsed faster than the patient's own. "We're working on developing a pacemaker to synchronize them," said Barnard. "We'll pick up the impulse from the one heart and stimulate the other with that, so the two will beat synchronously."

There were other problems. The patient suffered a mild stroke while he was on the heart-lung machine, but Barnard was confident that it would do no permanent harm. Not to be brushed aside so lightly was the possibility of an immune reaction, the mechanism by which the system tends to reject any intruding foreign body, especially protein. Ebullient as usual, Barnard was hoping that with what has been learned since 1967, the immune mechanism might be controlled so that the donor heart would not be rejected.* Even if rejection occurred and the donor heart had to be removed, he contended, the patient's own repaired heart, after its rest, might be able to take over and do the job necessary to keep the patient alive. Other heart-transplant surgeons, burned by past experience, were not so optimistic.

But they gave Barnard credit for another imaginative innovation.

"The longest-surviving heart-transplant patient, Indianapolis Schoolteacher Louis Russell, 49, died last week, six years and three months after receiving a donor heart at the Medical College of Virginia Hospitals in Richmond. Extremely active as teacher, public speaker and counselor of heart-disease patients, Russell had suffered only minor rejection problems, but became ill two months ago with a disturbance of heart rhythm that could not be corrected with artificial pacemakers.

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