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09/13/2006

Lithium Batteries Power a Heart

This past Monday was a beautifully clear, crisp day just as it was
five years earlier on that date. Ever since then, any such day
brings back memories of the events of 9/11. I had posted my
column for 9/11 the night before the Trade Center attacks.
Ironically, on that day of death, my column was on the origin of
life. Five years later, 9/11 is still taking its toll in death and
suffering among those who labored in and breathed the toxic mix
that was the atmosphere around Ground Zero. I went back in the
archives to see what I had written following that terrible day and
found that my columns of 9/18, 9/25 and 10/2/2001 (especially
the first and last of these) captured my feelings and the prevailing
mood pretty well. (If you’re interested, click on “Archives” at
the end of this column.)

This seems like a good time to talk about saving lives. After
retiring from Bell Labs in 1989, I joined a battery group in the
Bioengineering Division of the Surgery Department at UMDNJ
Robert Wood Johnson Medical School. There, I wrote a proposal
to NIH (National Institutes of Health) to work on a lithium
battery for use in a ventricular assist device (VAD), an
implantable device that assists a weakened heart. The proposal
was approved but not funded. Naturally, I was interested to read
last week that the FDA had approved an artificial heart powered
by lithium batteries. An article by Angela Stewart in our
September 7 Star-Ledger headlined “A self-contained heart
comes to Jersey” reported the FDA’s action and the selection of
Robert Wood Johnson Hospital in New Brunswick as one of two
hospitals in New Jersey to implant this mechanical heart, known
as the AbioCor.

Those of you old enough will remember the excitement back in
1982 when Barney Clark, a 61-year-old dentist, received an
implanted artificial heart known as the Jarvik-7. (Younger
readers may only know Robert Jarvik, the inventor of Jarvik-7,
for his current TV commercials for a cholesterol-lowering drug!)
Clark lived 112 days with the Jarvik heart and suffered a number
of strokes caused by blood clots. Because the heart was air-
driven, it relied upon a large compressor about the size of a
washing machine. Clark was tied to that machine and had very
limited mobility. His experience and quality of life did not bode
well for the future of artificial hearts.

However, research and development continued and the AbioCor
appears to be the most promising device to date. In a clinical
trial of 14 patients, the longest-lived patient with the implanted
AbioCor lived for 17 months while another lived for 10 months,
according to the Star-Ledger article. I couldn’t find detailed
results of the clinical trial but did find additional information on
the AbioCor on the Web site of Abiomed, its manufacturer.

The AbioCor artificial heart is the thoracic unit, the replacement
for the heart containing valves and a motor-driven pump. This
artificial heart weighs only about two pounds but is still on the
large side, suitable only for men and too large to fit some smaller
men. Abiomed is working to reduce the size so as to fit men and
women. The thoracic unit does not stand alone. A rechargeable
lithium battery and a controller unit are implanted in the
abdomen with connections to the thoracic unit, to each other and
to a third component implanted in the chest. This is the TET
(transcutaneous energy transmission) device, essentially a coil
for the transmission of energy from a source outside the body.

By placing an external TET (another coil connected to a power
supply) on the chest over the internal TET, electrical energy is
transmitted through the skin to the internal TET. This powers
the controller, the artificial heart and/or charges the internal
lithium battery. No wires pass through the skin, eliminating a
potential source of infection. In addition to the external TET, the
patient carries or wears a lithium battery pack and a control
module. A console supplies the energy to charge the batteries.

Let’s look at the mobility issue, a key to an acceptable quality of
life. If you want to take a shower or engage in another activity
unencumbered by the external gear, you have about a half hour,
running on the internal lithium battery. The internal battery
normally is on a continuous charge and should be capable of
delivering full capacity. Even so, being a battery person, I would
not want to push the outer limits of that half hour! Wearing the
external battery pack, you can manage about 4 hours before
needing to hook up with your console. It’s clear that a patient
must always be aware of the time and plan activities carefully in
case of unanticipated problems - traffic jams, for example.

Not everyone is eligible for an AbioCor implant. Currently, you
must have end stage heart failure with a life expectancy of less
than 30 days; you also must be ineligible for a human heart
transplant and have no other treatment options. If you qualify,
you’re clearly at death’s door and the restricted life you’d lead
with an artificial heart would still seem a desirable alternative!
Certainly the AbioCor patient will have a much greater degree of
freedom and mobility than poor Barney Clark. There’s another
factor that could determine one’s eligibility for an AbioCor –
cost. The Ledger article estimates the cost at about $250,000 and
insurance coverage is currently uncertain.

I feel obligated to finish in a lighter vein. In a recent Week in
Review column, Brian Trumbore kindly mentioned an amazing
(for me) round of golf a couple of weeks ago in which I made par
on all four par 3s and one par4. I’ve never had par on all the par
3s on any course and five pars in a round is a record for me. Last
Friday I returned to normal on the same course, with only one
par and a score 10 strokes higher. However, it was an interesting
round, relating in a sense to a TV show premiering this week
called Six Degrees, apparently based on that old bit about anyone
being related in some fashion to anyone else by six degrees of
separation.

I was teamed up with a psychiatrist and an attractive young blond
woman. The poor psychiatrist missed three or four complete
holes due to calls from patients on his cell phone even though it
was his day off! The blond gal had an accent and I determined
she was Swedish. She hit the longest drives of any woman I’ve
ever played with. Regular readers will know that I shamelessly
take any occasion to mention my hole-in-one and breaking my
leg on the same hole. Naturally, I mentioned it to my playing
companions. The gal said her husband had a hole-in-one on the
very same hole, which I thought quite a coincidence.

Then, after witnessing her amazing drives for 17 holes, I jokingly
asked her if her maiden name was Sorenstam. No, but her best
friend and frequent golfing buddy was on a national junior team
in Sweden with Anika! The friend came to the U.S. on a golf
scholarship and dispenses many golfing tips when the two play
together. I now feel there are only three (or is it two?) degrees of
separation between me and Anika and, having observed the
blond lady’s swing very carefully, expect my golf game to
improve significantly.

Allen F. Bortrum



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-09/13/2006-      
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Dr. Bortrum

09/13/2006

Lithium Batteries Power a Heart

This past Monday was a beautifully clear, crisp day just as it was
five years earlier on that date. Ever since then, any such day
brings back memories of the events of 9/11. I had posted my
column for 9/11 the night before the Trade Center attacks.
Ironically, on that day of death, my column was on the origin of
life. Five years later, 9/11 is still taking its toll in death and
suffering among those who labored in and breathed the toxic mix
that was the atmosphere around Ground Zero. I went back in the
archives to see what I had written following that terrible day and
found that my columns of 9/18, 9/25 and 10/2/2001 (especially
the first and last of these) captured my feelings and the prevailing
mood pretty well. (If you’re interested, click on “Archives” at
the end of this column.)

This seems like a good time to talk about saving lives. After
retiring from Bell Labs in 1989, I joined a battery group in the
Bioengineering Division of the Surgery Department at UMDNJ
Robert Wood Johnson Medical School. There, I wrote a proposal
to NIH (National Institutes of Health) to work on a lithium
battery for use in a ventricular assist device (VAD), an
implantable device that assists a weakened heart. The proposal
was approved but not funded. Naturally, I was interested to read
last week that the FDA had approved an artificial heart powered
by lithium batteries. An article by Angela Stewart in our
September 7 Star-Ledger headlined “A self-contained heart
comes to Jersey” reported the FDA’s action and the selection of
Robert Wood Johnson Hospital in New Brunswick as one of two
hospitals in New Jersey to implant this mechanical heart, known
as the AbioCor.

Those of you old enough will remember the excitement back in
1982 when Barney Clark, a 61-year-old dentist, received an
implanted artificial heart known as the Jarvik-7. (Younger
readers may only know Robert Jarvik, the inventor of Jarvik-7,
for his current TV commercials for a cholesterol-lowering drug!)
Clark lived 112 days with the Jarvik heart and suffered a number
of strokes caused by blood clots. Because the heart was air-
driven, it relied upon a large compressor about the size of a
washing machine. Clark was tied to that machine and had very
limited mobility. His experience and quality of life did not bode
well for the future of artificial hearts.

However, research and development continued and the AbioCor
appears to be the most promising device to date. In a clinical
trial of 14 patients, the longest-lived patient with the implanted
AbioCor lived for 17 months while another lived for 10 months,
according to the Star-Ledger article. I couldn’t find detailed
results of the clinical trial but did find additional information on
the AbioCor on the Web site of Abiomed, its manufacturer.

The AbioCor artificial heart is the thoracic unit, the replacement
for the heart containing valves and a motor-driven pump. This
artificial heart weighs only about two pounds but is still on the
large side, suitable only for men and too large to fit some smaller
men. Abiomed is working to reduce the size so as to fit men and
women. The thoracic unit does not stand alone. A rechargeable
lithium battery and a controller unit are implanted in the
abdomen with connections to the thoracic unit, to each other and
to a third component implanted in the chest. This is the TET
(transcutaneous energy transmission) device, essentially a coil
for the transmission of energy from a source outside the body.

By placing an external TET (another coil connected to a power
supply) on the chest over the internal TET, electrical energy is
transmitted through the skin to the internal TET. This powers
the controller, the artificial heart and/or charges the internal
lithium battery. No wires pass through the skin, eliminating a
potential source of infection. In addition to the external TET, the
patient carries or wears a lithium battery pack and a control
module. A console supplies the energy to charge the batteries.

Let’s look at the mobility issue, a key to an acceptable quality of
life. If you want to take a shower or engage in another activity
unencumbered by the external gear, you have about a half hour,
running on the internal lithium battery. The internal battery
normally is on a continuous charge and should be capable of
delivering full capacity. Even so, being a battery person, I would
not want to push the outer limits of that half hour! Wearing the
external battery pack, you can manage about 4 hours before
needing to hook up with your console. It’s clear that a patient
must always be aware of the time and plan activities carefully in
case of unanticipated problems - traffic jams, for example.

Not everyone is eligible for an AbioCor implant. Currently, you
must have end stage heart failure with a life expectancy of less
than 30 days; you also must be ineligible for a human heart
transplant and have no other treatment options. If you qualify,
you’re clearly at death’s door and the restricted life you’d lead
with an artificial heart would still seem a desirable alternative!
Certainly the AbioCor patient will have a much greater degree of
freedom and mobility than poor Barney Clark. There’s another
factor that could determine one’s eligibility for an AbioCor –
cost. The Ledger article estimates the cost at about $250,000 and
insurance coverage is currently uncertain.

I feel obligated to finish in a lighter vein. In a recent Week in
Review column, Brian Trumbore kindly mentioned an amazing
(for me) round of golf a couple of weeks ago in which I made par
on all four par 3s and one par4. I’ve never had par on all the par
3s on any course and five pars in a round is a record for me. Last
Friday I returned to normal on the same course, with only one
par and a score 10 strokes higher. However, it was an interesting
round, relating in a sense to a TV show premiering this week
called Six Degrees, apparently based on that old bit about anyone
being related in some fashion to anyone else by six degrees of
separation.

I was teamed up with a psychiatrist and an attractive young blond
woman. The poor psychiatrist missed three or four complete
holes due to calls from patients on his cell phone even though it
was his day off! The blond gal had an accent and I determined
she was Swedish. She hit the longest drives of any woman I’ve
ever played with. Regular readers will know that I shamelessly
take any occasion to mention my hole-in-one and breaking my
leg on the same hole. Naturally, I mentioned it to my playing
companions. The gal said her husband had a hole-in-one on the
very same hole, which I thought quite a coincidence.

Then, after witnessing her amazing drives for 17 holes, I jokingly
asked her if her maiden name was Sorenstam. No, but her best
friend and frequent golfing buddy was on a national junior team
in Sweden with Anika! The friend came to the U.S. on a golf
scholarship and dispenses many golfing tips when the two play
together. I now feel there are only three (or is it two?) degrees of
separation between me and Anika and, having observed the
blond lady’s swing very carefully, expect my golf game to
improve significantly.

Allen F. Bortrum