Eighty-two of those patients used their devices only temporarily until human hearts could be transplanted, reflecting the "bridge" role the devices took on after serious problems dogged efforts to install them permanently. Research may still produce permanent artificial hearts, scientists say.
In the meantime, the number of human heart transplants has virtually doubled every year since 1983 to reach 1,368 in 1986, according to the federal Office of Organ Transplants.
One reason was federal approval in 1983 of the drug cyclosporine for keeping the body from rejecting transplanted organs, said Jon Gold, deputy director of the transplant office.
Increasing rates of transplant success also led to more transplant programs, he said. By the end of last year, 94 American hospitals offered heart transplants, compared with 37 in 1984.
"It's been a real bandwagon phenomenon," said Dr. Bruce Reitz, professor of surgery and chief of cardiac surgery at the Johns Hopkins Medical Institutions in Baltimore.
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In the early 1980s, Reitz recalled, surgeons saw patient survival improving and the cost of the surgery coming down. "It really looked like something that had become more or less an everyday type thing," he said.
By 1983 and 1984, surgeons began thinking "you had to get started now"
because regulations might one day make it tougher to establish transplant programs, he said.
Insurance-company acceptance also fueled the boom. More than 85 percent of private insurers offer coverage for heart transplants, estimated Roger Evans, senior research scientist at the Battelle Human Affairs Research Centers in Seattle.
But too few donor hearts are available. The current potential supply of around 1,800 hearts a year falls far short of the 14,000 to 15,000 people in the nation who die every year and who could have been helped by transplants, Evans said.
A permanent artificial heart could help ease the crunch. But to be practical, many researchers say, such a machine must develop beyond the unwieldy setup in which a patient is tethered by pneumatic hoses to a huge power source and control panel.
"What we're looking for is a device that's totally implantable," said Frank Altieri, deputy chief of the devices and technology branch of the National Heart, Lung and Blood Institute. "You want to have a good quality of life."
The institute plans to award contracts for research into implantable hearts next year, he said. Some research has already begun.
Only five of the world's 87 artificial heart implants were intended to be permanent.
Barney B. Clark, who received the first permanent heart Dec. 2, 1982, at the University of Utah, lived with it for 112 days. William J. Schroeder lived 620 days, longer than anybody else, after his implant Nov. 25, 1984, at Humana Hospital Audubon in Louisville, Ky.
Murray P. Haydon received an artificial heart at Humana on Feb. 17, 1985, and died June 19, 1986. In Sweden, Leif Stenberg lived on an artificial heart
from April 7, 1985, to Nov. 21 of that year.
Finally, Jack Burcham lived 10 days on a heart implanted April 14, 1985, at Humana.
Strokes, blood clots, and kidney and neurological problems in the patients have discouraged further use of the heart as a permanent implant, said William Letzing, deputy director of the division of cardiovascular devices at the Food and Drug Administration, which authorizes implants.
But as of the end of August, 82 patients worldwide had received artificial hearts temporarily, and 64 had gone on to get new human hearts, according to a registry kept by the Institute of Biomedical Engineering at the University of Utah.
Forty-three implants were done last year, after only eight in 1985, said Dr. Don Olsen, director of the institute. About half the cumulative total of implants have been done at a dozen centers in the United States, with the balance in Austria, Canada, England, France, Sweden and West Germany, he said.
Most patients spend 12 to 15 days on an artificial device before getting a human heart.
Olsen is looking forward to a permanent artificial heart, a totally implantable "Stage 2" device to replace the current technology.
But the record of temporary implants shows "a remarkable success, I think, for 'Stage 1,' " he said.
