Stilling the Artificial Beat

By Anastasia Toufexis

Shortly after he received an artificial heart in 1984, William Schroeder was euphoric. "I feel like I've got ten years left right now," he exulted. But that was not to be. Last week at Humana Hospital Audubon in Louisville, the former Government quality-control inspector, who was 54, suffered a massive stroke. Tuesday morning he was discovered unconscious with labored breathing; 30 hours later his breathing had stopped for good. With Schroeder's family gathered round, doctors pronounced him dead, but there remained a last grim task: to turn off the pneumatically driven device that had kept him alive for 20 months. Surgeon William DeVries put his hand on the chrome key in the front of the refrigerator-size air console; then Schroeder's wife Margaret and their six children, one by one, laid theirs atop his. Together they twisted the key counterclockwise, and the artificial heart beat no more.

Schroeder's death marked the end of a valiant struggle for life, but it renewed debate about whether there should be a moratorium on permanent implants of the Jarvik-7 heart. Though Schroeder lived a record 620 days -- almost a third longer than Artificial Heart Recipient Murray Haydon, who died in June -- it was a seesaw survival that mixed moments of triumph with stretches of pain and anguish for both him and his family. "It's incredible how many times he had medical complications that would have finished a normal person," says DeVries.

Within days of the implant, Schroeder was up, cracking jokes and drinking beer. But in less than three weeks, he suffered multiple strokes, a complication that has plagued three of the five permanent Jarvik-7 heart recipients. The seizures left him partly paralyzed, with impaired speech and memory. He recovered enough to move across the street from the hospital into a specially equipped apartment, where he lived with his wife and was attended by nurses and technicians. That idyll lasted barely a month before a second stroke. Again he fought back and eventually he was able to make a trip to his hometown of Jasper, Ind., to serve as a parade grand marshal. He went fishing with his sons and Artificial Heart Developer Robert Jarvik and celebrated his 33rd wedding anniversary at a Louisville restaurant.

But last November Schroeder suffered another stroke that left him bedridden, semiconscious and unable to speak. By Christmas his condition had so deteriorated that his family and doctors decided not to connect him to a respirator should his lungs fail. Schroeder lingered in a twilight state for seven months, until last week. Family members, summoned to his bedside, initially balked at the doctors' request for a CAT scan but finally agreed. The test confirmed that a massive stroke had destroyed most of Schroeder's brain, and last rites were given.

Schroeder's troubled history, and that of other permanent Jarvik-7 patients, has led critics to call for a temporary halt in the program. Examination of some of the implanted hearts has revealed accumulations of platelets, which can contribute to blood clots in the brain, in the devices' crevices and along the path blood travels. Says Dr. Lyle Joyce, who assisted DeVries at the first Jarvik-7 implant operation on Barney Clark and is now head of the artificial-heart program at the Minneapolis Heart Institute: "It is time to wait for new modifications of the Jarvik-7."

The current device, many believe, should be used to sustain a patient until a natural heart can be transplanted. About a dozen such operations have been performed in the U.S. Some experts argue that the need for a permanent implant is waning as heart transplants have become increasingly successful and the criteria have been broadened to accept previously rejected candidates. Indeed, notes DeVries, the last five patients referred to him as potential recipients of permanent artificial pumps have been given transplants. He remains convinced of the need for a permanent artificial device. With FDA permission for three more operations, he is looking for the next candidate. Says DeVries, who gave the eulogy at Schroeder's funeral in Jasper last weekend: "It's always sad to see someone you love leave, but he has given us a new motivation to go on."

With reporting by Barbara Dolan/Chicago and Gideon Gil/Louisville