Professor assists with first total artificial heart implantation in Russia

Russian_heart_pt_Tatyana_Ad.jpgPaul Nolan, professor, Pharmacy Practice and Science, assisted with the first implantation of a total artificial heart in a human in Russia March 2010.

Nolan went to Moscow accompanying a team from SynCardia Systems, Inc., the Tucson company that makes the CardioWest™ Total Artificial Heart, which is the only total artificial heart approved by the FDA.

Nolan was chosen for the project because he has years of experience in the postoperative management of patients after they have had mechanical circulatory support surgery, and because he has a grant from SynCardia to provide training in managing the medication therapy of post-implant patients.

Although the patient, a 60-year-old woman suffering from end-state heart failure, was the world’s 850th recipient of the Total Artificial Heart, she was the first recipient in Russia.

“It was reported on Russian television that night,” says Nolan. “This was a big story in Russia, as it is in many U.S. communities who perform this for the first time.”

The TV news video that aired in Russia, and which included footage of Nolan, was posted on a Russian Web site. In addition, a Russian Web site published the story in English and SynCardia posted a news release.

Nolan had multiple roles in the implantation. Before and after the surgery, he gave lectures to train Russian physicians and pathologists in the approaches he uses to manage patients’ medications after they’ve been implanted with the Total Artificial Heart.

In the operating room, Nolan directed the pre-clotting of the cannulae that would connect the heart to the patient’s circulatory system. Preclotting of the cannulae was necessary to prevent any leakage of blood through the porous material that constitutes the cannulae. The preclotting in this case was challenging because the patient was on cardiopulmonary bypass and, therefore, receiving heparin, which had to be neutralized with titrations of protamine so the blood would clot along the inner surfaces of the cannulae.

After surgery, Nolan performed what he calls his primary role.

Nolan_Russia2_Web.jpg“My main job in Moscow, as it has been following other implantations, was to use medications to prevent inappropriate blood clots from forming within the patient or the device,” says Nolan. “Clots could result in dangerous embolic phenomena such as stroke. At the same time, we had to manage the therapy in a way so as the patient would not experience excessive bleeding.”

Nolan has many years of experience in this role, having assisted in the post-operative care of 102 patients who were implanted with the Total Artificial Heart at University Medical Center.

The purpose of implanting a Total Artificial Heart at this time is as a bridge to heart transplantation. It allows the patient to live while waiting for a donated human heart. So far, the implantation in Russia can be considered a success.

“This woman really wanted to live to see her grandchild born,” says Nolan, “and he was born a day or two after the implant. The great news is that she was able to go with her surgeon to visit her daughter and grandson in the maternity hospital a few days later.

“This was a wonderful opportunity to use the skills, insights and talents that I’ve developed over the years to help someone in a foreign country and to interact with skilled health professionals in another country,” says Nolan. “It was very gratifying.”