thank you very much well this is
different for me on a Saturday afternoon
I might be watching rugby or cricket or
something like that usually on a
Saturday afternoon I was where I always
am and that’s in an operating theatre
this is of course a very different talk
to the one you’ve just had that is me in
oh that was me in my uniform and what I
want to talk to you today is something
that’s topical right now you may have
heard that the government want to make
donating organs something that everybody
should do unless you opt out and that’s
instead of you signing a form and opting
in and saying I want to be philanthropic
and be an organ donor now whatever the
morality of that and and I don’t
personally believe in snatching organs
without express permission but whatever
the morality of that it’s for a good
reason
I was brought up in the back streets of
Scone thought northern steel town half
way between us and where I’ve come from
today in Oxford which was very different
from Scunthorpe and across the road from
me lived my grandfather now my
grandfather lived in the steelworks and
he smoked so he worked in smoke and he
lived with smoke and not surprisingly by
the time he was 60 I was out walking the
dog with him one day around the slag
tips because there was nowhere else to
go
when he clutched his chest and fell to
his knees and he was having his first
heart attack now he got up after about
half an hour went home there was nothing
to be done the doctors couldn’t do
anything back in the early fifties so I
watched it happen again and again and I
gradually watched him sink
to what we know is heart failure now
heart failure is very common you can see
from the slide behind me that heart
failure is just about the commonest
cause of death and it’s miserable it’s
an absolutely miserable condition and
most patients will only get pills to
pretend that heart transplants are a
treatment for severe heart failure is
absolute nonsense there are 15,000
patients under the age of 60 in Great
Britain who died from end-stage heart
failure and there are about a hundred
and fifty heart transplants a year so
heart transplants apply to about one
percent of the people that are suffering
and when I mean suffering
I mean suffering when you go into heart
failure firstly you you cannot exercise
before too long you can’t go out to the
shops without being breathless and with
the breathlessness comes tiredness and
with the tiredness comes swelling of the
ankles and swelling of the belly and
this is a progressive phenomenon as the
heart fails and it is eternally
miserable and one of the big problems is
the only people that derive survival
benefit from a heart transplant are
right at the end of the curve if you
transplant people here they may well die
15 percent died soon after the operation
so predicting when to intervene is very
very difficult so I always wanted having
worked in Papworth and hair field I
always wanted to find an alternative to
heart transplants and the complications
of immunosuppressive drugs they’re a
problem in themselves they they’re
predisposed to infection and cancer so
could we do something different
could we
place the human heart with a machine now
that is simply pumping blood what the
heart does is it pumps blood it’s a very
sophisticated organ I operated on 12,000
before I stopped way from tiny babies to
people in their 90’s and heart surgery
is terrific these days but once you get
to severe heart failure there is nothing
else you can do a surgeon called Michael
DeBakey who was in charge of the
American Armed Forces medical services
in World War two developed a pump to
assist with blood transfusion before
1934 there wasn’t any blood transfusion
and before world war ii the weren’t any
antibiotics so there was no way that you
can actually contemplate doing heart
surgery heart surgery came about after
World War two when a lot of the army
medics
from the US and Europe came together and
started this discuss how they could get
into a heart to operate and at the same
time there was John Gibbon a surgeon in
Philadelphia who was trying to make a
machine to save people that were dying
from what we call pulmonary embolus a
blood clot to the lungs and initially he
didn’t foresee that that could be a
machine to facilitate heart surgery but
others pointed that out to him and in
1952 they tried to get started
Gibbons first few patients all died and
he became very nervous and it was his
fifth patient where he got a survivor
with a very simple operation and then
when he went on he had two more little
girls aged five with a hole in the heart
and they both died and Gibbon gave up
the abandoned his heart-lung machine he
wasn’t a psychopath
like most cardiac surgeons are
the people that got heart surgery going
just had to persist against the terrible
mortality that it generated in the 1950s
half the patients used to die after
heart surgery when I first went to
medical school in 1966 one in three
still died after the heart operation but
artificial hearts are not easy pumping
blood is not easy because blood is very
delicate it’s a fluid but all that red
stuff in it
a tiny cells that are fragile so unless
you treat the cells extremely gently
they’re going to fragment and release
what we call hemoglobin into the
circulation and those hemoglobin
molecules block the kidney tubules and
will cause heart failure the other thing
is the heart responds to all sorts of
responses nerves hormones all that stuff
and actually the right side of the heart
and the left side of that don’t even
pump the same volume so to make an
artificial heart was not easy it was a
difficult job we back to Michael DeBakey
who went back from Europe in World War
two to set up the Baylor cardiac
surgical program in Houston and he was
determined to produce a pump to try and
improve survival in patients that he
couldn’t wean off the heart-lung machine
because cardiac surgery is damaging when
you stop the heart for half an hour in
those days it was difficult to get it
started so he developed this little pump
air driven to try and help with this and
this young woman was the first the very
first survivor with that device the
first patient to survive with a
ventricular assist device and that was
the year I went to medical school the
very next year Christian Barnard who I
knew extremely well
eventually he told me the
background to the heart-transplant and
so on and it’s far more complicated than
anybody imagines but when Chris Barnard
started heart transplantation there were
very few donors so there was a
prerogative to produce an artificial
heart to keep people alive when they
were in end-stage heart failure to the
point where a donor could be found so
this was the first total artificial
heart done by Denton Cooley in Houston
in 1969 at the Texas Heart Institute and
as you can see they had very smart
carpets in the intensive care unit
moreover this patient Haskell carp you
see him on his artificial heart driven
by a huge equipment outside his body
they woke him up for ten minutes and
took his tube out to take that picture
and then rapidly put the tube back and
he was dead a couple of days later the
message was if the artificial heart is
ever to achieve its objective it’s got
to be more than a pump it must be more
than functional reliable and dependable
you’ve got to be able to put it into a
patient so they can forget about it if
you go on artificial heart you don’t
want to be in a bed the whole time
attached to an air compressor this is
kind of where I got involved in 1981 I
went to work in America and I got to
know dr. Cooley and I watched the only
second total artificial heart that was
ever done in Houston and I was so taken
by that and having worked in heart
transplant units and become
disillusioned that I became dedicated to
try and produce an artificial heart
myself why our total artificial hearts
not the right way to go well this is a
modern total artificial heart and if you
view what you can see there all of that
has to go into the body everything there
can get infected and it’s like having a
washing machine inside you so people
went to just supporting the left side of
the heart
with pulsatile devices because nobody
believed that a patient or a person or
even an animal would survive without a
pulse the Americans came to me in Oxford
to do the first permanent implant of one
of these left ventricular assist devices
and you can see that they think that
surgeons are not as bright as physicians
because they put arrows on the device to
make sure I didn’t put it the wrong way
around there’s one of my patients they
did very well with these pulsatile left
ventricular assist devices but they were
large there were bulky and the power
line on your right they tended to get
infected by accident I met the
artificial heart engineer Robert Jarvik
who had worked with the Total Artificial
hearts and also felt that they were non
feasible and he produced a thumb-sized
device which was a high-speed turbine I
met him by accident and I sat in in
Texas and I said can I work with you on
this I don’t think it’s gonna work I
think the high speed rotary blood device
that that spins at 12,000 rpm will
damage the blood this is where we
started but to cut a long story short I
went back to Oxford tested in in sheep
and I have to tell you I detest animal
work but nobody was going to let me
implant any type of device into a human
without testing it and everybody said
not having a pulse in the circulation
because you’ve got a pump with a high
speed turbine making continuous flow
they said you can’t have pulseless
people I said I’ve had pulseless sheep I
think the people will do well now there
was a big rouse with the government big
rouse with the medical profession
eventually I found a patient who the
cardiologist guaranteed would not live
for more than six weeks
that’s Peter Halton there and if you
look at his feet they’re purple
his legs were all serrated
he couldn’t walk into my room he came in
a wheelchair he had a huge dilated
abdomen and I implanted him with this
tiny turbine pump and he lived for eight
years and then he died of a nosebleed
the other thing I did which I thought
was clever to get over that line
infection where we put electricity into
the body to power these devices I put a
plug in the head because if you screw a
plug to the skull it doesn’t move in
relation to the skin so it doesn’t wear
away it’s like Frankenstein so I became
the first real doctor Frankenstein right
there in Oxford and it worked these
didn’t get infected so here we are
putting power into the body
that’s the pump in the heart on the
x-ray there’s the pedestal on the skull
the patient’s carried a battery the very
first guy Peter was out shopping with
his device and a young boy thought it
was a camera bag snatched a bag and
tried to run away and the power cable
pinged out of Peters head and of course
the alarm went off and the boy dropped
the bag and a little old lady plugged
him in again
I had another poor patient who went out
shopping before Christmas without a
spare battery and he had 20 minutes to
change the batteries they didn’t get
home it just died in the street that was
sad but a testament to how effective
these devices actually are the problem
is they cost the same as a Ferrari
they cut the American devices cost about
a hundred and twenty thousand dollars
now we had Cambridge doing pig hearts an
Oxford doing artificial hearts pig
hearts kept people alive for seven days
mine kept a patient alive for eight
years and many more patients so I Rock I
won that Boat Race if you look at
transplants now they are good but there
are so few of them the average survival
is twelve years
some patients have lived as much as 30
years but 15% die within a year and as
I’ve said there’s only a hundred and
fifty donor organs per year
take a pump from the shelf and stick it
in first thing in the morning instead of
needing a dead person and flying around
in a helicopter overnight
snatching organs from other people’s
hospitals these are devices that are in
use now sure they have their
complications but it’s better to be
alive than dead so if you look at
transplants versus rotary blood pumps we
now know that the survival of the two is
equivalent if you get a pump it’s almost
as good as having a heart transplant
statistically again back to the cost the
NHS cannot afford them so for the past
10 years I’ve been working to provide an
affordable British pump and we’ve done
this with high science the American
devices were designed but without this
computational flow dynamics that we’ve
used so effectively in Great Britain
we’ve modelled flow so that we don’t
damage blood and when we compare our
pump with the American pumps it handles
blood better so we think that the
patients will do better for that this is
the British pump I’m very proud of it
I hope lots of patients will get it in
future that’s how it looks
I am planted into the apex of the heart
and it takes blood out of the failing
left ventricle and pumps it around the
body and the right ventricle and the
right side of the heart looks after
itself because that is normally a low
pressure system so we only need to
address one side of the heart we can do
it with very small pumps that are
user-friendly and they’re off-the-shelf
we don’t need somebody to die first
so next time the British government says
we’re going to take all your organs
without you signing the forms you can
say well we’ve heard that you can take a
pump off the shelf and plug it into a
patient and they can do as well as if
they’ve had a heart transplant and it’s
all been done in good old Great Britain
and I think this is an appropriate way
to end this is yours truly with the
great dr. Cooley at a conference in
America he said a successful
cardiovascular surgeon should be a man
who asked to name three best surgeons in
the world would have difficulty in
naming the other two you probably
realized by now that heart surgeons are
a sort of personality type I’m afraid we
are most of us are unbearable at least
at least was but we’re a personality
type because it’s a high-risk business
but we always have your best interests
in heart at heart and I’ll finish by
saying you’re in Newcastle one of the
very best units in the country for heart
transplants and artificial hearts is
right here in the city it’s very very
good the Freeman hospital
thank you very much [Applause]
different for me on a Saturday afternoon
I might be watching rugby or cricket or
something like that usually on a
Saturday afternoon I was where I always
am and that’s in an operating theatre
this is of course a very different talk
to the one you’ve just had that is me in
oh that was me in my uniform and what I
want to talk to you today is something
that’s topical right now you may have
heard that the government want to make
donating organs something that everybody
should do unless you opt out and that’s
instead of you signing a form and opting
in and saying I want to be philanthropic
and be an organ donor now whatever the
morality of that and and I don’t
personally believe in snatching organs
without express permission but whatever
the morality of that it’s for a good
reason
I was brought up in the back streets of
Scone thought northern steel town half
way between us and where I’ve come from
today in Oxford which was very different
from Scunthorpe and across the road from
me lived my grandfather now my
grandfather lived in the steelworks and
he smoked so he worked in smoke and he
lived with smoke and not surprisingly by
the time he was 60 I was out walking the
dog with him one day around the slag
tips because there was nowhere else to
go
when he clutched his chest and fell to
his knees and he was having his first
heart attack now he got up after about
half an hour went home there was nothing
to be done the doctors couldn’t do
anything back in the early fifties so I
watched it happen again and again and I
gradually watched him sink
to what we know is heart failure now
heart failure is very common you can see
from the slide behind me that heart
failure is just about the commonest
cause of death and it’s miserable it’s
an absolutely miserable condition and
most patients will only get pills to
pretend that heart transplants are a
treatment for severe heart failure is
absolute nonsense there are 15,000
patients under the age of 60 in Great
Britain who died from end-stage heart
failure and there are about a hundred
and fifty heart transplants a year so
heart transplants apply to about one
percent of the people that are suffering
and when I mean suffering
I mean suffering when you go into heart
failure firstly you you cannot exercise
before too long you can’t go out to the
shops without being breathless and with
the breathlessness comes tiredness and
with the tiredness comes swelling of the
ankles and swelling of the belly and
this is a progressive phenomenon as the
heart fails and it is eternally
miserable and one of the big problems is
the only people that derive survival
benefit from a heart transplant are
right at the end of the curve if you
transplant people here they may well die
15 percent died soon after the operation
so predicting when to intervene is very
very difficult so I always wanted having
worked in Papworth and hair field I
always wanted to find an alternative to
heart transplants and the complications
of immunosuppressive drugs they’re a
problem in themselves they they’re
predisposed to infection and cancer so
could we do something different
could we
place the human heart with a machine now
that is simply pumping blood what the
heart does is it pumps blood it’s a very
sophisticated organ I operated on 12,000
before I stopped way from tiny babies to
people in their 90’s and heart surgery
is terrific these days but once you get
to severe heart failure there is nothing
else you can do a surgeon called Michael
DeBakey who was in charge of the
American Armed Forces medical services
in World War two developed a pump to
assist with blood transfusion before
1934 there wasn’t any blood transfusion
and before world war ii the weren’t any
antibiotics so there was no way that you
can actually contemplate doing heart
surgery heart surgery came about after
World War two when a lot of the army
medics
from the US and Europe came together and
started this discuss how they could get
into a heart to operate and at the same
time there was John Gibbon a surgeon in
Philadelphia who was trying to make a
machine to save people that were dying
from what we call pulmonary embolus a
blood clot to the lungs and initially he
didn’t foresee that that could be a
machine to facilitate heart surgery but
others pointed that out to him and in
1952 they tried to get started
Gibbons first few patients all died and
he became very nervous and it was his
fifth patient where he got a survivor
with a very simple operation and then
when he went on he had two more little
girls aged five with a hole in the heart
and they both died and Gibbon gave up
the abandoned his heart-lung machine he
wasn’t a psychopath
like most cardiac surgeons are
the people that got heart surgery going
just had to persist against the terrible
mortality that it generated in the 1950s
half the patients used to die after
heart surgery when I first went to
medical school in 1966 one in three
still died after the heart operation but
artificial hearts are not easy pumping
blood is not easy because blood is very
delicate it’s a fluid but all that red
stuff in it
a tiny cells that are fragile so unless
you treat the cells extremely gently
they’re going to fragment and release
what we call hemoglobin into the
circulation and those hemoglobin
molecules block the kidney tubules and
will cause heart failure the other thing
is the heart responds to all sorts of
responses nerves hormones all that stuff
and actually the right side of the heart
and the left side of that don’t even
pump the same volume so to make an
artificial heart was not easy it was a
difficult job we back to Michael DeBakey
who went back from Europe in World War
two to set up the Baylor cardiac
surgical program in Houston and he was
determined to produce a pump to try and
improve survival in patients that he
couldn’t wean off the heart-lung machine
because cardiac surgery is damaging when
you stop the heart for half an hour in
those days it was difficult to get it
started so he developed this little pump
air driven to try and help with this and
this young woman was the first the very
first survivor with that device the
first patient to survive with a
ventricular assist device and that was
the year I went to medical school the
very next year Christian Barnard who I
knew extremely well
eventually he told me the
background to the heart-transplant and
so on and it’s far more complicated than
anybody imagines but when Chris Barnard
started heart transplantation there were
very few donors so there was a
prerogative to produce an artificial
heart to keep people alive when they
were in end-stage heart failure to the
point where a donor could be found so
this was the first total artificial
heart done by Denton Cooley in Houston
in 1969 at the Texas Heart Institute and
as you can see they had very smart
carpets in the intensive care unit
moreover this patient Haskell carp you
see him on his artificial heart driven
by a huge equipment outside his body
they woke him up for ten minutes and
took his tube out to take that picture
and then rapidly put the tube back and
he was dead a couple of days later the
message was if the artificial heart is
ever to achieve its objective it’s got
to be more than a pump it must be more
than functional reliable and dependable
you’ve got to be able to put it into a
patient so they can forget about it if
you go on artificial heart you don’t
want to be in a bed the whole time
attached to an air compressor this is
kind of where I got involved in 1981 I
went to work in America and I got to
know dr. Cooley and I watched the only
second total artificial heart that was
ever done in Houston and I was so taken
by that and having worked in heart
transplant units and become
disillusioned that I became dedicated to
try and produce an artificial heart
myself why our total artificial hearts
not the right way to go well this is a
modern total artificial heart and if you
view what you can see there all of that
has to go into the body everything there
can get infected and it’s like having a
washing machine inside you so people
went to just supporting the left side of
the heart
with pulsatile devices because nobody
believed that a patient or a person or
even an animal would survive without a
pulse the Americans came to me in Oxford
to do the first permanent implant of one
of these left ventricular assist devices
and you can see that they think that
surgeons are not as bright as physicians
because they put arrows on the device to
make sure I didn’t put it the wrong way
around there’s one of my patients they
did very well with these pulsatile left
ventricular assist devices but they were
large there were bulky and the power
line on your right they tended to get
infected by accident I met the
artificial heart engineer Robert Jarvik
who had worked with the Total Artificial
hearts and also felt that they were non
feasible and he produced a thumb-sized
device which was a high-speed turbine I
met him by accident and I sat in in
Texas and I said can I work with you on
this I don’t think it’s gonna work I
think the high speed rotary blood device
that that spins at 12,000 rpm will
damage the blood this is where we
started but to cut a long story short I
went back to Oxford tested in in sheep
and I have to tell you I detest animal
work but nobody was going to let me
implant any type of device into a human
without testing it and everybody said
not having a pulse in the circulation
because you’ve got a pump with a high
speed turbine making continuous flow
they said you can’t have pulseless
people I said I’ve had pulseless sheep I
think the people will do well now there
was a big rouse with the government big
rouse with the medical profession
eventually I found a patient who the
cardiologist guaranteed would not live
for more than six weeks
that’s Peter Halton there and if you
look at his feet they’re purple
his legs were all serrated
he couldn’t walk into my room he came in
a wheelchair he had a huge dilated
abdomen and I implanted him with this
tiny turbine pump and he lived for eight
years and then he died of a nosebleed
the other thing I did which I thought
was clever to get over that line
infection where we put electricity into
the body to power these devices I put a
plug in the head because if you screw a
plug to the skull it doesn’t move in
relation to the skin so it doesn’t wear
away it’s like Frankenstein so I became
the first real doctor Frankenstein right
there in Oxford and it worked these
didn’t get infected so here we are
putting power into the body
that’s the pump in the heart on the
x-ray there’s the pedestal on the skull
the patient’s carried a battery the very
first guy Peter was out shopping with
his device and a young boy thought it
was a camera bag snatched a bag and
tried to run away and the power cable
pinged out of Peters head and of course
the alarm went off and the boy dropped
the bag and a little old lady plugged
him in again
I had another poor patient who went out
shopping before Christmas without a
spare battery and he had 20 minutes to
change the batteries they didn’t get
home it just died in the street that was
sad but a testament to how effective
these devices actually are the problem
is they cost the same as a Ferrari
they cut the American devices cost about
a hundred and twenty thousand dollars
now we had Cambridge doing pig hearts an
Oxford doing artificial hearts pig
hearts kept people alive for seven days
mine kept a patient alive for eight
years and many more patients so I Rock I
won that Boat Race if you look at
transplants now they are good but there
are so few of them the average survival
is twelve years
some patients have lived as much as 30
years but 15% die within a year and as
I’ve said there’s only a hundred and
fifty donor organs per year
take a pump from the shelf and stick it
in first thing in the morning instead of
needing a dead person and flying around
in a helicopter overnight
snatching organs from other people’s
hospitals these are devices that are in
use now sure they have their
complications but it’s better to be
alive than dead so if you look at
transplants versus rotary blood pumps we
now know that the survival of the two is
equivalent if you get a pump it’s almost
as good as having a heart transplant
statistically again back to the cost the
NHS cannot afford them so for the past
10 years I’ve been working to provide an
affordable British pump and we’ve done
this with high science the American
devices were designed but without this
computational flow dynamics that we’ve
used so effectively in Great Britain
we’ve modelled flow so that we don’t
damage blood and when we compare our
pump with the American pumps it handles
blood better so we think that the
patients will do better for that this is
the British pump I’m very proud of it
I hope lots of patients will get it in
future that’s how it looks
I am planted into the apex of the heart
and it takes blood out of the failing
left ventricle and pumps it around the
body and the right ventricle and the
right side of the heart looks after
itself because that is normally a low
pressure system so we only need to
address one side of the heart we can do
it with very small pumps that are
user-friendly and they’re off-the-shelf
we don’t need somebody to die first
so next time the British government says
we’re going to take all your organs
without you signing the forms you can
say well we’ve heard that you can take a
pump off the shelf and plug it into a
patient and they can do as well as if
they’ve had a heart transplant and it’s
all been done in good old Great Britain
and I think this is an appropriate way
to end this is yours truly with the
great dr. Cooley at a conference in
America he said a successful
cardiovascular surgeon should be a man
who asked to name three best surgeons in
the world would have difficulty in
naming the other two you probably
realized by now that heart surgeons are
a sort of personality type I’m afraid we
are most of us are unbearable at least
at least was but we’re a personality
type because it’s a high-risk business
but we always have your best interests
in heart at heart and I’ll finish by
saying you’re in Newcastle one of the
very best units in the country for heart
transplants and artificial hearts is
right here in the city it’s very very
good the Freeman hospital
thank you very much [Applause]
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