The Future of Medicine: The Era of Artificial Hearts

05Between artificial knees, total hip replacements, cataract surgery, hearing aids, dentures, and cochlear implants, we are a society that is fast becoming transhuman. Basically, this means we are dedicated to improving human health through substitution and augmentation of our body parts. Lately, bioprinting has begun offering solutions for replacement organs; but so far, a perfectly healthy heart, has remained elusive.

Heart disease is the number one killer in North America, comparable only to strokes, and claiming nearly 600,000 lives every year in the US and 70,000 in Canada. But radical new medical technology may soon change that. There have been over 1,000 artificial heart transplant surgeries carried out in humans over the last 35 years, and over 11,000 more heart surgeries where valve pumps were installed have also been performed.

artificial-heart-abiocor-implantingAnd earlier this month, a major step was taken when the French company Carmat implanted a permanent artificial heart in a patient. This was the second time in history that this company performed a total artificial heart implant, the first time being back in December when they performed the implant surgery on a 76-year-old man in which no additional donor heart was sought. This was a major development for two reasons.

For one, robotic organs are still limited to acting as a temporary bridge to buy patients precious time until a suitable biological heart becomes available. Second, transplanted biological hearts, while often successful, are very difficult to come by due to a shortage of suitable organs. Over 100,000 people around the world at any given time are waiting for a heart and there simply are not enough healthy hearts available for the thousands who need them.

carmat_heartThis shortage has prompted numerous medical companies to begin looking into the development of artificial hearts, where the creation of a successful and permanent robotic heart could generate billions of dollars and help revolutionize medicine and health care. Far from being a stopgap or temporary measure, these new hearts would be designed to last many years, maybe someday extending patients lives indefinitely.

Carmat – led by co-founder and heart transplant specialist Dr. Alain Carpentier – spent 25 years developing the heart. The device weighs three times that of an average human heart, is made of soft “biomaterials,” and operates off a five-year lithium battery. The key difference between Carmat’s heart and past efforts is that Carmat’s is self-regulating, and actively seeks to mimic the real human heart, via an array of sophisticated sensors.

carmat-artificial-heartUnfortunately, the patient who received the first Carmat heart died prematurely only a few months after its installation. Early indications showed that there was a short circuit in the device, but Carmat is still investigating the details of the death. On September 5th, however, another patient in France received the Carmat heart, and according to French Minister Marisol Touraine the “intervention confirms that heart transplant procedures are entering a new era.”

More than just pumping blood, future artificial hearts are expected to bring numerous other advantages with them. Futurists and developers predict they will have computer chips and wi-fi capacity built into them, and people could be able to control their hearts with smart phones, tuning down its pumping capacity when they want to sleep, or tuning it up when they want to run marathons.

carmat_heart1The benefits are certainly apparent in this. With people able to tailor their own heart rates, they could control their stress reaction (thus eliminating the need for Xanax and beta blockers) and increase the rate of blood flow to ensure maximum physical performance. Future artificial hearts may also replace the need for some doctor visits and physicals, since it will be able to monitor health and vitals and relay that information to a database or device.

In fact, much of the wearable medical tech that is in vogue right now will likely become obsolete once the artificial heart arrives in its perfected form. Naturally, health experts would find this problematic, since our hearts respond to our surroundings for a reason, and such stimuli could very well have  unintended consequences. People tampering with their own heart rate could certainly do so irresponsibly, and end up causing damage other parts of their body.

carmat_heart2One major downside of artificial hearts is their exposure to being hacked thanks to their Wi-Fi capability. If organized criminals, an authoritarian government, or malignant hackers were dedicated enough, they could cause targeted heart failure. Viruses could also be sent into the heart’s software, or the password to the app controlling your heart could be stolen and misused.

Naturally, there are also some critics who worry that, beyond the efficacy of the device itself, an artificial heart is too large a step towards becoming a cyborg. This is certainly true when it comes to all artificial replacements, such as limbs and biomedical implants, technology which is already available. Whenever a new device or technique is revealed, the specter of “cyborgs” is raised with uncomfortable implications.

transhuman3However, the benefit of an artificial heart is that it will be hidden inside the body, and it will soon be better than the real thing. And given that it could mean the difference between life and death, there are likely to be millions of people who will want one and are even willing to electively line up for one once they become available. The biggest dilemma with the heart will probably be affordability.

Currently, the Carmat heart costs about $200,000. However, this is to be expected when a new technology is still in its early development phase. In a few years time, when the technology becomes more widely available, it will likely drop in price to the point that they become much more affordable. And in time, it will be joined by other biotechnological replacements that, while artificial, are an undeniably improvement on the real thing.

The era of the Transhumanism looms!

Source: motherboard.vice.com, carmatsa.com, cdc.gov, heartandstroke.com

The Future of Medicine: Fake Muscles and 3D Printed Implants

3d-printed-jawWhen it comes to the future of medicine, its becoming increasingly clear that biomimetics and 3D printing will play an important role. Basically, this amounts to machines that are designed to mimic biology for the sake of making our bodies run better. In addition, it means that both medical machines and organic parts could be created on site, allowing for speedier, accessible and more cost-effective interventions and augmentations.

For example, research being conducted at Harvard’s Wyss Institute for Biologically Inspired Engineering and the Harvard School of Engineering and Applied Sciences has led to the creation of artificial muscle that can imitate the beating motion of the heart – also known as the “Left Ventricle Twist”. This development, which is a big break in the field of biomimetics, could also be a game-changer when it comes to producing artificial hearts.

Artificial-Muscles-pic-1-400x267Their research started with what is known as a pneumatic artificial muscle (PAM), one which was modeled after the striated muscle fibers found in the heart. Made from silicone elastomer and embedded with braided mesh, this artificial heart was then hooked up to an air tube to see how it would handle being inflated. When air was pumped into the PAM, it responded by twisting and thus becoming shorter. This is similar to what the natural fibers of the heart do, which contract by twisting and shortening.

Several of the PAMs were then embedded within a matrix of the same elastomer from which they were made. Through a process of manipulating their orientation to one another, along with selectively applying different amounts of pressure, the researchers were able to get some of the PAMs twisting in one direction, at the same time that others twisted in the opposite direction. As a result, the silicone matrix exhibited the same three-dimensional twisting motion as the heart.

ArtificialMusclespic2-375x252The immediate applications for this are obvious; in short, creating a range of artificial hearts for patients who suffer from severe disorders or heart damage. Unlike conventional artificial hearts, these ones would be able to provide pumping action similar to the real thing. In addition, the PAMs were able to mimic the change in motion that is caused by various heart disorders, and these could be used to help in the research of such conditions, not to mention the development of treatments for them.

Equally exciting are the possibilities being offered by 3D printing which now offers a range of artificial replacements. The latest example comes from the Netherlands, where a 22-year old woman has had the top of her skull replaced with a 3D printed implant. Due to a severe condition that causes a thickening of the skull, the patient was suffering from severe and worsening symptoms. And in a first of its kind procedure, she was given a tailor-made synthetic replacement.

3d-printed-skullAs Dr. Bon Verwei of the University Medical Center (UMC) Utrecht explained, the surgery was not only a first, it was absolutely essential:

The thickening of the skull puts the brain under increasing pressure. Ultimately, she slowly lost her vision and started to suffer from motor coordination impairment. It was only a matter of time before other essential brain functions would have been impaired and she would have died. So intensive surgery was inevitable, but until now there was no effective treatment for such patients.

So far, 3D printing has been used to produce lower jaw implants, prosthetic arms, legs, and cells (kidney, liver, and skin cells). In this instance, the skull was 3D-modeled and then printed as a single full piece that was able to be slotted and secured into place. Prior to the procedure, Verwej and his team had to familiarize themselves with reconstructions and 3D printing, in particular that which pertained to partial skull implants.

3d-printed-cheekImplants have often been used when part of a skull has been removed to reduce pressure on an patient’s brain. However, Verweij claimed that cement implants are not always a good fit, and that 3D printing allows for exact specifications. As he explained it:

This has major advantages, not only cosmetically but also because patients often have better brain function compared with the old method.

Verweij worked with an Australian company called Anatomics – which uses 3D printing to produce custom-made implants and surgical models for medical practitioners – to produce the replacement skull. The surgery, only just announced, was carried out three months ago and was a success. According to Verweij, the patient has fully regained her vision and has returned to her normal life. The work undertaken on the procedure means that UMC Utrecht is now is a position to carry out other similar work.

3d-printed-skull-0The ability to tailor-make synthetic bones, which are exact duplicates to the original, offers exciting possibilities for reconstructive and replacement surgery. It also does away with some rather invasive and unsatisfactory procedures that involve putting shattered bones back together and joining them with pins, bars and screws. And considering that such procedures often require multiple operations, the combination of 3D scanning and 3D printed replacements is also far more cost effective.

And be sure to check out the video below that shows the Utrecht procedure. Be warned, the video contains actual footage of the surgery, and is therefore not recommended for the squeamish! English subtitles are also available via the video controls.


Sources:
gizmag.com, (2), wyss.harvard.edu

Year-End Health News: Anti-Aging and Artificial Hearts

medtechHere we have two more stories from last year that I find I can’t move on without posting about them. And considering just how relevant they are to the field of biomedicine, there was no way I could let them go unheeded. Not only are developments such as these likely to save lives, they are also part of a much-anticipated era where mortality will be a nuisance rather than an inevitability.

The first story comes to us from the University of New South Wales (UNSW) in Australia and the Harvard Medical School, where a joint effort achieved a major step towards the dream of clinical immortality. In the course of experimenting on mice, the researchers managed to reverse the effects of aging in mice using an approach that restores communication between a cell’s mitochondria and nucleus.

MitochondriaMitochondria are the power supply for a cell, generating the energy required for key biological functions. When communication breaks down between mitochondria and the cell’s control center (the nucleus), the effects of aging accelerate. Led by David Sinclair, a professor from UNSW Medicine at Harvard Medical School, the team found that by restoring this molecular communication, aging could not only be slowed, but reversed.

Responsible for this breakdown is a decline of the chemical Nicotinamide Adenine Dinucleotide (or NAD). By increasing amounts of a compound used by the cell to produce NAD, Professor Sinclair found that he and his team could quickly repair mitochondrial function. Key indicators of aging, such as insulin resistance, inflammation and muscle wasting, showed extensive improvement.

labmiceIn fact, the researchers found that the tissue of two-year-old mice given the NAD-producing compound for just one week resembled that of six-month-old mice. They said that this is comparable to a 60-year-old human converting to a 20-year-old in these specific areas. As Dr Nigel Turner, an ARC Future Fellow from UNSW’s Department of Pharmacology and co-author of the team’s research paper, said:

It was shocking how quickly it happened. If the compound is administered early enough in the aging process, in just a week, the muscles of the older mice were indistinguishable from the younger animals.

The technique has implications for treating cancer, type 2 diabetes, muscle wasting, inflammatory and mitochondrial diseases as well as anti-aging. Sinclair and his team are now looking at the longer-term outcomes of the NAD-producing compound in mice and how it affects them as a whole. And with the researchers hoping to begin human clinical trials in 2014, some major medical breakthroughs could be just around the corner.

carmat_artificialheartIn another interesting medical story, back in mid-December, a 75 year-old man in Paris became the  recipient of the world’s first Carmat bioprosthetic artificial heart. Now technically, artificial hearts have been in use since the 1980’s. But what sets this particular heart apart, according to its inventor – cardiac surgeon Alain Carpentier – is the Carmat is the first artificial heart to be self-regulating.

In this case, self-regulating refers to the Carmat’s ability to speed or slow its flow rate based on the patient’s physiological needs. For example, if they’re performing a vigorous physical activity, the heart will respond by beating faster. This is made possible via “multiple miniature embedded sensors” and proprietary algorithms running on its integrated microprocessor. Power comes from an external lithium-ion battery pack worn by the patient, and a fuel cell is in the works.

carmat_2Most other artificial hearts beat at a constant unchanging rate, which means that patients either have to avoid too much activity, or risk becoming exhausted quickly. In the course of its human trials, it will be judged based on its ability to keep patients with heart failure alive for a month, but the final version is being designed to operate for five years.

The current lone recipient is reported to be recuperating in intensive care at Paris’ Georges Pompidou European Hospital, where he is awake and carrying on conversations. “We are delighted with this first implant, although it is premature to draw conclusions given that a single implant has been performed and that we are in the early postoperative phase,” says Carmat CEO Marcello Conviti.

medical-technologyAccording to a Reuters report, although the Carmat is similar in size to a natural adult human heart, it’s is somewhat larger and almost three times as heavy – weighing in at approximately 900 grams (2 lb). It should therefore fit inside 86 percent of men, but only 20 percent of women. That said, the company has stated that a smaller model could be made in time.

In the meantime, it’s still a matter of making sure the self-regulating bioprosthetic actually works and prolongs the life of patients who are in the final stages of heart failure. Assuming the trials go well, the Carmat is expected to be available within the European Union by early 2015, priced at between 140,000 and 180,000 euros, which works out to $190,000 – $250,000 US.

See what I mean? From anti-aging to artificial organs, the war on death proceeds apace. Some will naturally wonder if that’s a war meant to be fought, or an inevitably worth mitigating. Good questions, and one’s which we can expect to address at length as the 21st century progresses…

Sources: gizmodo.com, newsroom.unsw.edu.au, (2), carmatsa.com, reuters.com