CABGs and kings??
During the summer after my 2nd year at HMS...I got a summer job working at AVCO-Everett Research Labs. They were a hi-tech lab stuffed with physicists and fluid dynamicists whose claim to fame was they had solved the space re-entry problem...They worked on lasers (nobody knew what they were good for), superconductors,,MHD energy generation (dont ask),,,but the lab director,,Arthur Kantrowitz,,world renowned scientist, had a brother Adrian,,a New York cardiac surgeon,,,and Arthur was always bothered by the fact he had to explain to his mother he was a "physicist" which was different from a "physician"...So Arthur had bid and received a small government grant to evaluate heart assistance devices... AVCO had previously worked on a "U-shaped ventricle" which was implanted by his brother.
My job was to evaluate the devices in development. This was during the Johnson adm. LBJ had a terrible heart...This was hayday of cardiac surgeons. In 1965 Dr. Michael DeBakey presented LBJ with a golden box. In side was a note that read. "By Valentine's day 1970 there will be a man walking arround with artificial heart"..Toward the end of the summer, Kantrowitz called me into his office and ask my opinion on the devices... I told him there was one device I was not sure would "pump" blood...He told me as a physicist, it. That device was the Aortic balloon pump (IABP). I told him it was clearly the best and AVCO should concentrate on it. He ask me why..I told him because although people thought of the heart like a car engine,, it was actually like an aeroplane engine..In that when it failed you needed very quick remedies. The IABP could be utilised like a respirator and did not need major surgery.. AVCO went on to develop the IABP in close association with DRs G. Austin and M. Buckley cardiac surgeons at Mass General. Kantrowitz was kind enough to pay as a med consult to the lab all through med school (I was very poor) and I got to see alot of the cardiac team.
The thing Dew brings up kind of bothers me.. The truth is cardiac bypass proceedures (aka "pump runs"), are hard on most of the blood elements,,there is sigificant damage to the red cells (RBCs) called hemolysis, platlets, coag elements etc. It is the artificial surface. Nothing is good as the endothial lining,,, Consequentially (at least in the old days) pump run patients had to be typed and crossed for at least 8 units old blood and 8 units fresh blood. My concern is since there is a wholesale injury and loss of blood elements rather than merely a depletion of AT3,,,,is AT3 loss easily replace by giving either fresh whole blood or fresh plasma which would be rquired to replace other blood elements??? This was the question raised by Dew's post
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