Previously published in Mayo Clinic's research magazine, Discovery's Edge.
As a science writer, Iâ€™m typically juggling a recorder, a note pad and a pen. Sometimes a camera. Today, the heart I held in my hand was warm and firm, red and healthy-looking.
And beating. In my hand.
Just an hour earlier it was in the body of a 110 pound pig. Over the next few hours Iâ€™ll watch as Christopher Livia, an M.D.-Ph.D. student, his summer student Scott Rohren and Tyra Witt, veterinary technician, get a cold, dead heart to beat again. This work in the Behfar laboratory is part of the Van Cleve Cardiac Regenerative Medicine Programâ€™s initiative to increase the number of available hearts for transplantation.
The first heart transplant was performed in 1967 on a grocer from Cape Town, South Africa. While the patient, Louis Washkansky, only lived 18 days, the surgery emboldened other medical centers. Advances in immunology and the discovery of the anti-rejection medication cyclosporine in 1976, made transplantation a real option for those in need.
When the cart with the pig heart is wheeled into the lab, itâ€™s ex vivo as they sayâ€”outside the body. The heart chills in an icy liquid that keeps it paralyzed. This solution, developed by Livia, stills the beating of the heart and provides electrolytes to keep those cardiac cells happy during the extraction. Clamps are peeking out of the top of the jar, Â keeping air out of the heart.
He lifts the heart out of the slushy liquid and starts trimming. Itâ€™s cold slippery work.
â€śFor the speed of removing it from the chest cavity, we take as much tissue as we can,â€ť Livia says, â€śto get it on ice as fast as we can.â€ť
But then they need to clean it up. All they need is the heart and part of the aortaâ€”thatâ€™s where the heart will be connected to the pump and tubing that mimics circulation within the body.
What is that, I ask?
â€śTrachea,â€ť says Livia. â€śFeels like a bendy straw.â€ť
I will forever look at bendy straws differently I reply.
â€śYeah, so did I,â€ť he says.
Healthy Heart, After Death
After a year of perfecting the set-up and variables for this procedure, Livia and his team are about to embark on a structured series of experiments to see if a dead heart can be awoken and the damage of death mitigated.
â€śThe whole point of this this project,â€ť Livia explains, â€śis to think of different ways and methods to preserve hearts for transplantation.â€ť
In the first decades ofÂ heart transplantation,Â few patients survived longer than five years. But today about 75 percentÂ of transplant patients survive for that long. And according to the United Network for Organ Sharing, heart transplants have made up a 9.6 percent slice of the total transplant pie, or about 64,085 surgeries over the last 28 years.
â€śTypically in heart transplantation the donor is considered brain dead but maintained on life support,â€ť says Livia. â€śThe vital organs are still functioning.â€ť
But that pool of donors is far smaller than the list of recipients.
â€śWe are trying to think of different ways we might be able to procure organs from someone who has had cardiac death,â€ť says Livia, â€śwhere the heart has stopped for an extended period of time.â€ť
Because hereâ€™s the thingâ€”the heart doesnâ€™t need a green light from the brain. It will begin to contract spontaneously under the right conditions.
Heart Experiment Highlights Heartâ€™s Needs
â€śWe do these experiments in animal models where the animals are deceased for an extended period of time.â€ť explains Livia. â€śWe try different solutions and techniques to see if we can revive the heart, and then we monitor certain characteristics of the heart to compare, from alive versus dead, if they function in the same way.â€ť
Now that the cold heart is free of other body tissue and blood, itâ€™s ready to be attached to the set-up that mimics the bodyâ€™s circulatory system, called a Langendorff system.
In this case, the set-up consists of two large and six small glass containers, two pumps, tubing, clamps, valves, a heater and electric leads which can be used in a variety of combinations. Langendorff systems have been used to test the effects of drugs on the heart, electrical conduction, the effect of genetic mutations, and myriad of other types of investigations.
â€śThis is an invaluable tool because you can have the heart isolated in the system and test whatever you want on it,â€ť says Livia. â€śThe options are limitless for the most part.â€ť
Instead of blood, the system is using a solution that provides the heart with everything it needs.
â€śIt has all the same stuff thatâ€™s in your blood that you would need to keep muscle and tissue alive, without the cells,â€ť he says. â€śSo it has glucose, it has your electrolytes, itâ€™s at the right pHâ€¦â€ť The liquid is also heated and gassed with pure oxygen to feed the muscle. The pumps mimic the types of pressures youâ€™d experience in your arteries and veins.
Air: The Heartâ€™s Enemy
But before the pig heart is attached to the system, all the air bubbles must be out. Livia taps glass, lifts tubing, and flicks containers, trying to get the air bubbles to the travel up to a container called the â€śaortic bubble trapâ€ť (sadly, itâ€™s just a glass vessel with a great name).
Scott, who is working in the lab before returning to school at Texas A&M University in the fall, helps look for air bubbles in the tubing. This is, he says, much more interesting than his last job summer job (life guarding). He means in generalâ€” learning to set up the Langendorff, how to do western blot tests to detect proteins and genetic modification using E. coli, but considering life guarding, bubbles may well be more interesting, too.
The Langendorff looks good and ready so they place the connector into the aorta of the heart and start the pumps.
â€śIs that bubble in the coil fine?â€ť asks Scott.
â€śNo itâ€™s not fine, good catchâ€ť says Livia. â€śThanks for letting me know.â€ť
It doesnâ€™t reach the heart though so itâ€™s an easy fix. More clamping, flicking of tubes and the heart is out of danger.
â€śScott, keep watching for those bubbles,â€ť says Livia. Throughout the experiment he has been unfailingly polite and considerate of his team. Despite the need to quickly prepare the heart to preserve its function, Livia has calmly explained the experiment to me, and pointed out the finer details to his team while responding to general lab questions from other lab mates.
Hidden Heart Potential
The liquid begins to gently flow into the heart.
â€śOh, see itâ€™s moving already,â€ť notes Tyra Witt, a veterinary technician, a few minutes later. â€śSee how itâ€™s waking up? Itâ€™s adorable.â€ť
The top of the heart, the atria, are indeed beginning to pump.
Just like that.
Both Livia and Tyra assure me that once the heart warms up it will be more vigorous.
â€śIt was on ice, at four degrees [Celsius] like youâ€™d find in your fridge so that helps slow down the chemical processes and we slowly bring up the temperature,â€ť explains Livia. â€śYou have to reach full body temperature before all the muscles and metabolic activity fully gets going.â€ť
â€śYou can get gloves and touch it if you want,â€ť he says.
The heart feels like the muscle it is, sort of like a chicken breast. Itâ€™s firm but yielding (â€śWhen it gets rigid and stiff you know itâ€™s completely dead,â€ť notes Livia). Itâ€™s warm and fits easily in my hand. But although the atria at the top are pumping, the ventricles at the bottom are just shivering.
Livia decides to shock the heart to get the ventricles into rhythm. After a defibrillator malfunction (fixedâ€”no jokeâ€”by unplugging it and then plugging it back in), and two 50 joule shocks, the ventricles of the heart start to beat. EveryoneÂ gathers to watch.
â€śSee that now? Thatâ€™s crazy,â€ť says Livia. â€śIt had that potential all the time. Thatâ€™s the magic of the heart.â€ť
The annual â€śFeel the Beatâ€ť event hosted by the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome (HLHS) will be held on October 8 in Rochester, Minn.Â â€śFeel the Beatâ€ť brings together clinicians, researchers, advocates, and families affected by a severe heart defect known as HLHS. The one-day event showcases the latest research, highlights guest speakers and brings together the congenital heart disease community.Â This yearâ€™s event will feature a patient and family-led panel focusing on patient engagement followed by a panel of collaborators from around the country discussing the transformation of HLHS care.
The event held Saturday, October 8, 2016, from 9 a.m. to 3 p.m. at Mayo Clinic in Rochester, Minn., is open to everyone.
Organized by the Regenerative Medicine Foundation (RMF), the Summit forges collaborations to advance cell therapies, while creating a supportive environment of regulation, legislation, financing, reimbursement and patient advocacy.
The Summit is the largest interdisciplinary stem cell meeting in the world, featuring more than 250 scientists, business leaders, investors, philanthropists, regulators, policy-makers, economic development officers, patient advocates and experts in law and ethics, presenting the latest scientific discoveries, commercial and innovation opportunities, legal and regulatory solutions, and best practices.
The interdisciplinaryÂ agendaÂ is designed to explore the fieldâ€™s most pressing topics with seven tracks:
Translation and Clinical Trials
Regenerative Medicine in the Clinic
Ethics, Law, Regulation and Society
Hot Topics and Future Trends
RegMed Capital Conference
During the summit, the Mayo ClinicÂ Center for Regenerative MedicineÂ will use social media to connect using the hashtagÂ #WSCS16Â . At the end of the week, we'll let the tweets, Google+ posts, Flickr photos, Facebook posts, Instagram, and YouTube videos tell the story.
Today, about 60,000 Americans have had theirÂ larynx removed due to disease or trauma. TheseÂ people are missing out on many of lifeâ€™s littleÂ pleasures because the procedureâ€™s resultant holeÂ left them without a voice and created an openingÂ directly into their lungs. A simple shower isÂ dangerous as even the slightest amount of water inÂ the lungs can be deadly. Bad weather can be lethal.Â Things that used to be a mere annoyanceÂ â€” such as a housefly â€” are now life-threatening.
Itâ€™s not overstating it to say that danger lurksÂ everywhere after a laryngectomy. And just atÂ the time you need extra support, your abilityÂ to communicate is greatly impaired. A simpleÂ interaction with a store clerk is frustrating andÂ can deliver looks of horror and pity.
As an ear, nose and throat specialist at MayoÂ Clinic, David Lott, M.D., has seen laryngectomiesÂ impair too many lives.
â€śIâ€™m tired of seeing patients over and over andÂ knowing thereâ€™s nothing to do,â€ť he says. SomeÂ patients become so hopeless in the face of aÂ laryngectomy that they forgo the procedure, optingÂ for certain death over such deeply impaired living.
Dr. Lott wants to restore hope for these people.Â And with the latest breakthroughs in transplant
and regenerative medicine, he knows how. Read the rest of this entry »
Often perinatal fistulae resist treatment, both with medications and through treatment withÂ a seton, a thread that is placed to promote drainage and healing. Currently standard therapies work less than half the time. Even when they do work, fistulae often return. Read the rest of the article on Discovery's Edge.