Nutrition for the first Total Artificial Heart patient: implications for future patients

Since the mid-1960s, millions of dollars in federal funds have been used for research in the development of the Total Artificial Heart (TAH). Significant advances in bio-materials and pump and energy systems, as well as animal experimentations, have led to the clinical reality of the TAH's use in man. On December 2, 1982, Dr. Barney Clark became the first recipient of a permanent TAH. He had been suffering from terminal congestive heart failure secondary to idiopathic cardiomyopathy. No other treatment was available, since, at the age of 61, he was too old for heart transplant. Dr. Clark's 112-day hospitalization was complicated by pulmonary problems, renal insufficiency, seizures, nosebleeds, and a broken heart valve. Dr. Clark appeared malnourished before surgery, and his numerous postoperative complications confounded attempts at nutritional support. Standard nutritional assessment techniques were inadequate or inappropriate in the face of severe edema, renal failure, and multiple transfusions. Although nitrogen balance was achieved intermittently, for the majority of his hospitalization Dr. Clark remained in negative nitrogen balance, due mainly to renal insufficiency. Some of the nutritional complications seen in the first TAH patient might have been preventable with early nutritional assessment and more aggressive support. The Artificial Heart Management Team at the University of Utah now includes a nutritionist, and future protocols outline detailed nutrition monitoring.