A Holiday for the Heart
Written by Jordan Wilkins
The Berlin Heart may have been developed in Germany, but some of the most predominant moments in the device’s history happen at the Stollery Children’s Hospital. Stollery Kids David Adamako-Anash and Melissa Mills both made headlines after being implanted with the artificial heart; David for living the longest with the Berlin Heart for 22 months and Melissa for being the first ever patient to have the device removed without receiving a heart transplant. Dr. Holger Buccholz, the Stollery’s director of the pediatric artificial heart program, got to know both David and Melissa very well, just like the other 33 Berlin Heart recipients he’s seen since coming from Germany in 2005 when he oversaw the Stollery’s first implant.
“The Berlin Heart was huge for pediatric cardiology,” Dr. Buchholz says. “Before, the only comparable device was a kind of heart-lunch machine (ECMO) and children could only live on it for 10 to 20 days. With the Berlin Heart, suddenly there was an option if no hearts were immediately available for transplant.”
The Berlin Heart is a pediatric ventricular assist device (VAD) that vibrates rhythmically and assists patients whose hearts cannot pump enough blood on their own. The device consists of one or two air-driven blood pumps – depending on whether the patient needs single- or bi-ventricle support – and small cannulas that connect the pumps to the atrium or ventricle and to the large arteries. Dr. Buccholz says it generally takes between four and five hours for a surgeon to implant the Berlin Heart and, except for rare cases, the device remains on the patient until a new heart is available.
Almost immediately this device increased the quality of life for children waiting for heart transplants, but Dr. Buccholz, who travels to hospitals around the world educating other doctors about the Berlin Heart, says this VAD didn’t immediately become the medical standard. The first ever implant was in in Germany in 1990 but even after more than a decade of successful results it wasn’t until 2004 that a North American child was able to benefit from the technology. Doctors at Standford University knew about the Berlin’s Heart’s success in Europe and in an emergency situation applied for a “humanitarian device exemption” from the Food and Drug Administration, which is not a full approval, but a special arrangement when there is no alternative. The implant was a success, became a cover story on The New York Times and rest is history, Dr. Buccholz says. Since then the Stollery, which is one of five centres in Canada that can administer the Berlin Heart, has implanted several each year.
Advanced technology has led to move VADs available to doctors and patients – today many are even less intrusive than the Berlin Heart – but Dr. Buchholz says the Berlin Heart is still the only choice for children who weight less than 15 kgs. Children no longer leave the hospital with a Berlin Heart (other VADs are used in these situations) but their stay isn’t limited to the intensive care unit like it would have been before the device existed. This allows children to rehabilitate and prepare while they wait for a transplant. Ultimately, Dr. Buccholz says the Berlin Heart isn’t a long-term solution like a transplant, but it does provide the next best thing for the Stollery’s smallest patients. “It gives the children time,” he says. “The Berlin Heart is like a holiday for the heart.”