Health | June 16, 2011

Fixing Broken Hearts in Berlin

Once termed a "huge miscalculation" by skeptics, 25 years later, the German Heart Institute Berlin is a world-renowned specialized center for heart treatment. Its program for artificial hearts is the largest one of its kind in the world.

Wofgang Festa carries a small black inconspicuous handbag over his shoulder. Without it, he would be dead. The bag contains the components of an artificial heart that are located outside the body - a control device and two rechargeable batteries. Festa, a former German Army officer, had the artificial heart implanted over three years ago at the German Heart Institute Berlin. A cable disappears under Festa's sweater.

"It goes into my body," Festa explains. "It contains a pump that takes over the blood circulation and assists the heart." One battery lasts for 4 1/2 hours. With two batteries, he can get through the entire day, Festa explains. "You get used to it after a while. After all, women always have a handbag with them."

Festa, 65, is one of over 1,700 patients who have received an artificial heart or a ventricular assist pump at the German Heart Institute Berlin since 1988. Roland Hetzer, head of the Department of Cardiothoracic and Vascular Surgery at the German Heart Institute, says that nowhere else have more artificial heart pumps been implanted. And nowhere else is the experience with ventricular assist and artificial heart systems with such a wide variety of builds, technologies and manufacturers as comprehensive.

He implanted the first artificial heart here back in 1987, about a year after the German Heart Institute was opened, he explains. "The original idea was to keep the patient alive until a donor heart was available. But then I saw that it worked! That you can use it to keep patients alive for months at a time."

Artificial hearts alternative to transplantation

In 2005, the German Heart Institute celebrated the world's first patient living with an artificial heart for longer than 1,000 days, or just under three years. In the meantime, there are patients whose artificial heart pumps already achieve a lifetime of five to nearly eight years. If signs of wear crop up, it is possible to implant a new artificial heart.

In addition, in the foreseeable future, smaller and more efficient systems will be available that have fewer friction losses, use less energy and work without a cable. Thus, artificial hearts will increasingly be implemented for long-term use as an alternative to transplantation.

"The original concept of bridging the time until transplantation has actually become increasingly less important," Hetzer adds. "On the one hand, we know that the pumps work on a long-term basis. On the other hand, the chances of someone getting a transplant are very low. We can't meet the demand."

Pediatric heart pumps "made in Berlin"

In 1990, Hetzer and his team also succeeded in implanting an artificial heart in a child for the first time in the world. It was a model manufactured by Berlin Heart. The German Heart Institute played a key role in the founding of the company and cooperates with it closely. "The company lives from these pediatric heart pumps. For children and infants, there is nothing like them anywhere in the world," Hetzer says. "Not even in America."

When a Berlin Heart pediatric heart pump is implanted somewhere else in the world, cardiac technicians and heart surgeons from the Heart Institute Berlin are often called on for support. Felix Berger is head of the Department of Congenital Heart Disease / Pediatric Cardiology at the German Heart Institute Berlin. He explains that while similar technology is available in most other places, ensuring the success of highly complex operations such as artificial heart implantation, especially in infants or children, requires the well-oiled teamwork of surgeons, cardiologists and anesthesiologists. And this has been developed over the years at the German Heart Institute Berlin.

Training courses for heart specialists around the globe

International training courses for artificial heart specialists are offered on a regular basis at the German Heart Institute Berlin, both for pediatric and adult surgery. Every month, a course is offered in English, along with one in German, for up to ten participants. Here, specialists receive in-depth training in all aspects related to the implantation of artificial hearts. In addition, there are cooperation arrangements with university hospitals in Bosnia-Herzegovina and Russia.

On top of their clinical work, most heads of department at the Heart Institute supervise research projects and are also professors at the Berlin Charité university hospital. The institute's structure is characterized by flat hierarchies, an open atmosphere of communication and short decision-making channels. The Institute has an annual budget of 95 million euros. Thanks to its organization as a foundation, 100% of all profits are invested in the ongoing improvement of the equipment and continuing education of the staff. Berger says that the goal is to be able to offer patients state-of-the-art treatment that is optimized in all aspects. "This means that all of us strive to innovate our specialty on a daily basis so that we will have even more new insights tomorrow. This is the spirit that characterizes our work here at the Heart Institute."

Wolfgang Festa has already profited from these highly motivated efforts. Festa says that he hopes to keep his artificial heart as long as possible. "I feel so good that I don't feel like having another transplantation at this point. I can basically do anything I want, like yardwork or mowing the lawn. In fact, I was even skydiving. Not by myself, mind you, it was just a tandem dive. But still, all those things are possible."