Top Docs 2012: Matters of the Heart
Meet the Top Doctors who keep an eye on the rhythms of the city.
Out of Body Experience
A tiny orange-tinted piece of plastic that looks a bit like a small tangerine with legs wobbles on the table. Dr. Max Mitchell picks it up and rolls it slowly and reverently in his hands. He’s familiar with the device’s power. This tiny bubble of plastic, called the Berlin heart, has saved three children in Denver in the past three years. Without it—and without Mitchell’s expertise—those children may not have otherwise had a chance to grow up.
Mitchell has been a pediatric heart surgeon for 13 years, repairing holes in the heart and fixing other congenital defects. In the past couple of years, however, he has been a part of one of the most critical advances in pediatric cardiac care in the United States. When children develop primary heart failure, meaning they have a normal anatomical heart that isn’t working properly, most will require a transplant. But the majority of children with heart failure become very sick waiting on a new heart, which can take several months.
For many years, the adult world of cardiac care has had access to devices that temporarily replace heart function until an organ is found. Until recently, that was not the case in pediatrics. Kids were dying even though the technology to save them existed. “Since the early 2000s, American pediatric heart physicians have been clamoring for a way to bridge kids to transplant,” Mitchell says, explaining that such devices were already available in other countries. “We finally got one approved by the FDA in July 2011.” Mitchell and others at Children’s Hospital Colorado were instrumental in that authorization of the Berlin heart, having participated in the clinical trials.
The Berlin heart is a paracorporeal ventricular device, which means during surgery Mitchell executes a series of steps to connect the device, which rests on the upper abdomen outside the body, to the heart. He attaches a tube to the left side of the heart; that tube comes through the abdominal wall and out to the inflow side of the Berlin heart. The Berlin heart is then connected to a pneumatic pump that vacuum-sucks blood into the ventricle and then pulses positive-pressure air back into the device to push a diaphragm that expels the blood through the outflow cannula, which is connected to the aorta. It’s not a simple process but, as Mitchell explains, having the ability to use this device allows his still-hospital-bound patients to remain in relatively good health until a new heart can be found. “There’s no substitute for the human heart,” Mitchell says, “but this really helps.”