Lois Rogers
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A MAN who survived for 7½ years with an electric heart pump has paved the way for a mechanical alternative to heart transplants.
Peter Houghton, from Birmingham, had been given just six weeks to live when he agreed to the experimental operation in June 2000. His chance of survival was put at no higher than 50%. He recovered to lead an active life, and cardiologists are now demanding a full medical trial of pumps to help some of the thousands of patients who die prematurely from heart disease.
His death last week at the age of 68 coincided with the revelation that 70% of the 1,044 donor hearts offered for transplant last year were rejected by doctors because of “medical issues”. The number of heart transplants carried out each year has halved from about 300 in the mid1990s. Only 78 patients have been approved for the heart transplant waiting list.
Transplant surgery at the celebrated Papworth centre in Cambridgeshire was temporarily halted last month when seven out of 20 patients who received transplants in the past year died soon after surgery. An investigation could not establish a reason for the high failure rate.
After his operation, Houghton became a tireless charity worker. He travelled the world to publicise the artificial heart programme at the Radcliffe infirmary, Oxford, which had so benefited him, and took part in a sponsored 80-mile walk from Birmingham to Oxford to help to raise more than £1m. That money was used to fund six more heart pump implants in Oxford. He and his wife, Diane, had no children but helped to raise 13 foster children, some of whom were with him when he died.
Heart disease is Britain’s biggest killer, claiming 216,000 lives annually and costing an estimated £1.7 billion in treatment.
Advocates of heart pumps argue that they can be used to restore thousands of sick patients to a full and active life and are no more expensive than kidney dialysis. They cost £50,000, but the outlay is offset by the huge reduction in drugs and doctors’ time needed by patients with heart failure.
Only six other terminally ill British patients have been approved to receive the devices. Apart from Houghton, the longest survivor has been kept alive by the device for four years.
The technological expertise developed in Britain is now being rapidly taken up elsewhere. Electric heart pump programmes have been set up in Berlin, Athens, Brussels and Caen in Normandy. The Berlin heart centre has implanted 81 devices, four of them in the past two months alone.
The US has become the world leader, implanting more than 1,000 in total, but many have been less effective than Houghton’s and have failed mechanically. America’s longest survivor was Sherri Selph, 54, from Alabama, who lived with an electric heart for seven years. Last year she was given a heart transplant.
Veronica Salpy Pamboukian, the cardiologist who runs the electric heart programme at Alabama University, where Selph was treated, acknowledged that heart pumps were on track to take over from transplant organs as the treatment of choice. “Once we get 70% of patients surviving for two to five years, that will change things,” she said. “We are on the brink of opening the floodgates and being able to apply this technology to a much larger population.”
Houghton was well suited for his role as a medical guinea pig.
A former social worker from South Africa, he had retrained as a psychotherapist and devoted his life to supporting the dying.
It was through this work that he met Rob George, a palliative care consultant, and the pair collaborated on a book called Healthy Dying. It was George who introduced him to the heart pump programme. “It is ironic that the first patient to live with an artificial heart was referred by a doctor specialising in care of the dying,” George said.
“Houghton was incredibly brave, but also quite philosophical. He was a committed Catholic, had last rites administered and was ready to take the risk of not waking up from the operation.” He delighted in showing people the power supply to the pump, which was plugged into a socket implanted in his skull, and the neat shoulder bag that carried his batteries.
Stephen Westaby, professor of biomedical science at Oxford, treated Houghton and the six other patients. He believes evidence from round the world now proves that heart pumps offer a realistic alternative to organ transplants.
Among a growing number of senior specialists who share his enthusiasm is Philip Poole-Wilson, professor of heart science at Imperial College, London. “There is an overwhelming need for rigorous trials to show clearly just how much benefit accrues from the use of these devices for lifetime treatment. Such a trial in the UK would bea fitting memorial to a brave, thoughtful and determined man like Houghton, and it is what he wanted,” he said.
Last year the Department of Health commissioned a cost-benefit analysis of heart pumps from Andrew Clegg of Southampton University’s health research department. He recommended a fully funded trial of their long-term use, but no decision has yet been taken.
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