October 28, 1984
BABOON'S HEART IMPLANTED IN INFANT ON COAST
By LAWRENCE K. ALTMAN <P>
In a bold surgical effort that could have a wide impact on the treatment of failing hearts, a 15-day-old girl received a baboon's heart in a five-hour operation Friday and was reported ''doing fine'' yesterday at Loma Linda University Medical Center in California.
Doctors attending the girl, who was described only as Baby Fae, said through a hospital spokesman that they were ''very pleased'' with the early postoperative results. However, they listed the baby in critical condition in the hospital's intensive care unit. That is standard for any patient who has undergone open-heart surgery.
The doctors said Baby Fae had been born with a severe birth defect, hypoplastic heart syndrome, which made the left side of her heart much smaller than the right side. Baby Fae ''almost died on her sixth day'' of life, said Joyce McClintock, a spokesman for the medical center.
Yesterday Baby Fae was ''stirring and opening her eyes'' and breathing with the help of a mechanical respirator, according to a hospital official.
The heart of a baboon somewhere between ''4 months and 1 year'' of age was used because a compatible human heart was not available, [/u]Mrs. McClintock said. She said that if the operation proved successful, Dr. Leonard L. Bailey, the 41-year-old head of the Loma Linda surgical team, expected the baboon's heart to grow at a normal rate as Baby Fae did. The prediction was based on animal experiments.
Six baboons that were housed at Loma Linda were initially selected for the compatibility tests.
After extensive immunological testing, the potential donors were narrowed to two baboons and then one. ''It's really uncanny,'' one of the doctors said, ''because we never thought we could actually get the data to support selection of one primate donor over another.''[/u]
The doctors said they had detected no other birth defects or conditions in Baby Fae after thorough examinations by specialists in the nervous system, genetics, kidney disease and other fields.
The operation is the first of five using baboon hearts planned by doctors at Loma Linda University, which is near Riverside, about 60 miles from Los Angeles. The animal-to-human transplant experiments were approved by the university's ethics committee although Mrs. McClintock said she did not know when the approval was granted.
The series of experiments give a concerted new push to the medical profession's effort to use animals as a source of organs for transplantation. If the new effort with Baby Fae and other humans succeeds, doctors might overcome the shortage of donor human hearts. That shortage has appeared to be an insurmountable barrier to widespread application of heart transplant programs. Ethics of Using Animals
The success of cross-species transplants could be expected to open up new avenues of research into heart disease as well as raise some thorny ethical questions, Dr. Claude J. Lenfant, director of the National Heart, Lung and Blood Institute, said in an interview.[/u]
Dr. Bailey indicated he was aware of the ethical issues.
''We're not in the business of uselessly sacrificing animals,'' he said in a news release issued yesterday. ''But we're forced here to make a choice. We can either decide to continue to let these otherwise healthy human babies die, because they are born with only half of their heart, or we can intervene and, in so doing, sacrifice some lesser form than our own human species.''
Dr. Bailey noted the similarities and differences in anatomy of simian and human hearts.
''The baboon has only two arch vessels, while the human heart usually has three,'' he said, referring to the aortic arch, ''but for all practical purposes, the internal structure of the baboon heart is virtually the same as the human heart.'' Earlier Attempts Failed
While four earlier efforts to use ape hearts dating to 1964 all failed, this new effort comes when organ transplants are meeting with much greater success than ever before. The reasons for better success include a wider body of scientific knowledge as well as the development of improved tests to detect the rejection phenomenon and drugs to fight it since the first human- to-human heart transplant was done in 1967.
Dr. Christiaan N. Barnard performed the first successful human heart transplant at Groote Schuur Hospital in Cape Town, South Africa, and doctors in many centers elsewhere quickly joined in after learning that such transplants were technically feasible.
The death rates were appalling, however, because of the inability to stop the body from rejecting the donated heart, and almost all centers abandoned the attempts. The striking exception was Dr. Norman Shumway's program at Stanford University in California.
In 1977 Dr. Barnard developed a new approach to heart transplant surgery by piggy-backing ape hearts to the failing hearts of two patients.
In one operation Dr. Barnard piggy-backed a baboon's heart and the patient died hours after the operation. In the other, he used a chimpanzee's heart; the patient died three and one-half days later.[/u]
But Dr. Barnard soon gave up on that approach because of the rejection phenomenon, saying that ''we will go ahead again'' when better antirejection drugs were developed.
Dr. Barnard also said in an interview in 1978 that he abandoned the technique of using ape hearts in humans ''not because I'm so convinced I'm on the wrong track, but I got emotionally involved with the chimp.''[/u]
Experts have credited the new surge of transplantation activity to the development of the drug cyclosporin-A. However, when Mrs. McClintock, the Loma Linda spokesman, was asked if the baboon transplant would have been done if cyclosporin-A was not available, she said she did not know.
Dr. Lenfant of the National Heart, Lung and Blood Institute said in an interview that the Federal institute had not provided financial support to the Loma Linda group for its baboon transplant experiments.
Mrs. McClintock said the Loma Linda doctors and medical center were donating their services to Baby Fae's care. But she said she did not know if any Federal, state or health insurance funds would be used.
Dr. Lenfant said officials at the institute ''would follow the experiments with interest.'' He expressed concern about the possibility of complications that might result from long-term use of cyclosporin-A. He said he presumed that because of the crossing of the species barrier, the dosage of cyclosporin- A might be higher than in transplants of human hearts.
Although the success rates of heart transplants have improved significantly at Stanford and several other centers that have begun to do them again using cyclosporin-A, the procedure is still reserved for recipients who have advanced heart disease and who otherwise would have little chance for survival. Age as Survival Factor
Doctors have found that younger patients generally have better survival rates, and doctors have usually set an arbitrary upper age limit of 50 years for potential recipients of human heart transplants.
As the success rates have improved, transplant surgeons have become bolder in giving hearts to younger people.
Last August, doctors in London transplanted a heart into 9-day-old Hollie Ruffey, who suffered from the same hypoplastic heart birth defect condition that affected Baby Fae in California. Hollie Ruffey was the world's youngest heart-transplant recipient and she died less than three weeks later.[/u]
Baby Fae's heart had an inadequate left ventricle, the main pumping chamber of the organ, according to Mrs. McClintock. The birth defects also affected the two valves on the left side of Baby Fae's heart and her aorta, the main artery leading from the heart.
Since Baby Fae was admitted to Loma Linda University Medical Center on Oct. 19, doctors sustained her life by using a variety of medical measures. Her breathing was supported by a mechanical respirator, for example. In another effort to sustain circulation, the doctors prescribed a prostaglandin- type drug to treat a condition called a patent ductus.
- but that's timber for ya 
