Artificial leather, artificial milk, artificial meat…In the past few years, with the maturity of technology, all kinds of "artificial objects" are no longer a new topic, and there are many commercial applications.
But if you have heard of "artificial heart" for the first time, you will probably find it a little weird.
Can the heart be made artificial? It's really ok.
The starting point of the artificial heart was much earlier than we expected. In December 1982, a heart patient named Clark was implanted with Jarvik 7, the first artificial heart in history, and successfully survived 112 days.
The clinical results of this case also prove that it is not impossible to rely on a completely man-made machine to simulate heart function. Today, 40 years later, there are already thousands of patients with advanced heart failure who rely on artificial hearts to maintain their lives. However, there are not many choices for these patients. At least until 2021, only Syncardia is the only company in the world, which has passed the approval of the regulatory authorities in the United States, Canada, and Europe to carry out the commercial use of artificial hearts in these three places.
The new challenger is French medical equipment company Carmat. The company recently announced that its artificial heart products have been approved by European regulatory agencies and will be launched on the market in the second quarter of 2021.
Why are companies developing artificial hearts so scarce? What is the purpose of developing such artifacts? These are all questions we are curious about.
Million yuan for heart, or man-made
According to reports, the artificial heart produced by Carmat is made of biological materials, which simulates the two ventricles, two atria, and four valves in the human heart. It also has sensors, lithium batteries and other components, which can change according to the activities of the human body. Automatically adjust the flow rate of blood.
But the weight of this "heart" is also 3 times heavier than the traditional human heart, and it is currently only suitable for larger men and women.
How was such a science fiction product made?
This has to go back to 1993. At that time, a French heart expert named Alain Carpentier had the idea of developing an artificial heart. In order to achieve his goal, he needs to find some helpers who are very knowledgeable about cutting-edge technologies.
Alain found Jean-Luc Lagardere, the founder of the military company Matra, and the two hit it off. Then they began to use the original missile laboratory and engineering resources to develop artificial hearts, and gradually developed to the Carmat company we see now.
In 2013, Carmat implemented the first artificial heart into the body trial, which is also the first artificial heart developed by the company to replace a real heart.
But this is not over yet. It was not until December 2020 that Carmat's artificial heart products obtained the European Union's CE certification and officially entered commercial use.
In other words, it took Carmat almost 30 years from the concept of artificial heart to the actual development of the finished product and then to the market.
With continuous investment and a long time period, companies that can really build artificial hearts are indeed rare.
At present, Carmat plans to focus on the French and German markets with a large number of patients, and then expand to the top five European countries.
According to Carmat CEO Stephen Piatt, there are about 2,000 patients waiting for heart transplants in Europe alone, and they will all become potential users of artificial hearts.
The bigger problem is price. At present, the unit price of an artificial heart is very expensive, about 150,000 euros, which means you have to pay more than 1 million yuan to complete the transplant.
But in the face of high costs, many people are still willing to abandon the "original heart" and put a man-made object in their body.
Because in many cases, this may be the only option to continue your life.
Humans rebuild their hearts, not for longevity
Most people living with artificial hearts suffer from heart failure, which is also the main target for artificial hearts.
We need to first understand the heart failure disease, what is "heart failure"?
We all know that the heart is an important organ for blood circulation, and an important feature for life to be maintained is to have a normal circulatory system.
As for heart failure, it simply means that the heart function is abnormal and there is not enough "strength" to meet the requirements of blood transport, resulting in a series of symptoms including difficulty breathing.
Treating heart failure has always been a problem in the medical profession. If it is an early heart failure, it can be effectively relieved by adjusting work and rest and taking drugs, but once it enters the late stage, we can only use external means to save the heart.
One way is to use a ventricular assist device.
It is equivalent to installing a "water pump" for your heart and connecting it to an external power source. Then the high-speed rotating rotor in the heart pump will generate pressure to help the heart complete the work of the blood circulation system.
Strictly speaking, the ventricular assist device here is not an "artificial heart" in the strict sense, because it does not need to remove the original human heart, just install an "accessory" for it.
However, if the patient’s condition becomes more serious and develops into biventricular failure, it will be difficult for a single ventricular assist device to achieve the therapeutic effect. At this time, it is really necessary to consider "exchanging the heart."
The question is whether to replace a real human heart or an artificial heart.
▲ As of 2015, North America and Europe accounted for the majority of the number of heart transplants recorded by the International Heart and Lung Transplant Association
The heart will not be created out of thin air. Some people have to "change their hearts" and others have to "donate their hearts."
According to the data given by Carmat, the current heart failure disease affects at least nearly 26 million people worldwide, but relatively, the annual number of heart transplant operations is only about 4000-5000, which means that the supply is far below demand.
Not having enough heart donors means that many people have to wait for months or years on the brink of life and death before they can get a transplant. Some people may regret their death before the transplant.
This is one of the reasons why we need artificial hearts. Because before heart transplantation, even a "fake heart" has a chance to prolong the life of the patient.
The operating mechanism of the artificial heart is different from what many people think. At least at this stage, we still can't put a miniature nuclear fusion reactor directly on our chest like "Iron Man", so as to obtain almost unlimited energy.
This is the artificial heart in reality, which is actually more like an external intubation device.
If you are curious about how the doctor implanted it in your body, you might as well watch this tubing video , because the picture is too bloody and it is not recommended to enjoy it while eating.
▲ Two artificial ventricles need to pass through the human body and connect to the extracorporeal air pump
The picture above is Syncardia’s artificial heart product. The white block is the "heart" implanted in the human body. The pipeline connected to it will pass through the chest wall and connect with an external portable air compressor to allow the artificial heart to complete diastole and contraction.
Looking at the composition alone, the artificial heart is similar to the ventricular assist device mentioned above, but the artificial heart device is significantly larger and heavier. The air compressor alone weighs 6kg.
The point is that no matter where the patient goes, eating, sleeping or going to the bathroom, he has to carry this huge "mobile power" and endure the noise made by the device itself.
▲ Picture from: The Verge
In 2015, The Verge reported on the lives of these patients who had been implanted with "artificial hearts", in which there was a description:
"Steve Williams needs someone to accompany him from time to time, usually his wife, to prevent machine breakdowns; he needs to always be connected to the power pack or power source, and he has to take a lot of blood thinners to ensure his body temperature. ; He can’t soak in water, can’t go to the cinema, and rarely go to public places, because the air pump in the backpack keeps making noise.”
To some extent, when the patient has an artificial heart implanted, these electronic devices have become part of the patient's body and will always be with them.
Can an artificial heart be permanently implanted?
In the field of computer graphics rendering, ray tracing technology is often regarded as the "Holy Grail" in this field because it can bring light and shadow effects close to reality in the virtual world.
The artificial heart is also one of the holy grails of the medical industry. After all, artificial organs are a seemingly impossible thing, and the heart is the most important part of the human body.
At this stage, the artificial heart is more used as a "pre-transplant transition device", rather than completely replacing the original human heart and permanently implanting it.
Because the artificial heart is also an electronic device that is full of high-precision components and only needs to be powered on, so it is difficult to avoid problems such as life cycle and failure rate.
Just imagine, if the artificial heart completely replaces the human heart, and it fails during the period, it is actually similar to a computer crash. If it is too late to help, the person will definitely die.
In 2016, similar problems occurred in 4 clinical trials conducted by Carmat. Two of the patients died because of blood infiltration into the driving fluid of the artificial heart, causing the electronic device to malfunction, which also caused Carmat to suspend clinical trials of the artificial heart.
According to the existing records, it is difficult to guarantee the number of days that the artificial heart can survive the patient. There are cases where patients persist for 1-2 years, and there are cases where only two or three months survive. The time is not fixed, and many of them are still Died due to complications such as infection.
In that case, why do we have to implant these artifacts with uncertain risks?
This is always a personal choice. For example, when you are in danger, one option is to wait for death, and the other is to temporarily implant an artificial heart and continue to live. Waiting for the arrival of the heart donor, which one would you choose?
▲The survival rate of 81 patients who received artificial heart transplantation was 70% one year after transplantation, while the survival rate of the 35 control patients who did not receive artificial heart was 31% one year later
According to statistics , the artificial heart that exists as a "transition therapy" can indeed effectively improve the survival rate of patients, and most people can persist until the arrival of heart transplantation.
Creating a chance for patients to survive, rather than realizing the luxury of longevity with a robotic heart, is the true value of artificial hearts at this stage.
In China, a product called " Yongrenxin " was approved by the State Food and Drug Administration in August 2019 and entered clinical trials last year. Although it is more like a ventricular assist device than a complete artificial heart, as the first implantable heart system approved for marketing in China, it has been able to fill this gap well.
Perhaps one day, humans can really solve all technical problems and develop a permanent artificial heart without any side effects. By that time, does it also mean that we can achieve longevity, or even immortality, by relying on "mechanical mind"?
When death is no longer the end of life, we can discuss the topic of technological immortality.
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