Rewiring Cardiology: How Technology has Transformed Patient Care in Medicine

By Angeli Mittal

Dr. Benjamin Bryner is an assistant professor of surgery at the Feinberg School of Medicine
(hereafter referred to as Feinberg), as well as an adult cardiac surgeon at the Northwestern
Medicine Bluhm Cardiovascular Institute. He also serves as the institute’s associate director of
heart transplantation and mechanical support.

Dr. Esther Vorovich is an associate professor medicine in cardiology at Feinberg, as well as the
medical director of the Mechanical Circulatory Support Program and also works at the Bluhm
Cardiovascular Institute. She routinely works as a heart failure transplant cardiologist, treating
patients with malfunctioning hearts.

As an aspiring physician-scientist interested in the intersection between medicine and

engineering, I spoke to Dr. Bryner and Dr. Vorovich on the technologies utilized in resuscitating
patients with heart failure, connecting a mechanic’s workshop to a physician’s clinic.

[These interviews have been edited for brevity and clarity.]

What kind of technologies do you utilize in your clinical practice?

Last October, N.U. performed the state’s first successful transplant of a heart that was donated
after circulatory death. This “Heart in a Box” device makes patients who have experienced
cardiac or respiratory failure to also be viable heart donors — this bypasses the requirement for
heart donors declared brain dead but harboring a pumping heart.

Dr. Bryner: (The device) is a size of a couple suitcases, designed to fit inside a small jet or like
the back of an SUV. It has a reservoir where the blood sits. There’s a pump, a gas exchanger —
so a device that does the work of the lungs, exchanges the oxygen and carbon dioxide in the
blood — and then a box for the heart to fit in that gets plugged in for the flow to be pumped into
it. The blood goes from the reservoir, through the gas exchanger, into the heart, and then drains
back out of the heart back into the reservoir.

Since then, the hospital has performed at least six successful surgeries of this kind.

Dr. Vorovich utilizes different technologies, which similarly focus on pumping the heart.

Dr. Vorovich: A left ventricular assist device (LVAD) is a mechanical pump, and it really takes
over the functioning of the left side of the heart. Imagine we put a straw into the heart and then a
motor on the other side of the straw, suck the blood out of the left ventricle, and then pump it into
the main blood vessel that leads from the heart to the rest of the body.
How have these technologies impacted the medical field?
Dr. Vorovich said LVADs have increased the lifespan for patients who suffer from heart failure.

Dr. Vorovich: It is an amazing life-saving therapy. The average survival of those patients before
the pump is nine months, and we have patients (on LVADs) who now have years and years and
years. The newest pump has only been around since 2018, and the one-year survival in that study
was around 90%.

But when resuscitating the heart isn’t possible, a heart transplant is needed. Traditional heart
transplants require a heart to be placed in a cooler, pumped with warm blood, and then
transferred to the recipient patient within four hours. However, the “Heart in a Box” procedure
forgoes the cooler, continuously pumping warm blood through the heart during delivery.

Dr. Bryner: Without the “Heart in a Box” device, we really only have four hours from the time
the heart leaves the donor to the time the heart is already sewn into the recipient and sees blood
again. So that means if you draw an imaginary circle, we could only go as far as a 90-minute
flight around Midway Airport to get hearts.

Dr. Bryner: With this device, though, we can keep it on the pump (for) up to 12 hours, so we
can fly, basically, as far as we can get on one tank of gas in an airplane. The other thing that it
lets us do is assess the heart, so once we hook up the heart to this machine, we can see it beat, see
how well it squeezes, and make a final decision as to whether or not this is a good enough heart
for our recipient before we really commit to putting the recipient through the big operation.

Without this technology, Dr. Bryner said recipients run the risk of going through a surgery with a
dead heart that may not have been viable for transplant. Not only does this impact the recipient,
but he said it also impacts the donor’s family, who may try to salvage “some silver lining from
their loved ones’ death.” With this technology making significant advancements in heart
preservation, Dr. Bryner said the donor pool size has grown and the waitlist time has shrunk,
allowing more people who need a heart able to receive one.

Yet, he said the technology still has a lot of potential to continue improving the medical field.

Dr. Bryner: A lot of the possibilities are still untapped because we have this kind of window
where the heart is on this machine and it’s not hooked up to a person. So we could potentially
treat the heart with, say, really aggressive antibiotics without worrying about the impact on the
kidneys. We could treat it with various different chemicals, and we can try to strip out all the
immunologic responses from the heart without destroying someone’s actual immune system. We
sort of have the heart isolated, and we really are just beginning to figure out what we can actually
do with it.