Adrian Kantrowitz (October 4, 1918 – November 14, 2008) was an American
cardiac surgeon
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to cor ...
whose team performed the world's second heart transplant attempt (after
Christiaan Barnard
Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-v ...
) at
Maimonides Medical Center
Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, Brooklyn, Borough Park, in the New York City Borough (New York City), borough of Brooklyn, in the U.S. state of New York (state), New York. Maimonides is b ...
in
Brooklyn
Brooklyn () is a borough of New York City, coextensive with Kings County, in the U.S. state of New York. Kings County is the most populous county in the State of New York, and the second-most densely populated county in the United States, be ...
,
New York
New York most commonly refers to:
* New York City, the most populous city in the United States, located in the state of New York
* New York (state), a state in the northeastern United States
New York may also refer to:
Film and television
* '' ...
on December 6, 1967.
[ McRae, Donald (2006). ''Every Second Counts: The Race to Transplant the First Human Heart'', New York: Penguin (Berkley/Putnam).] The infant lived for only six hours. At a press conference afterwards, Kantrowitz emphasized that he considered the operation to have been a failure.
Kantrowitz also invented the
intra-aortic balloon pump
The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta, ...
(IABP), a
left ventricular assist device
A ventricular assist device (VAD) is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of a VAD differs from that of an artifici ...
(L-VAD), and an early version of the implantable pacemaker.
In 1981, Kantrowitz became a founding member of the
World Cultural Council
The World Cultural Council is an international organization whose goals are to promote cultural values, goodwill and philanthropy among individuals. The organization founded in 1981 and based in Mexico, has held a yearly award ceremony since 198 ...
.
Early life and education
Kantrowitz was born in New York City on October 4, 1918. His mother was a costume designer and his father ran a clinic in
the Bronx
The Bronx () is a borough of New York City, coextensive with Bronx County, in the state of New York. It is south of Westchester County; north and east of the New York City borough of Manhattan, across the Harlem River; and north of the New Y ...
, and his grandparents were from Vermont. Adrian told his mother as a three-year-old that he wanted to be a doctor, and as a child built an
electrocardiograph from old radio parts, together with his brother
Arthur
Arthur is a common male given name of Brittonic languages, Brythonic origin. Its popularity derives from it being the name of the legendary hero King Arthur. The etymology is disputed. It may derive from the Celtic ''Artos'' meaning “Bear”. An ...
.
[
He graduated from ]New York University
New York University (NYU) is a private research university in New York City. Chartered in 1831 by the New York State Legislature, NYU was founded by a group of New Yorkers led by then-Secretary of the Treasury Albert Gallatin.
In 1832, the ...
in 1940, having majored in mathematics. He attended the Long Island College of Medicine (now SUNY Downstate Medical Center
SUNY Downstate Health Sciences University (Downstate) is a public medical school and hospital in Brooklyn, New York. It is the southernmost member of the State University of New York (SUNY) system and the only academic medical center for hea ...
) and was awarded his medical degree in 1943 as part of an effort to accelerate the availability of physicians during World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
.[ During an internship at the Jewish Hospital of Brooklyn, he developed an interest in ]neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
, and had a paper published in 1944, "A Method of Holding Galea Hemostat
A hemostat (also called a hemostatic clamp, arterial forceps, or pean after Jules-Émile Péan) is a surgical tool used in many surgical procedures to control bleeding. For this reason, it is common in the initial phases of surgery for the initia ...
s in Craniotomies", in which he proposed a new type of clamp to be used while performing a craniotomy
A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clot ...
during brain surgery.[
]
Early career
He served for two years as a battalion surgeon
{{no footnotes, date=February 2013
In the United States Army and Marine Corps, a battalion aid station is a medical section within a battalion's support company. As such, it is the forwardmost medically staffed treatment location.
During peacet ...
in the United States Army Medical Corps
The Medical Corps (MC) of the U.S. Army is a staff corps (non-combat specialty branch) of the U.S. Army Medical Department (AMEDD) consisting of commissioned medical officers – physicians with either an M.D. or a D.O. degree, at least one ...
[ and was discharged from the Army in 1946 with the rank of major.][
After his military service, he switched to specialize in ]cardiac surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to corr ...
due to the paucity of positions in neurosurgery. In 1947, he was an assistant resident in surgery at Mount Sinai Hospital in Manhattan
Manhattan (), known regionally as the City, is the most densely populated and geographically smallest of the five boroughs of New York City. The borough is also coextensive with New York County, one of the original counties of the U.S. state ...
.[
]
Montefiore Hospital
He was on the surgical staff of Montefiore Hospital in the Bronx from 1948 until 1955.[ He started at Montefiore as assistant resident in surgery and pathology, and progressed to cardiovascular research ]fellow
A fellow is a concept whose exact meaning depends on context.
In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements.
Within the context of higher education ...
before becoming chief resident in surgery. At the New York Academy of Medicine
The New York Academy of Medicine (the Academy) is a health policy and advocacy organization founded in 1847 by a group of leading New York metropolitan area physicians as a voice for the medical profession in medical practice and public health ...
, on October 16, 1951, he screened the world's first movies taken inside a living heart, showing the sequential opening and closing of the mitral valve
The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all one-w ...
inside a beating heart. Using dogs and other animals as experimental subjects, Kantrowitz developed an artificial left heart, an early version of an oxygen generator for use as a component in a heart-lung machine
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...
and a treatment for coronary artery disease
Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...
in which blood vessels would be rearranged during surgery.[Finding Aid to the Adrian Kantrowitz Papers, 1944-2004]
, United States National Library of Medicine
The United States National Library of Medicine (NLM), operated by the United States federal government, is the world's largest medical library.
Located in Bethesda, Maryland, the NLM is an institute within the National Institutes of Health. Its ...
. Accessed November 19, 2008. He also developed a device that allowed individuals who were paralyzed to have their bladders empty through a signal sent from a radio-controlled device.[
]
Maimonides Medical Center and early work on left ventricular assist device (LVAD)
From 1955 to 1970, he held surgical posts at Maimonides Medical Center
Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, Brooklyn, Borough Park, in the New York City Borough (New York City), borough of Brooklyn, in the U.S. state of New York (state), New York. Maimonides is b ...
in Brooklyn.[ In February 1958, a ]heart-lung machine
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...
Kantrowitz had developed was used during open heart surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to corr ...
on a six-year-old boy while the surgeons repaired a one-inch hole between the chambers of the boy's heart that was present since birth. In an October 1959 lecture at the American College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913.American College of Surgeons Online "What is the American College of Surgeons?"/ref>
See also
*American College of Physicians
The American College o ...
, Kantrowitz and colleague Dr. William M. P. McKinnon reported on a procedure in which a portion of muscle from the diaphragm was used to create a "booster" heart to help pump blood in a dog, taking over as much as 25% of the pumping burden of the natural heart. The booster heart functions by receiving a signal sent by a radio transmitter triggered by the pulse of the natural heart. Kantrowitz noted that the procedure was not ready to be performed on humans. Ruff, a "friendly dog of unknown ancestry" was honored by the New York Academy of Sciences
The New York Academy of Sciences (originally the Lyceum of Natural History) was founded in January 1817 as the Lyceum of Natural History. It is the fourth oldest scientific society in the United States. An independent, nonprofit organization wit ...
as "research dog of the year" for his unwitting participation in the implantation of a booster heart 18 months earlier in a procedure performed by Kantrowitz.
In the early 1960s, Kantrowitz developed an implantable artificial pacemaker
An artificial cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural cardiac pacemaker) or pacemaker is a medical device that generates electrical impulses delivered by electrodes to the chambers of the heart eith ...
together with General Electric
General Electric Company (GE) is an American multinational conglomerate founded in 1892, and incorporated in New York state and headquartered in Boston. The company operated in sectors including healthcare, aviation, power, renewable energ ...
. The first of these pacemakers was implanted in May 1961. The device included an external control unit that could adjust the pacing rate from 64 to 120 beats per minute to allow the patient to deal with physical or emotional stress.
Throughout the 1960s, he collaborated with a team that included his brother, engineer Arthur Kantrowitz
Arthur Robert Kantrowitz (October 20, 1913 – November 29, 2008) was an American scientist, engineer, and educator.
Kantrowitz grew up in The Bronx and graduated from DeWitt Clinton High School.Overbye, Dennis"Arthur R. Kantrowitz, Whos ...
, on the development of a left ventricular assist device
A ventricular assist device (VAD) is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of a VAD differs from that of an artifici ...
. Building on his experiments with dogs, he performed the world's second permanent partial mechanical heart implantation in a human on February 4, 1966, which was successful, though the patient died 24 hours after surgery as a result of preexisting liver disease. His second implant of a partial mechanical heart on a 63-year-old woman, on May 18, 1966, lasted 13 days, until the patient died of a stroke.[ During these almost two weeks after the surgery, the patient was improving, and was able to sit up and eat well. This surgery used a valveless device developed with his brother Arthur in which the natural electrical impulses of the patient's heart controlled the action of the pump.
As part of Kantrowitz's research for this project, he conceived of ABO-incompatible heart transplantation,] though it would be three decades before it would be put into practice.[Klein, A. A., Lewis, C. J., & Madsen, J. C. (2011). Organ Transplantation: A Clinical Guide. p.116. Cambridge University Press.]
Worldwide context of heart transplantation
Dr. James Hardy had performed the world's first heart transplant attempt and first heart xenograft
Xenotransplantation (''xenos-'' from the Greek meaning "foreign" or strange), or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenograft ...
at the University of Mississippi Medical Center
University of Mississippi Medical Center (UMMC) is the health sciences campus of the University of Mississippi (Ole Miss) and is located in Jackson, Mississippi, United States. UMMC, also referred to as the Medical Center, is the state's only aca ...
on January 24, 1964. Since there was no standard of brain death, Hardy had acquired four chimpanzees as potential back-up donors. A comatose Boyd Rush
Boyd Rusia Rush (July 4, 1895 – January 24, 1964)''Social Security Death Index, 1935–2014''. Social Security Administration. was an American upholsterer who was the recipient of the world's first heart transplant on January 24, 1964, at Univers ...
with a faint pulse had been brought to the hospital several days earlier and when he went into shock and was taken into surgery, Hardy polled the fellow doctors on his team, with three voting yes and one abstaining. Hardy and his team then proceeded with the transplant using a chimpanzee heart which beat in Rush's chest approximately 60 to 90 minutes (sources vary), and Rush died without regaining consciousness. The hospital's public relations department put out a guarded statement, with many of the early newspaper articles making the assumption that the donor was a human. In addition, when Hardy attended the Sixth International Transplantation Conference several weeks later, he was treated with "icy disdain." Hardy withdrew from active pursuit of a successful heart transplant.[''Every Second Counts'', McRae, in Ch. 7 "Mississippi Gambling," pertaining to Hardy's 1964 xenograft transplant]
pages bottom 122 through 127
[Heart Transplantation in Man: Developmental Studies and Report of a Case]
''JAMA'' (''Journal of the American Medical Association''), James D. Hardy, MD; Carlos M. Chavez, MD; Fred D. Kurrus, MD; William A. Neely, MD; Sadan Eraslan, MD; M. Don Turner, PhD; Leonard W. Fabian, MD; Thaddeus D. Labecki, MD; 188(13): 1132-1140; June 29, 1964. Pertaining to James Hardy's 1964 xenograft.
Obituary, ''New York Times'' (Associated Press), Feb. 21, 2003.
In what turned out to be a four-way race between South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
n cardiac surgeon Dr. Christiaan Barnard
Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-v ...
and Americans Norman Shumway
Norman Edward Shumway (February 9, 1923 – February 10, 2006) was a pioneer of heart surgery at Stanford University. He was the 67th president of the American Association for Thoracic Surgery and the first to perform an adult human to human ...
and Richard Lower, Kantrowitz prepared for a potential human heart transplant by transplanting hearts in 411 dogs over a five-year period together with members of his surgical team. On June 29, 1966, by which time Kantrowitz had completed the necessary technical research, one of his patients was an 18-day-old infant who very much needed a new heart. He and his team had located an anencephalic
Anencephaly is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development. It is a cephalic disorder that results from a neural tube defect that occurs when the rostral (head) end of the neural tube fail ...
baby whose parents agreed to let her be the donor. Due to disagreements with senior staffers Howard Joos and Harry Weiss, Kantrowitz was forced to wait until cardiac death (instead of the more modern use of brain death
Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...
) to retrieve the donor heart, which was found to be useless. According to the ''Every Second Counts: The Race to Transplant the First Human Heart'' (2006), Kantrowitz did not know at the time that the donor parents in Oregon both expected and wanted their baby's heart to be taken before it stopped beating (anencephalic babies typically live 24 to 48 hours). Barnard performed the first human-to-human heart transplant with an adult donor and recipient on December 3, 1967, at Groote Schuur Hospital in Cape Town, South Africa.[''S Afr Med J'',]
A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town
, Barnard CN, 1967 Dec 30; ''41''(48): 1271–74.
Worldwide, especially following Barnard's December 1967 transplant, there were more than 100 transplants were performed by various doctors during 1968. However, only a third of these patients lived longer than three months.[The Adrian Kantrowitz Papers, Replacing Hearts: Left Ventricle Assist Devices and Transplants, 1960–1970](_blank)
National Institutes of Health, U.S. National Library of Medicine.
Kantrowitz's 1967 pediatric heart transplant attempt at Maimonides
On December 6, 1967, at Maimonides Medical Center
Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, Brooklyn, Borough Park, in the New York City Borough (New York City), borough of Brooklyn, in the U.S. state of New York (state), New York. Maimonides is b ...
, Kantrowitz's team, including Bjørnstad PG, Lindberg HL, Smevik B, Rian R, Sørland SJ, Tjønneland S, performed the world's first pediatric heart transplant attempt as well as the first human-to-human heart transplant
A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common proce ...
in the United States. The donor infant was David McIntire Bashaw who was anencephalic baby with a brain which was "grossly malformed" and who had a poor Moro reflex
The Moro reflex is an infantile reflex that develops between 28 and 32 weeks of gestation and disappears at 3–6 months of age. It is a response to a sudden loss of support and involves three distinct components:
# spreading out the arms ( abdu ...
(infant's startle response). However, this infant could move its extremities and had a feeble cry. According to ''Every Second Counts'', both this infant and the recipient infant had their body temperatures cooled from 98.6 to 59 °F, at which time surgeons then waited for the donor baby's heart to stop beating.[''Every Second Counts'', McRae, in Chapter 12 "The Man with the Golden Hands,]
pages 215 to 220
The recipient infant was 19-day-old Jamie Scudero who had the heart conditions of tricuspid atresia and Ebstein's anomaly. At 3:45 a.m., the cooling procedure began. At 4:25 a.m., the Bashaw baby flat-lined, and Jordan Haller removed his heart. He and Kantrowitz sutured the heart into Scudero's chest. This took 40 minutes. Kantrowitz was relying on hypothermia alone for Scudero which meant the entire operation needed to be completed in less than an hour. The team then warmed Scudero to 79 °F, at which point they administered an electrical shock to the heart and it began to beat. Scudero lived for a little more than six hours, and then his new heart stopped beating and could not be restarted.[''Heart: An American Medical Odyssey'', Dick Cheney, Richard B. Cheney, Jonathan Reiner, MD, with Liz Cheney, Scribner (division of Simon & Schuster), 2013]
"Three days later, on December 6, 1967, Dr. Adrian Kantrowitz . . . "
/ref> At a press conference, Kantrowitz emphasized that he did not view the operation as a success.
Alex Faltine was the head technician and was responsible for re-warming Scudero. During the procedure, a connector between two hot water pipes came loose. Faltine simply held it in place with his thinly-gloved hands and didn't say anything to slow down the operation. Afterwards, Haller was astonished to see his blistered hands and asked Faltine how long he had had to hold the pipes together. Faltine, a man in his fifties who occasionally showed off by doing one-armed push-ups in the hallway, simply shrugged it off.
Pump to assist heart
The intra-aortic balloon pump
The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta, ...
was invented by Kantrowitz, working in conjunction with his brother, Arthur Kantrowitz
Arthur Robert Kantrowitz (October 20, 1913 – November 29, 2008) was an American scientist, engineer, and educator.
Kantrowitz grew up in The Bronx and graduated from DeWitt Clinton High School.Overbye, Dennis"Arthur R. Kantrowitz, Whos ...
. Inserted through the patient's thigh, it was directed into the aorta
The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ...
, and alternately expanded and contracted in order to reduce strain on the heart. Based on Kantrowitz's theory of "counterpulsation", the device inflated the balloon with helium gas when the heart relaxed and deflated it when the heart pumped blood.[ The pump did not require surgery and could be inserted using local anesthetic in an emergency room or at a patient's bedside. The device was first used in August 1967 to save the life of a 45-year-old woman who was having a heart attack. The device could be used in the 15% of heart attack patients who went into severe shock, 80% of whom could not be helped by the protocols that existed before the balloon pump. Since the device went into widespread use in the 1980s, it had been used in some three million patients by the time of his death.][
]
Sinai Hospital
He and his entire team of surgeons, researchers, biomedical engineers, and nurses relocated to Sinai Hospital (now Sinai-Grace Hospital
DMC Sinai-Grace Hospital is the largest of the eight hospitals that comprise the Detroit Medical Center. Located in northwest Detroit, Sinai-Grace provides health care services in over 40 specialties and has 334 inpatient beds, is a full-service h ...
) in Detroit
Detroit ( , ; , ) is the largest city in the U.S. state of Michigan. It is also the largest U.S. city on the United States–Canada border, and the seat of government of Wayne County. The City of Detroit had a population of 639,111 at th ...
in 1970, where he assumed the position of attending surgeon and chairman of the Department of Surgery.[
At Sinai Hospital, Kantrowitz experimented further with heart transplants and continued development of the balloon pump, and partial mechanical hearts.][ In August 1971, he implanted an artificial heart booster in a 63-year-old man whose weakened heart could not pump sufficient oxygenated blood to his body. The patient became the first partial mechanical heart patient to be sent home, and died three months after the surgery.][
]
Personal life, heart failure, and death
Kantrowitz married Jean Rosensaft on November 25, 1948. His wife was an administrator on the surgical research laboratories at Maimonides Medical Center while he was there. In 1983, they co-founded L.VAD Technology, Inc., a company specializing in research and development of cardiovascular devices, with Kantrowitz as president and his wife as vice president.[
Kantrowitz died at age 90 in ]Ann Arbor, Michigan
Ann Arbor is a city in the U.S. state of Michigan and the county seat of Washtenaw County, Michigan, Washtenaw County. The 2020 United States census, 2020 census recorded its population to be 123,851. It is the principal city of the Ann Arbor ...
, on November 14, 2008, of heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
.
Awards and honors
* Golden Plate Award of the American Academy of Achievement
The American Academy of Achievement, colloquially known as the Academy of Achievement, is a non-profit educational organization that recognizes some of the highest achieving individuals in diverse fields and gives them the opportunity to meet o ...
(1966)
References
External links
First U.S. Human-to-Human Heart Transplant
at Wayne State University
Wayne State University (WSU) is a public research university in Detroit, Michigan. It is Michigan's third-largest university. Founded in 1868, Wayne State consists of 13 schools and colleges offering approximately 350 programs to nearly 25,000 ...
Library contains high-definition images from this procedure, performed by Dr. Adrian Kantrowitz.
AP Obituary
Adrian Kantrowitz Papers (1944-2004)
- National Library of Medicine finding aid
The Adrian Kantrowitz Papers
- Profiles in Science, National Library of Medicine
{{DEFAULTSORT:Kantrowitz, Adrian
Physicians from New York City
United States Army Medical Corps officers
Founding members of the World Cultural Council
New York University alumni
1918 births
2008 deaths
American cardiac surgeons
United States Army personnel of World War II
SUNY Downstate Medical Center alumni
Burials at New Montefiore Cemetery
20th-century surgeons