Doctor Q&A:乔治·维塞尔塔勒
是什么吸引你从医的? 我听说你最初学的是电气工程.
All through childhood I wanted to be an electrical engineer — nothing else existed for me. But when I finished college and started working for a power company, I was so disappointed. 很无聊!
I had a background in medicine because my dad was a veterinarian. We had tons of animals and my brother and I would help out sometimes. After half a year, I told my dad I wanted to go into medicine. 他说:“太好了,你想接管我的生意吗?我说:“不,我想和人类一起工作。."
How did you get involved in working on 机械循环支架 devices?
A med school friend called me and told me about a program testing total artificial hearts in large animals that needed medical students. The animals spend a couple of days in the quarantine room and you do the job of an ICU nurse.
Pretty soon I was asking a lot of engineering-specific questions. 他们说,你怎么知道这一切呢?我说:“因为我是个工程师。." They said, "We need engineers for the driving units under development in the bioengineering lab.于是我搬到了那个实验室. 真是太迷人了. 一切都是全新的.
什么是驱动单元?
It's the controller for the [heart] pump — the brains of the device, if you will.
What happened when the first artificial hearts were implanted in people?
I saw how the patients could recover and also saw some things that didn't work out. The total artificial heart and the pumps in those days were really big. 这是一个大手术,对病人来说创伤很大. And smaller individuals, females and children, can't be served with these pumps. So, 还有一位生物工程师,他后来成了我最亲密的朋友, we said, “我们必须做一些完全不同的事情. 我们怎样才能制造更小的泵?"
To make the pumps smaller, they needed to work differently, too — can you explain that?
For years we had lived with the dogma that a patient has to have a pulsatile flow. We decided to focus on pumps that would allow the blood to flow continuously, 而不是模仿人类脉搏的泵.
And you eventually became the first surgeon to successfully implant a continuous flow device?
Yes. I became the program director for the first clinical trial of the MicroMed pump [developed by famed cardiac surgeon Dr. 迈克尔DeBakey]. 我们有了十大赌博平台排行榜上第一个没有脉搏的病人.
My department chair told me, "When you have those first patients, they are unique. 我希望你24小时都在.“最初,我和病人一起睡在房间里. 我一直和他们在一起. 他们康复了,变得更强壮了. 真是太神奇了.
The idea at that time was that the pumps would be a "bridge to transplant" — a way to keep patients alive until a heart became available — not a long-term solution?
Yes, because nobody knew at that time how long these pumps would last. And we did not know how long the human body would tolerate nonpulsatile flow. 我成功地为两个病人进行了移植, the first one four-and-a-half months after the implant and the second one after six-and-a-half months. 第一个病人还活着,他做得很好.
Now some 心脏衰竭 patients may not need a transplant at all, once the pump is implanted. 什么样的病人适合做这个?
最年长的植入病人是89岁. 他95岁还活着. 他很健康,后来心脏衰竭了.
像这样的病人,你可以排除大肾脏病, 肝肺功能衰竭, 以及中风,都是理想的人选. All you have to do is support the engine, so to speak, and the rest of the body is fine.
移植心脏是什么感觉?
说实话,对我来说,这一直是个奇迹. 你有一块肉, of flesh, 这是不动的, 太冷了, 你把它从一个人传给另一个人, 然后把它缝进去, flush it with warm blood and all of a sudden it starts beating. 一些死气沉沉的东西又复活了. 就像凤凰浴火重生.
Can you contrast a typical scenario for a 心脏衰竭 patient at the beginning of your career and now?
这就像白天和黑夜. 我们知道很多过去不知道的事情.
Today I saw a patient who sits in a chair and cannot walk anywhere. 她60多岁了,很聪明,还想工作. Her legs are swollen and she can hardly breathe appropriately. 她处于那种状态已经好几个月了. For her — while you can't guarantee anything — you can assume she's going to benefit dramatically, 让她回到正常的生活, including things like outdoor activities and going on holidays.
The most important thing is that as soon as patients are exhibiting pronounced symptoms of 心脏衰竭 — like shortness of breath, restriction of exercise capabilities — they should contact a specialized center. 越早被推荐的人越好.
How might these patients benefit from coming to UCSF rather than another center?
We have a very consolidated team of cardiologists and surgeons and 机械循环支架 coordinators. Also, because we are an academic center, we really push hard to go new routes. When I came here, we did the first minimally invasive implantation of the HeartWare泵 in the U.S. Now the majority of our patients get this minimally invasive approach.
这对恢复时间意味着什么?
It's faster. And because many are bridge-to-transplant, the transplant is way easier. 他们的状态更好了, and because you don't have to open up the whole pericardium [the sac surrounding the heart] and sternum, 他们的解剖情况更容易接近.
Currently, MCS patients have to wear an external power source that's connected to the device through an incision. 我们会很快看到无线电源吗?
Yes. There are a lot of little issues that prevent us from applying them in humans at this point, 但我认为在四到六年内是可能的.
你不断创新的主要动力是什么?
You have to have the mindset that you want to do things differently. When I came here and did the first minimally invasive implant, people said, "Nobody does that here." But I said, "This is the Bay Area, where people think outside the box. 如果不在这里,那么在哪里?" That's one reason I came here — I was impressed by that spirit of doing things differently.