By Thomas H. Maugh II November 20, 2008Dr. Adrian Kantrowitz, the pioneering cardiovascular surgeon who performed the first U.S. heart transplant, developed a balloon-pumping device that has saved hundreds of thousands of lives and developed mechanical heart-assist devices, died of heart failure Friday in Ann Arbor, Mich. He was 90.Over his six-decade career, Kantrowitz developed more than 20 electronic and medical devices to assist heart patients and paraplegics, but he is probably better known for his seminal role in the heart-transplant drama that swept the world in the 1960s.
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Kantrowitz could -- perhaps should -- have been the first surgeon to perform a human heart transplant. Working at the small, community-oriented Maimonides Medical Center in Brooklyn, N.Y., he had performed more than 400 experimental heart transplants in puppies and cats in preparation for the pioneering procedure.On a sweltering June night in 1966, Kantrowitz was ready to perform the first such transplant on a baby suffering from a terminal cluster of congenital heart defects, using as the donor a one-day-old baby who had been born without a brain -- a condition known as anencephaly. He had already received permission from the baby's parents to use its organ.As he prepared to begin the procedure, however, two members of his team intervened, pointing to the seemingly healthy body of the donor infant and arguing that he should wait until the heart stopped beating.
Kantrowitz acquiesced, and when they finally opened the infant's chest an hour later, the heart had been irretrievably damaged.Eighteen months later, he had resolved the ethical issues and was prepared finally to perform the procedure. But on Dec. 3, 1967, his daughter woke him with the news that Dr. Christiaan Barnard had beaten him to the punch.Three days later, Dec. 6, Kantrowitz performed the world's second human heart transplant and the first pediatric transplant, immersing the anencephalic donor in cold water to shock its heart into stopping. The 19-day-old recipient lived for only 6 1/2 hours, however.Kantrowitz was philosophical about Barnard seizing the crown of immortality."You can't always be first," he said later. "Some races you lose, some you win."Critics charged Kantrowitz with "jumping on Barnard's bandwagon," even though the South African had not done anywhere near as much preparatory research as he had.Undeterred, the following January, Kantrowitz performed the fifth U.S. transplant, this time on an adult but again with little success and to a mounting chorus of criticism.
Recognizing that researchers needed to develop much better anti-rejection drugs, he abandoned the transplant field, choosing instead to work on artificial heart aids.Beginning in the early 1950s, working with his brother Arthur, a physicist who was co-founder of the Avco-Everett Research Laboratories, Kantrowitz began developing an intra-aortic balloon pump for an idea that he called "diastolic augmentation" but that is now known more simply as counterpulsation.In many patients with various forms of heart failure, circulation is particularly restricted during the diastolic portion of the heartbeat, when the heart is expanding and refilling with blood before a contraction.Kantrowitz reasoned that they would benefit if circulation was boosted during this phase and invented a 6-inch-long sausage-shaped balloon that could be inserted into the aorta. Using electronics to monitor natural heartbeat, the device inflated when the heart relaxed, then deflated when it pumped, augmenting blood flow and easing strain on the heart.More than 3 million people have been treated with the device since it came into general use in the early 1980s.Working with his brother and other colleagues, Kantrowitz also developed a series of heart pumps called left ventricular assist devices, or LVADs. Instead of replacing a failing heart with an artificial heart, these devices are meant to augment the natural organ, working in concert with it to provide a boost to circulation until the injured heart can recover.
Kantrowitz performed the world's second implantation of such a device on Feb. 4, 1966, but the desperately ill patient died 24 hours later from preexisting liver disease. The surgeon's second attempt on May 18 was in 63-year-old Louise Ceraso, who was able to sit up and eat well after the surgery. Her condition continued to improve, but she died of a stroke 13 days later.The 1972 implant of a newer model in Haskell Shanks, a 63-year-old patient with chronic heart failure, marked the first time that an LVAD recipient was able to leave the hospital and return home. Haskell survived three months, but Kantrow Working with engineers from General Electric Co., Kantrowitz in 1962 also developed one of the first implantable pacemakers, designed to trigger heartbeats when the heart's own electrical system is malfunctioning.Kantrowitz was born Oct. 4, 1918, in New York, the son of a father who was a general practitioner in the Bronx and a mother who designed costumes for the Ziegfeld Follies. He exhibited an interest in medicine at an early age: He and his brother built a simple electrocardiograph from radio parts.
Kantrowitz graduated from New York University with a degree in mathematics in 1940, then enrolled in the Long Island College of Medicine, now a part of the State University of New York Downstate Medical Center. Through an accelerated program designed to provide physicians for the World War II effort, he received his medical degree in 1943 and became a battalion surgeon in the Army Medical Corps.At war's end, he had intended to become a neurosurgeon, but the lack of available positions led him to a cardiovascular surgery post at Montefiore Hospital in the Bronx. From 1955 to 1970, he held a variety of surgical posts at Maimonides, achieving many of his breakthroughs there.Unfortunately, a small community hospital like Maimonides was not an ideal place for an aggressive research program. Many of the hospital's elders, moreover, had qualms about the ethics of such procedures as heart transplants.
In 1970, he transferred his surgical team of 25 surgeons, engineers and nurses to Detroit, where he taught at Wayne State University School of Medicine and operated at Sinai Hospital. He also accepted a then-magnificent research grant of $3 million from the National Institutes of Health.Other achievements over the years included the development of an early heart-lung machine and the construction of a radio-controlled device that would allow paralyzed patients to empty their bladders. Using techniques developed in stimulating heart tissues, he became one of the first physicians to develop devices to allow paralyzed patients to artificially move their limbs.A driven man who worked 18-hour days, six days a week, Kantrowitz also found time to ride his motorcycle and was a licensed pilot with his own plane.
Kantrowitz is survived by his wife of 60 years, the former Jean Rosensaft; two daughters, Niki, a cardiologist in Brooklyn, and Lisa, a radiologist in Newport Beach; a son, Allen, a neurosurgeon in Williamstown, Mass.; his brother; and nine grandchildren.
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