This past July, cardiac surgeon O. H. “Bud” Frazier helped achieve the near culmination of his life’s work: the implantation in a patient’s chest of an artificial heart that, theoretically, will last decades. Now 84, Frazier, the codirector of the Center for Preclinical Surgical & Interventional Research at Houston’s Texas Heart Institute, has performed more than 1,200 transplant operations in his long career. Yet he came to believe such procedures were inadequate; they bought many patients years, not decades, of life. Frazier concluded, to the derision of many of his colleagues, that an artificial heart could be a better alternative.
Just as air travel wasn’t possible until inventors stopped trying to imitate birds in flight, Frazier thought researchers could create a permanent artificial heart only when they gave up on creating a device that could replicate a beating heart. The new device, invented by the Australian biomedical engineer Daniel Timms and tested by a team at THI guided by Frazier and his colleague William Cohn, is driven by a magnetically suspended rotor and has no valves or diaphragms or mechanical bearings that can break down. The creation of such a device, today known as the Bivacor Total Artificial Heart, was once inconceivable to almost everyone—but not Bud Frazier.
I spoke with Frazier at his office at THI, and after about an hour we walked over to talk with the 57-year-old recipient of the Bivacor, who has requested anonymity. Because the FDA is still assessing the feasibility of the device, it was left inside him only until a traditional transplant became available eight days later. Since then, temporary implantations have been done on two more patients, as part of the process to fulfill FDA requirements before the device can be put to long-term use.
TEXAS MONTHLY: When you saw the patient wake up in the ICU, were you excited?
Bud Frazier: Oh, pleased, I guess. I don’t get excited anymore.
TM: Okay, but something drove you to work on the artificial heart for years. What was it?
BF: Durability. If you transplant a heart in a twenty-year-old, there’s a good chance he’s not going to see forty. You’ve got to have a device. I was doing heart transplants on children [in the eighties], and I started seeing them all die. I began to realize that transplanting hearts was like treating cancer patients and getting them into partial remission.
TM: The first heart pumps imitated a heart’s mechanics. Why weren’t they the answer?
BF: We could only keep them going eighteen months, maybe twenty-
four. Just do the math: If your heart beats seventy times a minute—
that’s basically one hundred thousand times every twenty-four hours. So you had to have [a part] that would flex millions of times every year.
TM: You had to wait for technology to catch up to your imagination—you started your research when computers were the size of refrigerators. The first artificial heart patients were connected to enormous machines.
BF: The thing that makes the Bivacor work is this incredible technology—magnets suspend a spinning disc, which pumps the blood. And it can react more or less as your body needs it to. It has all this computerized information that tells it where to pump [the blood] and how. And it does it without any sort of activity by anybody. It’s automatic.
TM: How did you find your first patient?
BF: [According to FDA rules] the recipients have to be on a support device. And there has to be some limitation to their getting a transplant. In this patient’s case, the main limitation was his size. This guy was in the ICU, but it’s very hard to get an offer for a large patient. You have to match with a large donor, and the donors are rarely that large. They’re usually between one hundred and fifty to one hundred and eighty pounds. This patient was a big guy, and he was on a balloon pump [a device that inflates and deflates a balloon in the aorta to help the heart pump more blood but is often used for just a few days]. We got no offers for about four weeks. Then we decided to put the Bivacor in. You can only wait so long on a patient like that.
TM: You often say that the great mystery isn’t why patients die, but why they live.
BF: Back in 1987, there was a redheaded, freckle-faced woman who was dying of heart failure. She was having trouble breathing, and it got worse and worse. Any layman could see that she was sort of blue, even though she was redheaded and freckled. We got a heart and transplanted her. Nobody thought she would survive, including me. But she never had any trouble. She never rejected the heart. Why did she live when almost nobody else that we transplanted in ’87 survived? Sooner or later, we’re going to figure that out. But it’s like it’s dependent on magic, you know?
(Frazier and Swartz walk over to the patient’s room.)
TM: When you woke up, how did you feel?
Patient: All I wanted was something to drink. I don’t know why. I just wanted a soda or something. Something cold and iced.
TM: Your chest felt the same as if you had a normal heart?
Patient: Yeah. It’s like nothing ever happened. It was like I had the same heart. After I was able to get my legs under me again, I walked around a lot.
TM: What do you do for a living?
Patient: I work in oil fields. I’m a truck driver, thirty miles south of San Antonio.
TM: What made you think something was wrong?
Patient: I didn’t know what was going on with me. My legs and my foot were all swollen. We wear steel-toed boots, and I couldn’t put that boot back on, so I thought I’d put on my rubber boots. I was like, “Man, what’s going on?” And then when they got swollen to way up here [indicates his thigh], I called a supervisor, to let them see what was going on, and he said, “Man, you need to go home.” So I drove three and a half hours back home to Houston.
My wife saw me, and she said, “Oh no, you need to go [to the hospital]. Why’d you let yourself go like that? Anyone would have seen something was wrong when you see yourself blowing up like that.” She brought me to the emergency room.
BF: We put that balloon pump in you when you came in. It helped contribute to the swelling.
Patient: Yeah.
BF: It’s good for your heart, but not particularly for your legs.
Patient: They said I had congestive heart failure.
TM: You didn’t have any idea?
Patient: I said, “What’s that?” I’m like, “I’m too young for this. Why is this happening?” And that kept bothering me until the doctor told me it was genetic. I thought it was from all the energy drinks I was drinking, trying to stay awake in the oil fields. You know, when they’re drilling, it’s nonstop. Sometimes we work twenty, twenty-four hours a day the whole week.
TM: Is your wife ecstatic that you’re coming home?
Patient: She didn’t sound too happy. I think she thought I would get on her nerves.
TM: I hope you get some rest now.
Patient: I’ve been getting plenty of that.
This interview was edited for clarity and length.
This article originally appeared in the November 2024 issue of Texas Monthly with the title “The Pioneering Surgeon Who Dreamed of a Better Heart.” Subscribe today.
