Feature: Famed heart transplant surgeon a heart pump pioneer

The look in the eyes of a 19-year-old Italian boy has never slipped heart surgeon O.H. "Bud" Frazier's mind throughout the decades.

Fifty years ago, Frazier, then a medical student in his 20s, was with a team operating on the boy with an enlarged heart at the Methodist Hospital in Houston, Texas. His heart stopped after the surgery and Frazier immediately started massaging the heart with his hand. At one point, the boy opened his eyes and saw Frazier. He reached out to touch Frazier. But massaging wasn't enough to keep him alive.

"I could never forget how that boy woke up, looked at me and touched me," said Frazier, MD, chief of Transplant Services at Baylor St. Luke's Medical Center, professor of surgery at Baylor College of Medicine, and chief of the Center for Cardiac Support at the Texas Heart Institute at Baylor St. Luke's in Houston's Texas Medical Center.

"I kept thinking if I could keep that boy alive with my hands even for a brief moment, we should be able to have a mechanical device such as a pump that would do the same thing," said Frazier, 77.

That experience planted a seed for a lifelong mission Frazier would embark on after his return in 1970 from his two-year deployment in Vietnam where he had served in the U.S. Army as a flight surgeon. Frazier has since been spearheading the effort at the Texas Heart Institute to develop heart pumps.

"With the technology we've developed, a patient like the Italian boy wouldn't t die today," Frazier said.

After four decades of labor of love by Frazier and his team, the heart pump, also called a ventricular assist device (VAD), has been globally adopted by heart surgeons as a standard therapy for patients with a failing heart. Over the past decade, an estimated 30,000 VADs have been implanted in patients around the world. These electromechanical pumps, also known as mechanical circulatory support devices, augment or replace the function of the patient's own heart to circulate blood throughout the body. Baylor St. Luke's is one of about 160 hospitals in the U.S. that have performed heart pump implantations.

A surgical pioneer in heart transplants, Frazier has also been globally recognized as the leader in the development of left ventricular assist devices (LVAD), the most widely used heart pumps in the world. Additionally he is noted for his pivotal role in the development of total artificial hearts.

"Dr. Frazier is the world's foremost expert on LVADs who invented and popularized these devices," said heart surgeon Jeffrey A. Morgan, MD, chief of Cardiothoracic Transplant and Circulatory Support division at Baylor College of Medicine and the Texas Heart Institute.

Frazier was a protégé of the late, world-renowned heart surgeons Drs. Michael DeBakey and Denton Cooley, who were responsible for Houston's decades of fame as the mecca of heart science.

In addition to the impact of his encounter with the Italian patient, Frazier recalled how he felt pumped by U.S. President John F. Kennedy's announcement of the goal of the space race during his speech on Sept. 22, 1962 at Rice University in Houston.

"This city of Houston, this state of Texas, and this country of the United States were not built by those who waited and rested," Kennedy told the crowd. "We choose to go to the moon in this decade and do the other things not because they are easy, but because they are hard."

Frazier said, "I was inspired as a medical student. We were a Kennedy generation. I believed we could do anything. We were going to the moon. We were going to make an artificial heart."

Frazier spent the next four decades to blaze his own trail to become a luminary in clinical practice, research and teaching. He has performed nearly 1,400 heart transplants since 1982 and implanted about 1,000 LVADs, plausibly outnumbering any other surgeon in the world.

Five thousand adults under age 25 die from heart failure in the U.S. every year while 5 million Americans have congestive heart failure with 550,000 new cases reported annually, according to the Texas Heart Institute. According to U.S. National Institutes of Health (NIH), 100,000 patients could immediately benefit from a VAD or total artificial heart.

"Heart transplant is a wonderful therapy but we only have a limited number of donor hearts we can use. Many patients are too gravely ill to wait for a heart," said Frazier's collaborator, Bill Cohn, MD, professor of surgery at Baylor College of Medicine and director of the Texas Heart Institute Center for Technology and Innovation. "Dr. Frazier saw the future with incredible clarity and said, 'Look, mechanics can be used to save lives.' The heart is just a pump, and the idea was to develop a machine to keep the patient alive until a donor heart could be found."

Over the past four decades, Frazier and his team achieved numerous milestones in medical advances. Among them, in 1986, he performed the world's first implantation of HeartMate I, a pneumatically powered LVAD. The next-generation HeartMate II, a pump that he helped develop, has now become the most widely used implantable LVAD in the world.

In 2000, Frazier implanted the Jarvik 2000 LVAD, a continuous-flow pump widely used as long-term support for patients who may not be candidates for transplant.

Another breakthrough came in 2011 when Frazier, along with Cohn, implanted the first total heart replacement with two continuous-flow pumps inside a human patient.

In 2012, Daniel Timms, a biomedical engineer from Australia who had designed the prototype of an artificial heart called BiVACOR, joined the Texas Heart Institute team to continue on the work of Frazier and Cohn to further develop BiVACOR.

The development of LVADs - the continuous-flow pump in particular - has been Frazier' s most significant contribution to the medical industry.

LVADs serve as either a "bridge-to-transplant" transitional device for those waiting for a transplant or a "destination-therapy" permanent device for those who are not candidates for transplant.

Frazier's continuous-flow pump design is a revolution from the older pulsatile variety made to generate pulsated blood flow by mimicking the healthy human heart that beats 100,000 times every 24 hours. With the frequent pumping action, devices can wear out in as soon as months. The new generation of nonpulsatile pump produces a continuous flow of blood and is much smaller and more durable without the parts and workload to produce frequent pulses.

"The physiology of continuous-flow pumps that we use today is totally different from that of the devices developed to imitate normal physiology, such as artificial heart valves and pacemakers," said Frazier, "That's why I conduct teaching sessions about LVADs for our clinicians to help them understand the heart pump's unique physiology, how it works, and how best to work with patients with such devices so they receive the right care."

On the third Tuesday of each month, medical students, interns, residents, fellows, nurse practitioners and physician assistants gather around Frazier on the eighth floor of the heart institute's Denton A. Cooley Building to hear him talk about LVADs' history, associated preclinical lab work, their mechanisms of action, and postoperative management of the patients. The teaching rounds also draw cardiologists, cardiac surgeons, anesthesiologists, and other medical professionals who interact with patients with LVADs.

"These devices extend the patients' lifespan and enhance the quality of their lives, but we have more work to do," Frazier said, noting that the size and durability of the continuous-flow pump remain the main challenges researchers continue to tackle in development.

Frazier's medical endeavors and achievements are a far cry from his academic pursuit during his much younger years. Raised as a Methodist in Stephenville, Texas, about 438 kilometers northwest of Houston, Frazier studied English and history at the University of Texas. His course took a turn just before graduating and he decided to pursue medicine at Baylor College of Medicine.

The best decision ever, his colleagues say.

"I think what he's created (in the field of heart devices) is going to outlast him by 100 years," Cohn said.

Frazier takes his fame and cheers on his achievements in stride, Cohn noted, and enjoys quiet moments in his office.

"In the center of a cyclone is a quiet, modest Bud Frazier curled up in his office reading Shakespeare and the history of the Civil War," he said. Then he forges ahead again to find the next solution to saving lives.

"I feel part of my role is to evangelize Bud Frazier' s mission, and make sure that everybody understands the impact he had on our world and why so many cardiovascular 'firsts' have come out of Houston - it's the culture Bud Frazier created right here at the Texas Heart Institute at St. Luke's." Endit