Kantrowitz, Adrian

U.S. heart surgeon and medical investigator Adrian Kantrowitz was born on October 4, 1918 in New York City, to general practitioner Bernard Abraham and his wife Rose. Adrian Kantrowitz was responsible for pioneering developments in circulatory assist devices, artificial organs, medical electronics, heart transplantation, and research motion pictures. His interest in medical research began as a child through kitchen experiments conducted with his older brother Arthur, who eventually became a physicist and cofounder of Avco Research Laboratories. Adrian received his bachelor's degree in mathematics from New York University in 1940 before attending the Long Island College of Medicine, now known as the State University of New York (SUNY) Downstate Medical School. Due to the growing need for doctors during World War II, he underwent an accelerated program and was awarded his medical degree in 1943. From 1948 to 1955, Kantrowitz held various positions at the Montefiore Hospital in the Bronx. Through his experimental work with animals, Kantrowitz began developing an artificial left heart (a device he would continue refining for many years), a rudimentary oxygen generator for a heart-lung device, and a treatment for coronary artery disease that involved surgically rearranging blood vessels. In 1955, Kantrowitz received an appointment to the full-time position of Director of Cardiovascular Surgery at the Maimonides Hospital (later known as Maimonides Medical Center) where he led a research team that devised a series of innovative electronic devices to compensate for various physiological malfunctions.. Kantrowitz was a major contender in the race to perform the world's first total human heart transplant. His team transplanted hearts in 411 dogs over a five year period in preparation for human trials. The surgery required a suitable donor and recipient at the same time, which occurred in late 1967. On December 6, 1967, three days after Christiaan Barnard's historic surgery in South Africa, Adrian Kantrowitz completed the United States' first and the world's second human heart transplant. Ethical questions about the scope of Kantrowitz's research escalated existing tension with the administration at Maimonides Hospital. In 1970, Kantrowitz relocated his entire team of surgeons, researchers, biomedical engineers, and nurses to Sinai Hospital of Detroit, Michigan, where he was now an attending surgeon and Chairman of the Department of Surgery. Kantrowitz shifted his primary focus to partial mechanical devices that assisted rather than replaced the natural heart, considering artificial hearts and cardiac transplants too impractical for the foreseeable future. In 1983, Dr. and Mrs. Kantrowitz cofounded L.VAD Technology, Inc., a Detroit-based research and development company specializing in cardiovascular devices.

U.S. heart surgeon and medical investigator Adrian Kantrowitz was born on October 4, 1918 in New York City, to general practitioner Bernard Abraham and his wife Rose. Adrian Kantrowitz was responsible for pioneering developments in circulatory assist devices, artificial organs, medical electronics, heart transplantation, and research motion pictures.

His interest in medical research began as a child through kitchen experiments conducted with his older brother Arthur, who eventually became a physicist and cofounder of Avco Research Laboratories. Adrian received his bachelor's degree in mathematics from New York University in 1940 before attending the Long Island College of Medicine, now known as the State University of New York (SUNY) Downstate Medical School. Due to the growing need for doctors during World War II, he underwent an accelerated program and was awarded his medical degree in 1943.

A nine month internship at the Jewish Hospital of Brooklyn fostered Kantrowitz's initial career interest in neurosurgery. While there, he proposed a new type of clamp for performing craniotomies during intracranial surgery that became the subject of his first published paper, "A Method of Holding Galea Hemostats in Craniotomies," in 1944. World War II halted Kantrowitz's research work for two years while he served as a battalion surgeon in the U.S. Army Medical Corps. After being discharged in 1946 with the rank of major, Kantrowitz switched his specialty to general surgery because of the lack of available training positions in neurosurgery. He was intensely interested in the possibility of surgical procedures to help the failing heart, but at that time there were no training programs in cardiac surgery. He would spend the rest of his career devoted to cardiovascular research, typically working eighteen-hour days six days a week.

From 1948 to 1955, Kantrowitz held various positions at the Montefiore Hospital in the Bronx. Through his experimental work with animals, Kantrowitz began developing an artificial left heart (a device he would continue refining for many years), an early automated pump oxygenator for open heart surgery, and a treatment for coronary artery disease that involved surgically rearranging blood vessels. This practice of testing experimental surgeries on animals (particularly dogs) before human beings continued throughout his career. In 1954 with the help of Alan Lerrick, a colleague at Montefiore Hospital's Surgical Research Laboratory, he invented a plastic heart valve that served as an extra heart pumping blood into anemic organs. During his time at Montefiore, Kantrowitz entered a one-year fellowship under distinguished cardiovascular physiologist Carl Wiggers at the Western Reserve University School of Medicine in Cleveland.

During this time at Montefiore Hospital, Kantrowitz filmed the first of many pioneering research motion pictures. His film offered a color close-up look inside a living dog's heart while the organ was still inside its chest. The artificial heart designed by Kantrowitz to keep the dog's heart free of blood while supplying blood to the rest of the body also provided a clear view of the living organ in action. On October 16, 1951, he screened the world's first motion picture of the inside of a living heart before 350 physicians at the annual Graduate Fortnight of the New York Academy of Medicine.

Kantrowitz began a fifteen-year professorship at SUNY Downstate Medical Center in 1955 and established a lasting friendship with Chief of Surgery Clarence Dennis. That same year, Kantrowitz received an appointment to the full-time position of Director of Cardiovascular Surgery at the Maimonides Hospital (later known as Maimonides Medical Center), a 600 bed community hospital in Brooklyn. For the next fifteen years, Kantrowitz held a variety of positions at Maimonides and led a research team that devised a series of innovative electronic devices to compensate for various physiological malfunctions. These devices included the extremely sensitive, electronically controlled heart-lung machine (developed in 1958) that allowed him to execute a series of successful open heart surgeries in children. Kantrowitz also created a diaphragm booster heart with William M. P. McKinnon that functioned as a second heart, relieving the natural heart of 25% of its work. In 1960, Kantrowitz and Rene Khafif built a large electronic system to deliver electric shocks to anesthetized dog legs and produce walking motions, an important advancement in paralysis treatment. He programmed stimulation of limb muscle movements of a 25 year old paraplegic, enabling him to stand up and sit down under computer control. This was the first demonstration of the feasibility of programming walking movement in patients with paralyzed legs. A mini radio transmitter emitting signals that caused paralyzed human bladders to empty was also developed around this time. Kantrowitz also collaborated with the Electronics Laboratory at General Electric to successfully design and manufacture an external radio controlled, internal cardiac pacemaker to implant in human patients suffering from heart ailments such as Stokes-Adams disease.

Building upon past artificial left heart and booster heart experiments, Kantrowitz and collaborators such as his brother Arthur, Tetsuzo Akutsu, Franz Gradel, and Paul-Andre Chaptal worked throughout the 1960s on a mechanical auxiliary left ventricle to aid the failing heart. Their goal was to create an externally controlled, valveless, internal pump synchronized with the body's regular pumping cycle through the natural heart's electrical activity. It was implanted in the ascending aorta, leaving the native heart intact. After numerous dog tests, Kantrowitz carried out the world's second permanent partial mechanical heart implantation in a human on February 4, 1966. Although the auxiliary ventricle worked, the patient died after twenty-four hours from advanced liver disease. Kantrowitz's second highly publicized attempt at implanting a partial mechanical heart in 63-year-old Louise Ceraso on May 18, 1966, also ended in disappointment when she died of a stroke thirteen days later. At the same time, Kantrowitz was encouraged by the performance of the device. It took Mrs. Ceraso out of heart failure. When the device was turned off, she went back into heart failure, and when pumping was resumed, she was again taken out of heart failure. This cycle was repeated many times, confirming that such an assist device could become a treatment for heart failure. Kantrowitz later expressed the opinion that the difficulties faced by contemporary Michael E. DeBakey and himself suggested that effective mechanical heart implantation was still many years away.

The intra-aortic balloon pump created by Kantrowitz's team during this period proved to be a more successful heart assist device. Devised as a quick, non-surgical form of temporary mechanical heart assistance, the balloon pump facilitated increasing blood flow and oxygen to the heart muscle until the ventricle could resume pumping on its own, A trial run on a female patient in 1967 enabled her to recover from cardiogenic shock, almost always fatal at that time. Kantrowitz subsequently used the balloon pump to treat patients suffering from myocardial infarction and organized a cooperative study of 9 medical centers which confirmed his results.

Kantrowitz was a major contender in the race to perform the world's first total human heart transplant. His team transplanted hearts in 411 dogs over a five year period in preparation for human trials. The surgery required a suitable donor and recipient at the same time, which occurred in 1966. The procedure was cancelled because the condition of the donor heart was too poor. On December 6, 1967, three days after Christiaan Barnard's historic surgery in South Africa, Adrian Kantrowitz completed the United States' first and the world's second human heart transplant. A 2.5-week-old male infant suffering from severe tricuspid atresia received the heart of a two-day-old male infant dying of anencephalitis. The surgery was the first performed on an infant and lasted 2.5 hours; the recipient lived only 6.5 hours. After the death of his second patient (an adult) in January 1968, Kantrowitz renewed his efforts in mechanical methods of assisting the failing heart. He believed the key to success in heart transplantation lay in overcoming rejection, and that his community hospital could not develop the needed expertise in immunosupression. At the same time, the early deaths of recipients throughout the world were met with growing public criticism against cardiac transplants.

Ethical questions about the scope of Kantrowitz's research, in particular, whether the intraaortic balloon pump was really effective, escalated existing tension with the administration at Maimonides Hospital. In 1970, Kantrowitz relocated his entire team of surgeons, researchers, biomedical engineers, and nurses to Sinai Hospital of Detroit, Michigan, where he was now an attending surgeon and Chairman of the Department of Surgery. He held several positions at Sinai Hospital over the next three decades and also served as Professor of Surgery at the Wayne State University School of Medicine until his death, November 14, 2008. In this new work environment, Kantrowitz continued experimenting with heart transplants, the balloon pump, and partial mechanical hearts. In August 1971, he implanted an artificial heart booster (a more advanced version of the auxiliary left ventricle) into 63-year-old Haskell Shanks, who became the first partial mechanical heart patient to be sent home. He died three months after the surgery because of infection at the site where the tube to the drive unit exited through the skin. A second patient also was improved hemodynamically by the "dynamic aortic patch" as it was then called, but also died for the same reason. Dr. Kantrowitz suspended further work on the heart assist system to develop a skin access device that would remain stable and resist infection. For the next 20 years he collaborated with researchers at the University of Michigan to develop a percutaneous access device precoated with cells derived from the recipient's skin. This approach was successful and he resumed investigation of his improved left ventricular system, now called the CardioPlus, using it to treat patients in advanced heart failure.

Adrian Kantrowitz married Jean Rosensaft on November 25, 1948; she worked on the administrative staff of the surgical research laboratories at Maimonides Medical Center during his tenure there. In 1983, Dr. Kantrowitz, Mrs. Kantrowitz, and Paul Freed, a long-time bioengineering colleague, cofounded L.VAD Technology, Inc., a Detroit-based research and development company specializing in cardiovascular devices. Dr. Kantrowitz died on November 14, 2008, survived by his wife, Jean, two daughters, Niki Ellen and Lisa Robin, and a son, Allen Bernard.