by Heidi Norman
An early prototype for the world’s first long-term total replacement for a failing human heart. A machine with one perpetually moving part that could send oxygen and nutrients to human blood cells via a rotating disc levitating in a magnetic field. A thing of magic. A machine that could gift the 17 million people each year across the world who die from heart disease – the world’s number one killer – another ten or more years of quality life. A miracle small enough to be implanted inside a child so that they can walk, run, eat, drink, dance and live fully independently without a human heart and without a pulse.
‘Without a pulse?’ I said.
John nodded. And I said two words that Dan Timms has heard repeatedly these past 15 years; words so blindingly and maddeningly pessimistic they have come to fuel his relentless drive, two words up in lights beside the long night road of his endeavour.
‘That’s impossible,’ I said.
* * * * *
There was a time when men who wanted to fly threw themselves off medieval European towers with vulture feathers strapped to their arms. They were awed and terrified by Mother Nature. They respected her designs, mimicked her wondrous blueprint all the way down to their face-first solid-ground oblivion. In December 1903, the Wright brothers took human flight in a machine that tore up Mother Nature’s blueprint, burnt her designs in a petrol engine powering two wooden propellers. They bettered Mother Nature. A vulture can’t fly 13 000 kilometres from Houston, Texas, to Brisbane, Queensland, but a 747 can do it in 15 hours and 25 minutes. And here’s Dan Timms, far above clouds, flying home to make medical history.
He remembers where this all began. The closest thing he had to an apple dropping on his head, 15 years ago or more. A PhD engineering student at Brisbane’s Queensland University of Technology with a personal biomedical interest in the artificial heart. ‘Early, early, early, at the very beginning,’ he says. ‘I wrote down a rough drawing on a piece of paper.’
A private sketch of an image in his mind. A machine inside a body where a human heart once was. A metal housing for a levitated rotating disc. Large blades on one side of the spinning disc continuously pushing oxygen-rich blood to the body’s arterial tree. Small blades on the other side driving returning blood to the lungs to replenish oxygen. Perpetual. Perfect. He scribbled two words beneath his sketch: ‘Fuck yeah!’
‘I had no idea what was required to actually make that device, but it was an early version of what would become the BiVACOR,’ he says. He smiles, wistful and reflective. ‘Dad was still alive at that point.’
* * * * *
The morning of 8 January 2015, and Timms descends a set of stairs leading to an operating theatre in QUT’s Medical Engineering Research Facility at Prince Charles Hospital. The 36-year-old slips into blue scrubs and enters the theatre where a team of heart surgeons, engineers and researchers from the hospital – most of them volunteering their time – will implant his BiVACOR artificial heart inside the sedated sheep resting on a steel operating table in the centre of the room.
John Fraser is here, helping a team of surgeons monitor and prep the sheep. In the middle of it all stands Dr Billy Cohn, a pioneering American heart surgeon from the Texas Heart Institute in Houston who flew into Brisbane the day before. Beside Cohn stands Steve Parnis, arguably the most experienced cardiac animal surgeon in the world, also from the Texas Heart Institute.
‘Mother Nature’s a bitch,’ says Cohn. ‘But she has things she will tolerate and things she will not tolerate, and we’ve got to find those secrets. We’ve done 80-some odd cows in Houston with various iterations of continuous flow pumps, and the last seven of them were with the BiVACOR. We don’t know if we can do a sheep. The sheep represents children. No artificial heart has ever been small enough to go inside a child. The place where the heart is in a normal sheep is much smaller and much more restrictive than an adult human’s. If we can get this device to fit inside a sheep and work, it means small women, it means children.’
It means a leap in global medical science.
Five years ago, Timms knew Cohn only by reputation, a pioneer in the world of artificial heart research who, along with Cohn’s mentors, American medical titans Dr Bud Frazier and Dr Denton Cooley, has carried the flag in the Texas Heart Institute’s 50-year quest to find a durable, long-term replacement for the failing human heart. For a decade Timms travelled the world on his own dollar attending science conferences where Cohn and Frazier spoke about the history of the artificial heart.
Timms, the son of a hard-working Brisbane plumber, would sit in the back row of packed auditoriums hearing tales of gods: Cooley, who implanted the world’s first total artificial heart in 1969 that helped the patient survive for 64 hours until he could receive a donor heart; Frazier, who in emergency surgery in the 1960s opened the chest cavity of an Italian boy and pumped his heart with his own fingers, keeping him alive before his body eventually failed him, the boy’s penetrating, hopeful eyes locked on to Frazier’s as he died. If Frazier could keep a boy’s heart pumping with his own fingers, surely he could create a machine small enough to take his place?
Over decades, Frazier and engineers across the globe set about designing artificial hearts that mimicked the operations, the pulse, of the natural human heart. Great wonders were built, breakthroughs made, thousands of lives prolonged. In 1986, Frazier performed the world’s first implantation of a Left Ventricular Assist Device (LVAD), a machine that helps a weakened heart chamber pump blood but does not replace the heart, versions of which are commonly used today. In 2003, Frazier implanted the first Heart-Mate II, one of the world’s most advanced LVADs which now resides in the chests of 20 000 people around the world.
LVADs, however, aren’t without problems. ‘We see tonnes of patients come back with horrible complications,’ Cohn says. ‘A guy gets three or four years and then grows a big clot or has a stroke or has pump thrombosis and we’re left going, “Why?” [LVADs] are neat devices but they have their issues, and just upstream from it you’ve still got this horribly diseased heart.’
Most of science’s attempts at building a total artificial heart – a machine to fully replace a diseased human heart – have incorporated, says Timms, ‘a flexing sac that was driven by compressed air or fluid in order to create a physiological heartbeat and pulse, 42 million times per year. However, the sac would break or the driver would wear out inside two years. The devices were also inherently large, so they couldn’t fit in smaller patients – women and children.’
Last August, French biotech firm Carmat supplied a patient with its new total artificial heart – and the company announced in January that the patient was back home from hospital and ‘pedalling like crazy’. But even this state-of-the-art device, made of synthetic and natural materials, is not designed to last beyond five years – it’s still a stop-gap, in other words, before a donor heart can be found. ‘The Carmat is a brilliant device,’ says Cohn. ‘It’s got all sorts of cool things, but it’s huge and it beats 112 000 times a day; 42 million times a year. We’ve figured out some of the rules. You can’t have something beat 42 million times a year. That’s clear. That issue has been settled. No one has ever been able to make a device that can do that without breaking after a year or two.’
And always the eyes of the dying Italian boy remained fixed in Bud Frazier’s mind. He was not satisfied. Conventional artificial hearts have up to 50 moving parts, any of which can break. They’re too big. Too fragile. Too imperfect. From the back of auditoriums across the world, Timms watched Frazier stand up time and time again daring a heart science community built upon his own giant shoulders to conjure perfection. The answer, Frazier said, was to take human flight. The answer, he said, was to move away from mimicry, to take a giant leap of thought that did not match Mother Nature but outsmarted her.
‘I went to these conferences for ten years,’ Timms says. ‘I read 500 papers on artificial hearts and 100 of them were Bud Frazier’s. But he’s a god and I’m too young and insignificant to even ap
proach him.’ So for ten years the anonymous Australian plumber’s son would sit quietly at the back of Frazier’s packed conferences around the world, blood rushing through his restless heart and a single private thought circling through his mind: I’ve got something to show you one day.
* * * * *
It’s a heart surgeon’s version of a trophy cabinet. In his office at Prince Charles Hospital, John Fraser casts his eyes over a display case filled with a range of artificial hearts spanning 20 years of engineering. They are talismans for Fraser, life-saving machines revered by a man who’s seen, up close, countless lives lost to broken human hearts.
‘It’s a sad death, heart disease,’ he says. ‘Imagine your heart starting to fail. All the pumps have failed and in the same way any pump fails it backpressures, and it backpressures in your lungs so you can’t get your breath. Then it backpressures into your tummy and your legs swell up. You become bloated and breathless. You can’t go to the toilet without feeling terrible. It can be a horrible, insidious death, or it can be a very acute death. It’s the epidemic of the 21st century.
‘The whole idea of the pump, initially, was to keep you going until a heart transplant came around. It was a bridge to a destination. But heart failure is this epidemic. There’s more and more people needing transplants and there’s less and less donor hearts. So then you start looking at the destination. Well, we need something that can last, five, ten, 15 years.’
Fraser sits on a black vinyl sofa in his office. ‘This sofa was bought so Dan could sleep here,’ he says. ‘He used to stay in this room overnight.’
‘I’ve seen him work three days continuously, without sleep,’ says Fraser.
‘No one ever said stop,’ says Timms. ‘A lot of people said it was too hard, too difficult and it wasn’t going to work. But no one ever said stop.’
His father was the first to not say stop. When Gary Timms saw Dan’s ambitious artificial heart sketch he was struck with the same simple and thrilling question as his son: ‘Does it work?’
When Dan was a boy his father would drag him out to the back yard to demonstrate the mystical science of plumbing. Building pumps for outdoor irrigation systems, Gary detailed the wonders of gravity and water flow, circulation and currents, energy and force. ‘Plumber’ was never an apt description for Gary, a man who could not afford to go to university but possessed a wily scientific brain that thought in the farthest reaches of three dimensions.
‘I had some ideas and he was Mr Fixit, could build anything,’ says Dan. ‘The biggest background knowledge for [the BiVACOR] came from my dad. We would have a load of fun together working on ideas on how this thing might work.’
The shed at the Timms home in Ferny Hills was filled with moulds and models and tools and sketches and crass dummy versions of the rotary flowing non-pulsatile heart Dan saw in his head. When the shed got too tight, father and son persuaded mum Karen to free up space in the family kitchen. ‘We basically moved our backyard shed into the kitchen, put all the tools in there,’ Dan says. ‘We were surely the only Australian family who had a lathe set up next to their kitchen oven.
‘Then we’d sit for hours in the Bunnings plumbing section putting things together. We were trying to replicate a circulation system to plug the device into, a full circulation system, left side, right side. We were on the floor of Bunnings building a human body. Workers would come over, ‘Hey, what are you guys doing?’ ‘Oh, we’re building a circulation system for an artificial heart’.’ Curious onlookers became so plentiful that the tireless Timms boys were forced to dull their story. ‘What are you guys building?’ onlookers asked. ‘Fish tank,’ they’d yawn.
‘Then I go to Prince Charles Hospital, knock on the door,’ Dan says. ‘We had six surgeons and clinicians in the room upstairs here in 2001. I was just a PhD student. All I had was a crazy idea. Back then, honestly, a rotary pump device? No pulse? That was out of this world.
‘A lot of the surgeons said it was never going to work. In fact, one of the surgeons here smacked his fist on the table and said, ‘No, no, no. You must have a pulse! YOU CAN’T MAKE A PUMP WITHOUT A PULSE!’
But that surgeon didn’t say stop. The surgeons of Prince Charles saw something in the plumber’s son. Voids in their minds were filled with faith in the young man’s unearthly mechanics. ‘They opened up a space upstairs for me in clinical science,’ Dan says. ‘One room. They said, “Here’s a wage. Here’s a room. Good luck.”’
John Fraser met Dan Timms when the intensive care specialist enquired about the ungodly racket being made in the office next door. ‘I knew immediately he was a brilliantly clever man,’ Fraser says. He was ensnared in what Billy Cohn calls ‘the cult of Daniel Timms’.
‘All these brilliant people started to come together under the cult because Daniel is so driven and so brilliant,’ Cohn says. ‘It was almost like a Manhattan Project.’
Fraser began shouting Daniel’s name across the world, endlessly entrancing local and international government and business development financiers with his particularly Scottish gift of the gab. Timms, meanwhile, holed up, working 14, 16, 20-hour days to bring his BiVACOR to life, refusing to say no, refusing to stop. ‘With a crazy idea like this it appeared very unlikely that it was going to work, so it’s very hard to get investment in it. But the reality is, there is a need. So we were in that conundrum. We have an idea worth pursuing but we don’t have any money. So what do you do?’
You barter. For years, Timms travelled the world bartering his skills and knowledge with the greatest medical engineers in the world. ‘We couldn’t pay them money so we spent our expertise,’ he says. ‘We’d help them with their devices and they would help us with ours.
‘The Japanese helped develop the magnetic levitation system for us. But then we needed to put the pump together. Where do we go for that? Well, the guys in Germany have done that. So [Dan’s long-time friend and Brisbane engineer] Nick Greatrex and I went over to Germany for a couple of years. We worked on their projects and they worked on ours and slowly, slowly, slowly we get it to a stage where it is semi-implantable.
‘Short-term animal testing was completed in Australia and Taiwan, but we reached a stage where we needed to evaluate the performance of the device in awake animals, and the best place in the world for this was, of course, Texas Heart Institute.’
Timms had completed some animal tests using an early version of the BiVACOR device when, in 2009, he was invited to discuss his work in a Paris auditorium with 350 of the world’s leading cardiac surgeons, many of them dubious about the young Australian’s ideas. He spoke nervously of his device’s engineering ingenuity, its potential for transforming the global management of heart disease and, at the end of the talk, God stood up. ‘It was Bud Frazier,’ says Dan. ‘He turns and says to the entire audience, “This is going to be the future of total artificial hearts”.’
In September 2011, Timms walked into Cohn’s office at the Texas Heart Institute. Cohn’s secretary had written a reminder of Timms’ visit in his calendar: Daniel Timms from Australia. Artificial heart idea. ‘I see two new artificial heart ideas a month and 20 other ideas people have for me,’ says Cohn. ‘By and large, most of it’s shit. But you never know from where the next big thing is gonna come from so I see every one of them.
‘Daniel comes in. He’s unshaven, a hole in his blue jeans, shirt untucked, with a backpack full of shit. He starts unloading it and talking about this stuff. I start, as I do, looking for what is tragically flawed about this. He starts talking about his levitation scheme and his balancing scheme and I start thinking, “God, that’s kinda brilliant. Good Lord, who is this guy?”’
‘Where did you get this stuff?’ Cohn asked.
‘It’s just somethin’ I came up with,’ Dan said.
‘I ask who he’s been working on this with and he tells me about this ragtag team of really brilliant people around the world who all have jobs elsewhere,’ Cohn says. ‘He would fly out to their places, sleep on thei
r couches, living on air. And I said, “Who’s funding this?” He said, “Well, in the last ten years we have raised $600 000.”’
Cohn nodded. In one week, he raised $2.5 million for Dan’s beatless artificial heart.
‘Mattress Mack!’ Timms says, shaking his head, smiling, eyes alight.
Jim ‘Mattress Mack’ McIngvale, founder of America’s Gallery Furniture retail empire, had helped out Cohn before, when he’d been faced with an alarming shortage of gurneys for emergency patients. Cohn detailed the hospital’s desperate predicament and, the next day, Mack delivered two dozen recliners and mattresses. Almost two decades later, Cohn and Frazier performed an emergency artificial implant on Mack’s ailing brother, George, and Mack let his deep gratitude be known to Cohn: ‘If you ever need anything from me …’
‘Mack’s only ever been in it for the patients,’ Timms says. ‘A phenomenal man.’
‘We hit the ground running and over the last two years this device has made absurd progress,’ says Cohn. ‘We’ve had cows jogging on a treadmill with greater outputs than any artificial heart has ever done.’
Cohn marvels at his Australian colleague, his smarts, his humility. Timms avoids publicity with almost superstitious intensity. ‘[If] you do it for a money hit or an ego boost then you forget the real reason you’re doing it,’ Timms says. ‘You start thinking you’re clever, you’re done.’
Cohn laughs, dismissing such humility. ‘I think we should be shouting about this device from the rooftops,’ he says. Because it’s that good. ‘Anybody can sew the thing in,’ Cohn says. ‘Not anybody can build it.’
* * * * *
It’s 9 pm in the operating theatre in QUT’s Medical Engineering Research Facility. Pure silence. After a six-hour operation, Timms’ team of surgeons and engineers stands in mute awe, staring at the sheep sleeping on the operating table, breathing in and out, living without a pulse. Cardiac animal surgeon Steve Parnis points to a patch of wool deep beneath which Timms’ titanium heart is miraculously calibrating itself 10 000 times a second in accordance to the animal’s blood flow; the machine’s perfect magnetically levitating single moving part spinning 2000 times per minute. The animal sleeps soundly, its natural heart completely discarded, beatless but not breathless. ‘That’s something, isn’t it?’ says Cohn. ‘Where the heart should be is a device that has one moving part and the moving part is not touching anything. It’s floating in a magnetic field, spinning like a top, by these complex magnetic forces. The spinning part will never wear out. It never touches anything. There’s no mechanical wear. There’s no friction.
