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Adrian Kantrowitz; performed first US heart transplant

Three titans of heart surgery (from left), Christiaan Barnard of South Africa, Michael DeBakey of Houston, and Adrian Kantrowitz, conferred on the set of the CBS program ''Face the Nation.'' Three titans of heart surgery (from left), Christiaan Barnard of South Africa, Michael DeBakey of Houston, and Adrian Kantrowitz, conferred on the set of the CBS program ''Face the Nation.'' (AP/ File 1967)
By Thomas H. Maugh II
Los Angeles Times / November 20, 2008
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LOS ANGELES - Dr. Adrian Kantrowitz, the pioneering cardiovascular surgeon who performed the first US 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, Dr. Kantrowitz developed about 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.

Dr. 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, he had performed about 400 experimental heart transplants in puppies and cats in preparation for the procedure.

On a June night in 1966, Dr. 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 already has received permission from the baby's parents to use the 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.

Dr. 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 of South Africa had performed the first transplant.

Three days later, on Dec. 6, Dr. Kantrowitz performed the world's second human heart transplant and the first pediatric transplant, immersing the anencephalic donor into cold water to shock its heart into stopping. The 19-day-old recipient lived for only 6 1/2 hours, however.

The following January, he performed the fifth US 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, Dr. Kantrowitz abandoned the transplant field, choosing instead to work on artificial heart aids.

Beginning in the early 1950s, working with his brother Arthur, a physicist, Dr. 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.

He invented a 6-inch-long balloon that could be inserted into the aorta. Using electronics to monitor natural heart beat, the device inflated when the heart relaxed, then deflated when it pumped, augmenting blood flow and easing strain on the heart.

Working with his brother and other colleagues, Dr. 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 organ, working in concert with it to provide a boost to circulation until the injured heart can recover.

The 1972 implant of a 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 Dr. Kantrowitz concluded that the technique needed more development.

At the time of his death, the company started in 1983 by Dr. Kantrowitz and his wife, LVAD Technology Inc. of Detroit, had a newer form of the device under review by the Food and Drug Administration. That device is now in clinical trials.

Working with engineers from the General Electric Co., Dr. Kantrowitz in 1962 also developed one of the first implantable pacemakers, designed to trigger beats when the heart's own electrical system is malfunctioning.

Adrian Kantrowitz was born in New York. His father was a general practitioner in the Bronx, and his mother 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 old radio parts.

Dr. Kantrowitz graduated from New York University with a degree in mathematics in 1940, then enrolled in the Long Island College of Medicine. Through an accelerated program designed to provide physicians for the war, 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.

Dr. Kantrowitz leaves his wife of 60 years, Jean (Rosensaft); two daughters, Niki, a cardiologist in Brooklyn, and Lisa, a radiologist in Newport Beach, Calif.; a son, Allen, a neurosurgeon in Williamstown, Mass.; his brother; and nine grandchildren.

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