preeminence, a firm commitment to long-term quality is mandatory. More
so than in any other industry, the tracking of long-term outcomes is, by far,
the most important method of determining the best practices.
THE FUTUREWhat will the future look like? The easy answer is incremental
improvements in joint replacements, pacemakers, catheters, mesh, heart
valves, and deep-brain stimulators. Design tweaks and manufacturing
modifications will usher in slight improvements, but every manufacturer
in every discipline has a pipeline of implants that represent substantial
leaps forward, oftentimes opening up whole disease classes that were
previously unchallenged.
The device manufacturers are going small.
The initial heart lung machine was the size of an armoire, with multiple
whirring drums—pulsating crimson blood through wriggling tubing—and
countless moving parts. The mechanical heart was developed several
decades later, with the goal of providing cardiopulmonary function to an
ambulatory patient. While the first implantable artificial hearts of the
1980s did reside in the thorax of patients, the battery powered units were
still the size of a dishwasher. It has been a bumpy ride for artificial hearts,
but these devices now run under the control of an external miniature
computer that is powered by a battery the size of a ham sandwich. All told,
a patient wears a small satchel while walking around, and even exercising.
Besides the scars on the chest, modern mechanical heart recipients have
one distinct feature: no pulse. These machines have a continuous internal
rotating impeller that drives the blood without valves that open and shut.
Newer machines will become ever smaller, and the power plants of the
future will likely resemble an Iron Man–like implantable battery that lasts
for years. The artificial hearts of the future will be miniaturized to an
unimaginable degree, no longer resembling a machine pump. In fact, while
it is impossible to imagine now, the future artificial heart may truly be at
nanoscale.
Our kidneys are the size of fists, yet demand about one-fifth of the
blood supply of the body. They cleanse the blood of impurities (excreted in
the urine) and maintain electrolyte balance. When the kidneys fail, one