"When we first did it, people thought it was silly. You really don't have a good idea unless people think it's silly."– Adrian Kantrowitz, discussing the development of his left ventricular assist device (LVAD), October 13, 2003
Adrian Kantrowitz is perhaps best known as the surgeon who performed the first human heart transplant in the United States, three days after South Africa's Christiaan Barnard performed the world's first such operation in December 1967. For most of his career however, Kantrowitz was one of America's most prolific surgeon-inventors, whose innovations included cardiac pacemakers, mechanical left heart devices, and the intraaortic balloon pump, which is still used in thousands of cardiac patients each year. His pioneering research consistently explored and elucidated the potentials as well as the limitations of bioelectronic technology.
Kantrowitz was born in New York City on October 4, 1918, to Bernard Abraham, a physician, and his wife Rose, who designed costumes for the Ziegfeld Follies. Bernard Kantrowitz had a medical clinic in the Bronx, and Adrian showed an interest in medicine from an early age. He also had a considerable penchant for electrical devices: he and his older brother Arthur (who became a physicist) carried out many kitchen table experiments, e.g., building a simple electrocardiograph from old radio parts, and designing an automobile headlight that would automatically dim in response to an oncoming light.
After graduating from DeWitt Clinton High School in the Bronx, Kantrowitz earned a BA in mathematics from New York University in 1940. He attended an accelerated wartime program at the Long Island College of Medicine (now SUNY Downstate Medical School) and received his MD in 1943. From 1944 to 1946, he served as a battalion surgeon in the U.S. Army Medical Corps, stationed in Europe and then in Japan. Prior to going on active military duty, Kantrowitz served a nine-month internship at the Jewish Hospital of Brooklyn, where he worked with neurosurgeon Leo Davidoff. He took to neurosurgery immediately, and hoped to train with Davidoff after the war, but there were no residencies available by the time he was discharged in 1946. On Davidoff's advice, Kantrowitz pursued training in general and thoracic surgery, serving residencies at Mt. Sinai Hospital and Montefiore Hospital in New York.
Surgery on the heart had long been limited by the need to maintain blood circulation during the operation, but by the late 1940s thoracic surgeons had started developing corrective procedures that could be done quickly and without stopping the heart. Concurrently, they searched for ways to artificially slow or maintain the patient's circulation to extend the duration and scope of their operations. Kantrowitz joined these efforts, adding surgical research on animals to his regular surgical duties at Montefiore. Within several years he had developed a procedure to drain and expose the left side of the heart with a simple bypass pump, which would allow open heart work on, e.g., mitral valve stenosis (a disabling constriction of the valve between the left atrium and left ventricle, often caused by inflammation and scarring). Although the procedure was never adopted for human surgery, Kantrowitz filmed the canine operation in 1951, producing the world's first motion picture of the inside of a living heart.
In 1951-1952, on a U.S. Public Health Service fellowship, Kantrowitz studied hemodynamics with eminent physiologist Carl Wiggers at Western Reserve University School of Medicine in Cleveland. Searching for methods for increasing the blood flow to hearts weakened by coronary artery blockage or other conditions, he discovered that it was possible to manipulate blood flow in the aorta so as to pulse it into the coronary arteries during diastole (the relaxation phase between heartbeats). This increased the coronary and general circulation, while decreasing demand on the heart. This principle of "diastolic augmentation" or "counterpulsation" would be the basis for Kantrowitz's left ventricular assist devices (LVAD) and his intraaortic balloon pump.
In 1955, Kantrowitz was appointed Director of Cardiovascular Surgery at Maimonides Hospital in Brooklyn and Professor of Surgery at SUNY Downstate Medical Center. For the next fifteen years he led a research team that devised a variety of innovative bioelectronic devices. Their first LVAD was a section of diaphragm muscle wrapped around the aorta, which contracted when the phrenic nerve was electrically stimulated. While not effective for long-term use, this early assistive device inspired the development of other neuromuscular stimulators, for paralyzed bladders, intestines, and leg muscles. Collaborating with engineers at General Electric, Kantrowitz also developed one of the first implantable cardiac pacemakers, which was successfully used with hundreds of patients during the 1960s.
Kantrowitz also designed his first mechanical LVAD during the early 1960s. The U-shaped device, which attached to two points of the aorta, contained an inflatable chamber. During diastole, timed by electrocardiograph signals, an external pump inflated the chamber, propelling extra blood to the coronary arteries. In 1966, after extensive animal trials, Kantrowitz implanted the device in two patients with severe congestive heart failure. The second patient survived nearly two weeks, but the trial revealed design flaws that precluded permanent use. Modifying the LVAD design to provide temporary assistance for patients in cardiogenic shock, Kantrowitz developed the intraaortic balloon pump (IABP) which was placed inside the aorta itself. The IABP remains his most widely-used invention for cardiac assistance--thousands of patients are treated with them each year.
Although committed to finding mechanical support for people in heart failure, Kantrowitz knew that for patients with irreparable defects or damage, a heart transplant might provide another important option. In 1962, he and his team began animal transplant research, building on the work of Stanford surgeons Norman Shumway and Richard Lower. On December 6, 1967, only three days after Christiaan Barnard carried out the world's first human heart transplant in South Africa, Kantrowitz performed the second one, transplanting the heart of an anencephalic infant to a recipient baby with irreparable heart defects. The child, like many subsequent transplant recipients, did not survive long; tissue rejection, infection, and other problems plagued these early efforts. Discouraged after his second transplant patient--an adult--died in January 1968, Kantrowitz returned his attention to bioelectronics research, though he continued to participate in discussions regarding transplant protocols, methods, and ethics.
Kantrowitz left Maimonides Hospital in 1970, due to escalating clashes with hospital administrators over his seemingly risky and often highly publicized innovations, e.g., the LVAD, heart transplants, and intraaortic balloon pump. He accepted an appointment at Sinai Hospital of Detroit, which offered him a new research facility and an open-heart surgery program. Most of his New York staff moved to Detroit with him, and they soon reconstituted his research and surgical units. They continued to work on the IABP, and also on a new LVAD--the dynamic aortic patch. This was essentially a permanently installed IABP, with an air pump tube run through the chest wall. An early model was implanted in three patients in the early 1970s, working well until infections developed at the air tube access site. The team spent many years refining the LVAD design and developing a specialized access port to overcome the infection problem. These devices had just received FDA approval for use in clinical trials at the time of Kantrowitz's death on November 14, 2008.
Kantrowitz married Jean Rosensaft in 1948, and they had two daughters and a son, all of whom became physicians. Mrs. Kantrowitz, holding graduate degrees in business and public health, managed many aspects of the Kantrowitz lab operation. In 1983, Dr. and Mrs. Kantrowitz founded L.VAD Technologies, a bioelectronics development company devoted to cardiac assistive devices.
Kantrowitz published over 200 articles and numerous book chapters during his long career, and received more than 20 patents on his inventions. He also did pioneering work in filming surgical procedures. He was an active member of many professional organizations, and served as president of the American Society for Artificial Internal Organs (ASAIO) (1968-1969). His awards and honors included the ASAIO Lifetime Achievement Award, Teacher's Award, the Dr. Barney Clark Award, and several honorary doctorates.