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What will medicine be able to do with hearts?

From BBC - December 4, 2017

If heart transplantation - 50 years after Christiaan Barnard carried out the first operation - has become routine, what exactly will medicine be capable of in the future?

Will we one day be able to build, or even grow, replacement hearts, or will surgeons be able to use genetically modified animal hearts in their place?

The pace of progress has been staggering.

Harefield Hospital heart and lung transplantation director Mr Andre Simon says: "I fell into the trap when I was 18 and I saw my first heart transplant. That was 1986.

"There were two surgeons. I could see them tying knots, and you could not see their fingers because they were so fast. It was weird, fantastic.

"It was the end of the 'cowboy' time in cardiac surgery. I remember coming into the office, and I was impressed by the fact that everything was full of cigarette butts and empty beer bottles.

"It was a completely different time. Things have changed.

"Overall, we are in a lot better position because we can do things we could not do - but we have also lost some of the necessary will to push limits."

The operation that took medicine into the media age

Witness: The First Heart Transplant

New techniques are badly needed because the number of donor organs - about 200 per year in the UK - is dwarfed by demand. About 2,000 people under the age of 65 a year will die of heart failure without a transplant.

One option researchers hope to develop is to use stem cells to grow new cardiac muscle.

Dr Doris Taylor, director of the Center for Cell and Organ Biotechnology, at the Texas Heart Institute, in Houston, says: "If we want to build a whole heart, that takes hundreds of billions of cells.

"The good news is we can now do that.

"My goal is within the next six months to have two to three hearts built that are contracting at a level that makes them transplantable [into large animals such as cows]."

Using pigs, Dr Taylor's team are stripping cells from hearts, and then rebuilding them using stem cells.

They are hoping to perfect a technique where a diseased heart is plumbed up to a newly grown heart.

Ultimately, they hope the new heart can take over completely.

"What we have found is that cells that migrate to different areas tend to differentiate into the type of cell that belongs in the region in which they find themselves," Dr Taylor says.

However, cardiothoracic surgeon Prof John Dark warns against raising false hopes.

"One has seen people come up with very exciting ideas several times in the past," he says.

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