 So I wanted to first make sure we did proper introduction, so I wanted to introduce the film's director Richard Pierce on the far end here I don't know if any of you know from Texas Heart Institute and the film's producer, Meville Byrds, who is just introduced, and Bruce Dr. Brasher. So thank you for sharing. So I thought I'd start by asking you if you could explain a little more detail about why you love this film so much. You know, it's amazing to me that this was done in the late 70s, early 80s, when nobody was even thinking about a heart replacement with a total artificial heart. I started working on it in 1985. The bizarre thing, you know, Plato and Socrates say that art imitates life, but it's the case where life is imitating art. I don't know if you'd notice there was an emblem of the Texas Heart Institute in one of the scenes. But it was, I think, at a time when we were doing more of heart surgery than all of Western Europe at St. Luke's Hospital, because Dr. Cooley was such a master surgeon, and it was a, I think it sort of mimicked the Texas Heart Institute in many ways. But I thought the concept, and nobody had the concept, this was before Bar and Clark, first pulse to a heart. So nobody really had the concept of a continuous flow pump, and nobody, of course, thought it would work. But I think most of the people here will live to see the time that we don't do heart transplants with this piece of pump set. I'd like to talk to the director and producer about how this movie actually came about. I know James Salter was the screenwriter, he was a terrific journalist, and had also done a profile of Jarvik, I think, before the movie, correct? Yeah, the movie began with Salter, a great writer of fiction, but someone who had also dabbled in the movies. He wrote Downhill Racer for Robert Redford. And he felt that in these characters that he saw, he got an assignment from, I thought it was look, Dick thinks it was life, both neither of them are digital, so you can't really find the archives, okay? But he managed to get an assignment to talk to the emerging superstars of medicine who were chest surgeons, guys who did bypass operations, valve operations, and were not only, you know, because this is quite recent. I think the first bypass in America was in Boston in 1965, I believe. And then... When? What? You mean the coronary bypass? Yeah. It was 1965 at Methodist Hospital. Ed Garrett. Oh, Garrett. Yep. Ed Garrett. Okay, there was a guy in Peter Bent Brigham in Boston who claimed he... But anyway, it sort of swept the country. Salter went across the country and interviewed many of the emerging superstars, including Dr. Cooley and the surgeon that Rob Jarvik, who designed the heart for this movie, worked within Salt Lake City, William DeVries. And he just felt that there was a movie in it, and he knew about this artificial heart program that was sort of in its very, very early stages in Salt Lake City. And Jarvik was a kid. I mean, he might have been in his mid-twenties when this began, but was, like Daniel Timbs, a fabulous inventor. And that's the locus for the movie. Would you and Daniel like to show the bivouacour and talk about the differences and what we saw? I mean, actually, it was interesting. There's similarities and differences. Yeah, I mean, just a 50,000-foot view. So, okay. So, the movie in 1981 sort of outlines what's happened in the last 10 years, 7 to 10 years, just like they foretold in the movie. Every scene in that movie, sitting down at dinner with Fine, did you catch that as the last name was Fine, which is amazing, because so it was, except it was Mattress Mack there to bring Daniel in, and Daniel was sitting across, I mean, every scene. Jeff Goblin's 34. I'm 34 at that time. Yeah, he was 34. He's working on it 12 years. I'm working on it 12 years. Mattress Mack says, how old are you, Daniel? I mean, it's, the hair was standing up on the back of my neck every three minutes through that movie. So, this device, Dr. Frazier came up with the idea of a continuous floor artificial heart. Had never seen the movie. And by the way, I wasn't really thrilled with the movie because I didn't know I was even going to med school at the time. And then roll forward 35 years and we're doing an experiment and I'm getting this weird deja vu vibe and I'm saying, I've seen a movie about what we're doing right now. That does. Can I stop you for those of us who haven't spent the majority of their life on this, including me? Can you talk it just briefly the difference between continuous flow and what precedes? Close. Yeah, so all of your hearts, I'm guessing, fill and eject, fill and eject, fill and eject. It's a really nice way to pump blood, but your heart's two pumps, not one, right? One takes Athena's blood and pumps to your lungs. The other one takes the bright red blood coming back from your lungs and pumps it to the body. And to be able to do that effectively, your heart has to pump 60 to 100 times a minute. 100 times a minute is 144,000 times a day. It's 52 million times a year. That's okay because your heart can heal if something tears, cells go and repair the damage. Not if it's plastic though. And so there have been tons of plastic pumps that people have designed over the last 50 years to support the heart, even to replace it. But at 144 cycles every day, they last a year, a year and a half, maybe two years on the outside. Roll forward to 2002, 2003, 2004. A company, Abium, had spent a quarter of a billion dollars making the best pulsatile, artificial heart in the world. And after 14 implants, five of which Bud did, the longest pump went 14 months before it broke, they gave up. So in 2004, it didn't look like we were ever going to have an artificial heart. Well, Bud came up with the idea of using a spinning turbine. Turbines are great ways to pump fluid. That's how in the oil industry, in car pumps, gas pumps, everywhere, that's what we use. But you give up the pulse. And you need a pulse, right, to stay alive. We'll all assume that everybody here has a pulse, my dog has a pulse. Bud started doing the earliest experiments before anybody thought you could have a non-pulsatile pump in the blood and showed amazingly with Rich Wampler and another friend of ours that you could use a rapidly spinning pump to pump blood. Rob Jarving was working on a continuous flow pump as well, but these were to support the heart. Right when I came back from Boston, Bud said, hey, really, let's see if we can take these continuous flow pumps and replace the heart. And it was an amazing period where we were realizing you don't need a pulse. And then in a rogue move, sort of like you just saw in this movie, the two of us put one in a patient who was dying and had no other options. It got a lot of public attention. It was a National Geographic, NPR. We did a TED Talk. It was on the cover of Popular Science. Interdangel Tims, who had been working on this device for a decade, who shows up, flew to Houston on his own dime, and explained his concept to us. And we realized it eliminated all the challenges that our twin turbine device had, specifically two computers talking to each other. The right pump was really vulnerable to clot, and he figured out this elegant, elegant device. We immediately pivoted away from twin turbine. We got Mattress Mack to write the check to bring the team to Houston, and this small army of brilliant people that were living all over the world. In South America, in Aachen, Germany. And Daniel had been traveling from city to city, sleeping on sofas, living on air, no wage. He would help them solve their problems on whatever project they were working on in exchange for them contributing their brilliance to this. And now we were able to put the band together. They moved to Houston. And now, roll forward six or seven years. This will be the first practical permanent artificial arc. This is what you guys envision. It's much better than ours. Tell them how it works. Want to do that? Daniel, if you could just tell them what the older hearts looked like, how much bigger they were and who they could go in versus this. Yeah, I guess the older hearts that we're talking about are probably two to three times the size of what Billy's holding up here. They couldn't fit in any women and children and any large male adults would be able to be supported with those devices, whereas this device would be able to fit in a 12-year-old child. And it certainly can pump enough blood for an adult male exercising. So it's all doing that with a rapidly spinning disk that is magnetically levitated so there's no wearing out inside there. So that means that it can keep going and going and going like they say in the movie. It's not going to stop. This is not going to stop. And so for that reason, we can remove the native heart and put this in its place and eliminate that problem of heart failure as it's going along. But, you know, I mean, when we were watching this movie as a group, our team of engineers, we were only seeing this a couple of years ago as well. It actually convinced us that there's time trouble. There is definitely time trouble. And someone in our group has gone back and told me in the script because we're watching this and we're following the movie to see what's happening next. And we didn't know that this was our audience right here. Absolutely. One of the things that I thought was interesting in the movie and that I saw in my research was that people were so frightened in 1969 with the first implant that they wouldn't be who they were anymore. And there was all of that concern with transplants, if you put, when the character asked what color is the guy whose heart he got, can you talk a little bit about that? Would you like to address that? That's what people worry about if they're healthy, you know. But nearly the first thing the transplant patient will say when they wake up is, I can breathe. You know, they want to breathe. We all reach our time. And we have different modes, but being slowly suffocated, which is what the heart failure patient has to face, they don't really care about any of those things that are philosophical, as I said, if you're not sick. But I can breathe, that's the first thing you hear from them. And with the smaller pumps as well. And the truth of it is, your heart is just a muscle. There's no emotional content, but as humans we feel it respond to our emotion and we think it's somehow involved. And of course isn't. I was once on a date line and they said, you're holding someone's beating heart in your hand, what's it feel like? And I said, a lot like the spleen, but it wiggles around a bit. Did you have any issues with that when you were doing the movies? Did Salter feel any different? I realize he wasn't a doctor, but if he had a different idea about whether the heart is a muscle or whether it's connected to something larger. I think, I don't know the answer to what you felt. He would be great if he was here, he died a year and a half ago or so. Was it something you all looked at when you were doing the movie? We thought that her emotion had to be dealt with in some way. Even though even back then I agree with Bud totally that people who are sick and are helped are not anywhere near as emotionally hooked in as you think they would be. But I think we did have to figure out some way. We did it maybe not enough, but we did deal with her recovery and it wasn't a recovery based on her being well. It was a recovery based on her adjusting to having a smooth running pump in her chest. Do you want to talk a little about how you have a patient? Well, I think that's just a perfect example of a healthy young girl. You know, you think, well, there's some cause for it to eat too much bacon or something. The bulk of them are what we call idiopathic, which is the same derivatives as idiot. If we don't know what caused them. This is a healthy young girl who was on the A&M rowing team of all things. I don't know if they had any water up there, but somehow they have a rowing team. She was active and healthy and she came in and she was dying of heart failure. It was interesting to me because it was one of those experiences. I remember when I was a medical student, we had a young Italian boy who I got to know before his surgery and he needed a valve replacement. I thought he'd be well and Dr. DeBakey operated on me. He looked like he was doing well and a real nice young kid, 19 years old, really looking forward to a new life with a new valve and his heart stopped. I was the youngest and strongest at that time. This was 1965-66, so they got me to massage his heart. As long as I massaged his heart, he looked up at me and he didn't reach up at one time, but we couldn't get the heart to stop. Dr. DeBakey came in and finally said for us to quit. I couldn't quit, of course. Finally, the resident just hit me. I was thinking if my hand could keep this boy alive, why couldn't we do something that would do the same thing? It was sort of interesting with this young girl initially when we brought her into the operating room where her heart stopped. I had to massage her heart and we put her on the heart-lung machine through her leg. We had a pump that we pulled off the shelf just like I wished I'd had in 1965, and it worked. She's alive and well today. I think it's been a lot of work. It's one thing that I think people in Houston don't even realize. All really work has been done here of any merit with this technology. I had to work with companies in different parts. One was in Sacramento and one was in New York because we didn't have any companies here that were even involved in medical progress. It's by the fact that we had the largest medical center in the world, but it was a great satisfaction to me looking back on my life and thinking back to that young Italian boy and this young woman is about ten years out now doing fine. I think if we hadn't developed that technology, it would have been just like it was in 1965. I have a question about that, which is about medical experimentation. In the movie, they have to meet with one small group of people in the hospital and it's like, okay, we're going to go do it. Can you talk a little bit about what kind of hoops you all now have to jump through to get something like this in a patient? I don't know. Billy, you want to talk about that? Not really. Can you compare it to what happened? In all fairness, the device we put in Craig Lewis was made out of other components that were approved, two LVADs, hernia mesh, some medical silicones, some Dacron cardiovascular patches, maybe not for that exact indication, and you're sort of allowed to do that. We were sort of in the gray zone and we decided to ask for forgiveness instead of permission. In fact, when he went and sat in that room asking those guys for permission to use the device, I thought, oh man, big mistake. And you're allowed to do that twice, right? So for this device, we've actually met in person with the FDA. We've had long calls with them most recently, two weeks ago. So we're doing this by the books. But yeah, the FDA is trying to make it easier to do first in man in the United States with an early visiability study program, and there are all four invasions that they want to do safely and wisely. I have one more question for you all. Can I give a prop to you guys, though? My wife will tell you that whenever I watch medical shows, I go, it's never that way. He can't do that and that. Oh, they would never, when I walk out of the room or throw things at the TV. That movie really is the most accurate depiction of life as a heart surgeon. Every aspect of it is so accurate. Being on bypass, what's shocking the heart, the aspects, the EOR, everything. That said, after they give the diacetam, they turn the stopcock the wrong way. When you do CPR, you don't do five beats and pause. If someone's ventilating for you, that's only in CPR. It was a period of peace. You saw it was a Bork-Shiley valve. It was taken off the market to hear your movie came out. A coronary angiogram you showed showed the left main had nothing to do with the valves, but other than that. Ross, can I get it all right? Yeah. We spent some time here at the Texas Heart Institute. We vetted what we were going to do through a lot of doctors and stuff. We had people on the set making sure that we didn't make horrible mistakes. The mistakes you're talking about are probably would have killed them. But other than that, yeah. So we did our very best. We're not doctors, but we tried hard. I have an aesthetic question. My husband, I've been watching a lot of detective shows and there's a lot of violence that come in often at the wrong time. This movie had no suspenseful music at all. Did you decide to let the story tell itself to not get in the way? That's a good question. In a way, in order to get a movie like this made, it has to end up being something that can be put into a sentence. Will the girl live or die at the first artificial heart operation? And yet we didn't want to make one of those melodramatic medical movies. Because this is really not so much about whether the girl will live or die, even though that's part of the movie. It's about a lot of the complicated issues around taking an action like this and looking very closely at a surgeon. A surgeon's world and a surgeon's emotional connection to patients and all of this. Which was, I think, not going to fit into the mold of a medical melodrome or a TV procedural, a medical procedural. So part of the problem was to keep the audience from becoming too simplified and too non-dramatic. So this was very much, I mean we may have gone overboard. But I do feel like this is our audience. I mean this is an audience of doctors who look at this movie and go, yeah, for the most part this is the way it is. And that's what we dreamed about. We dreamed that we would make a movie that people could say that's actually the way it is. And particularly that's the way it is for a heart surgeon like Dent Cooley or Bud Frazier. This is their life in a way. The movies are remarkable. The operative depictions, I don't know how you did it. I don't know if you had a sheep or a goat or something. But it was really remarkable. We were determined to be able to have an audience look into the body of an open heart surgery and not cheat that, really to see a heart. And to see what the miracle of what a heart looks like inside the body. And to see it in a way that we began to see it as beautiful, not scary, okay? We were determined. We hope it's beautiful not scary. You would be the ones to tell us. Because it would be beautiful. But the lines were the same lines that you would have said in surgery. I guess you picked them up when he was down here with Dr. Cooley. But it was just right out of the OR. It was all super accurate. Beautiful. Go up, go down, flowing two liters, flowing three liters. They hardly de-air it at all. The table is so much smaller than yours. On the melodramatic aspects. I don't think you can do both. I don't think you can be accurate and invite people into this process. And also provide a melodramatic issue going to live, issue going to die. You know, you violate, there's a sort of membrane between the two. And so, you know, if you feel the film is slightly less melodramatic, then it would be. That's intentional. Yeah, that worked really well. Well, thank you all very much. Let's see if anybody has any questions. How does a movie like this disappear? Because it was very hard for us to get a print to show it tonight. What happened with it? In a nutshell, you know, it's always a longer story. 20th Century Fox was excited about the film based on its Toronto Film Festival opening. And then got scared, showed it to some people, you know, and were nervous about it. And basically held it for a couple of years, or at least a year and a half. And then Barney Clark's operation happened. And they said, oh my God, we have something here. And did the exact wrong thing and tried to say, here's the new movie. You know what I mean? Based on Barney Clark. And it really had nothing to do with Barney Clark. And Barney Clark actually left many people anyway with a very sour taste. So that's the story of its U.S. distribution. And it had, I was saying earlier today, it had the most famous, for me, last line in the New York Times review, a kind of, I can't imagine, the article, the review, Winston Candy wrote in the last sentence was a review, anybody interested in the future of heart surgery should see this movie. Talk about damning with K-Praise. There's never going to be a rewind that is there. I would like to say since it's a Houston, oh God. I didn't mean to interrupt you. No, go ahead. As the inventor, as you went from two turbines to one, how do you get the two circulations to work with only one turbine? Very good question. On either side of that turbine are different blades that pump to the body and to the left. So there's one moving part. Actually, you know what, I've got one in my palm. So it pumps on both sides. Correct, yes. One spinning disc and on one side the blades that pump to the lung and the other side that pump to the body. So just one more spinning disc there. And that's the, yeah, that's the heart of the... So they're different sized blades or something? Correct, yeah. They're different sized blades. So they get the different pressure on the one side and the smaller one? Correct, yeah. The lower pressure for the lung is the smaller diameter on this side here, as you can see. And the larger diameter for the rest of the body. There was the most remarkable thing about this and Daniel, I don't think he even thought about it because he designed it. We've never been able to make a continuous flow pump that had what we call a Starling's response. Like you're sitting there, your heart will only pump so much blood. But if you climb three flights of stairs, it'll pump more because it needs more. Well, the heart's had a billion years to figure that out. But we've never been able to do it with these pumps. But this pump actually does it. Just like that. We can put the calf on a treadmill and the pump will be pumping 10 liters and calves require a lot more blood than the human. And it'll go up to 15 liters without changing the RPM with the speed of the pump. It just has to deal with the position of that disc relative to the computers and the housing. So it's quite a remarkable thing. One of the really super-brilliant things that Daniel came up with is while this is spinning in the air, spinning in the blood but not touching anything, there's three electromagnets that are adjusting the strength that they pull 20,000 times a second to keep the thing floating in space. But 2,000 times a second, it makes a decision about does it need to pull this rotor a little this way or a little that way. And when I say a little, 600 microns, less than a millimeter, but it changes the relative strength of these two pumps. So 2,000 times a second, it says, what is the patient doing now? Are they coughing? Are they digesting? Are they standing up? Are they lying down? Are they straining to go to the bathroom? It makes the appropriate adjustments much faster than any of our hearts do. And everybody in here has a cardiac output between probably four and six and a half liters a minute. This will do 26 liters a minute. I always joke and Bud always rolls his eyes that the 2,200 Olympics are just going to be stock and modified.