 Anyway, everything is, you know, state of flux as I was speaking with Pranoff and Jennifer, I mean, the whole field of cardiac surgery has changed, and I guess that's, that's constant, nothing constant in life would change, of course, but we're really seeing it in our lives. Now there's, I guess this ticker came from this book, there's a woman wrote a book called ticker, it's actually pretty accurate about the events that have happened in the history of the development of these pumps in Houston, because all these pumps that are used worldwide started here, and the events are actually accurate, it's just the details are not exactly accurate, but they're more interesting when she tells them than they actually were, in fact, so I guess that's what a good writer does, anyway, and as any Irishman will tell you, you never let the truth get in the way of a good story, and it actually is sort of entertaining reading, almost entertained by it, even though I knew it was, she sort of elaborates on the real events. I said, this field has evolved and changed, but it's curious of it, started here in Houston really, and all the pumps that we use today started here, that are used worldwide. I was in Kazakhstan not long ago, and they put in over a thousand pumps that developed in our lab and around my desk in Kazakhstan, and so that is sort of gratifying, and I certainly, I actually, I certainly agree with this concept, when I was young, I knew nearly everything, you know, I was a DeBakey scholar in my medical school class, and you could ask me any question, I knew the answer, and I've spent the next 50 years growing less and less about more and more, and but we, you know, the application of medicine is more of an applied art than it is a science. One of the things I've had a lot of experience in is heart transplants, and mechanical assist, I've done a lot more heart transplants than anybody, and certainly in these pumps, and you wonder why I've done it, and of course, one of the reasons I did is nobody else wanted to do it, it wasn't like I was out, you know, working night and day so I could do these transplants, I've been trying to figure out how I could get out doing them, and I never got an associate until Igor in 2001, you know, when I was 61 years old. One of the reasons they didn't like to do it is I was involved in academic, I was the only person at St. Luke's that had an academic salary, so the bad hours and the low pay, I was used to that. I don't want to dwell on the medicine that I've discussed many times, but any discipline that's based on statistics can't be viewed as a science, and it still is more of an applied art. And that's one of the problems you have to deal with when you're doing something that hadn't been done before, because it's supposed to be evidence-based, but there's no evidence-based, if there's no evidence, if it hadn't been done, and that's always has been a problem certainly for me and in this field. A lot of what we do, particularly in medicine, is serendipity, you know, the actual application and observations of things that are nearly viewed by chance. This is the dictionary definition of serendipity, and they particularly refer to medicine and science as well, and some degree, some degree. You know, we have the largest medical center in the world, but in 1950, when Dr. DeBakey came here, it looked like this. It was just a forest, you know. Dr. DeBakey told me he heard gunshots when he came to interview here. This is Baylor, and this is Herman, of course. The rest was just forests. And, you know, and he thought he heard gunshots, and he did, because there were people hunting out of these woods where we are right here. You know, it was ridiculous. Here's Dr. DeBakey and his Groucho March look, but let me tell you, he was not funny. He was, as anybody said, they liked Dr. DeBakey. That's the thing you like Hitler, or you like Joe Stalin, or something. You know, you couldn't like him, but you had to respect him, because he worked all the time. He was always on you. When he came here, there were no hospitals. Obviously, there's none in the medical center, and he went to the VA. He went to Herman, and the doctors wouldn't let him see their patients at Herman. And, of course, he said there wasn't a single licensed surgeon in Houston, and he was right. He had passed the surgical boards when he came in 1950. He said at Herman, he saw them. There was one guy that repaired hernias by removing the testicle. Of course, it's a good way to repair the hernia, but on the other hand, if you just had one hernia, it might work, but he didn't want it anyway. So it was quite an experience. This is a way this place looked when I came in 1963, and I went into medicine surely by accident. I felt the same work. And, of course, you see, most of this place was parking, and I don't know where the medical students parked now. I think they're over here in Fort Bend County somewhere. We parked right here where UT Medical School is now. Had to walk all the way across here. Of course, Bentob was a dangerous place in those days. You know, we had gunshots. You could hear them. We had two gunshot wounds in our cafeteria one time and one day. Anyway, it was a lot more fun in those days. And all I did was play football growing up. And I decided to go to medicine because, you know, you couldn't just stay in school indefinitely. And I had to think of something to do. And my mother was very religious. Well, she didn't care what I did, as long as I didn't cheat, lie, or steal. Well, that sort of limits things, you know. And I was going to go to law school, but I decided not to. And I, because I couldn't, it couldn't meet my mother's criteria for sure. And I took all my pre-med courses in one year, which is impossible to do, but somehow I got into medical school. And as I said, this was always an applied, applied art. When I came here, Dr. DeVay... That was 1963, he made this statement. You know, I remember him telling me this, that by 1980, there'd be 100,000 patients with an artificial heart. Well, it was a little off with that. But it looks simple and it is simple enough to make a postal pump, but to make one that, you know, your heart beats 100,000 times every 24 hours if you do nothing. So to have one that would last a year and a half or two years, which is about all we got out of the postal pumps. I mean, it was quite remarkable that we even did that. And of course, Dr. DeVay, he always claimed he did everything. You know, he ended World War One. You know, he made the atomic bomb. He did everything. He didn't do the whole thing, but he did do this. He got this thing started. And when I was at Baylor, we had to do a medical school program, a research program every year. It's the best thing about going to Baylor. And I was always, I never studied more than two hours a night. And I was always late on everything. But one of my classmates was a very, you know, tight, you know, one of these guys that was always ahead of the curve with everything. He was an attorney brother of mine in Texas, you know, he was far from me as you could get. But when we started at Baylor, we had to have a research program. And they gave us, we started on the 1st of September. And by the 1st of November, we had to have a research program. And I didn't, you know, I'd never been involved in science. So I didn't have any thoughts about it. And it was October the 30th. And this is my fraternity brother came up to me and he said, what are you doing for your research project? And I said, well, Frank, I hadn't thought about it. You know, I've got another day. And he said, I knew you wouldn't have done anything. I've already got a research project in surgery. And I couldn't do it all by myself. And I knew you wouldn't have done anything. So I put your name down. So you don't have to do anything, just show up. And that's what I did. And it turned out, of course, everybody wanted to be a heart surgeon then. Dr. DeBakey was the most famous surgeon in the world on the cover of Time. Cooley was, of course, similarly, you know, not what Dr. DeBakey was, but he was, it was a thing to do, you know. But he had an intentional trimmer. It's not a big problem, but it can be a problem if you want to be a surgeon. It's hard to place the stitch if you have a trimmer. And he couldn't believe it, you know, but he finally got out of of surgery all together. And he left me in the surgery research lab doing these experiments. So that's how I got into it. You know, people say, oh, you're always going to be a surgeon. I said, no, I didn't know it. I just got into it by accident. Frank, by the way, went to Hawkins as a brilliant kid. And he ended up, he was one of the first doctors to investigate, you know, the HIV and the sarcomas that they thought they were getting. There were really HIV lesions. And if you go to Johns Hopkins, there's a wing of Johns Hopkins named for Frank Polk because he tragically died of a brain tumor in his 40s. But that's how I got into the whole field. And we, the mingle Lyota was working on it. He was an Argentinian. And he worked with this girl. There's a beautiful girl was there every day. And we never knew what she did. But she was good for, as we said in Vietnam, morale, she was good for morale of the troops. And we enjoyed her being there. But Lyota made these things himself. And she was actually a technician of some sort. She helped him with that. And he actually, the first device that was made, Lyota made it. And it was a patient that had to be supported with a a postal pump. And she actually lived for 10 days on this pump. And it was actually removed. And I was on the service at the time, which was also very stimulated me to be further interested in it. And she actually went home and there's a huge heart, you know, she all those patients that Dr. Reiki did with her valve, I never saw him have a valve replacement lift. And but this woman did and she died tragically of a car in a car accident in Mexico eight years after this pump was implanted. Now, of course, again, the CRISPR-Dart, I knew quite well, did the first heart transplant. And one thing people around here, we could Cooley did the first one in the US to live. There was one done in Canowitz in some way. East did one in the East Coast, West Coast, but they didn't live in, you know, they died quickly. And anyway, Dr. Cooley started doing these transplants. And Dr. Reiki was very reluctant to do anything experimental. And but it was, it was Ted Dietrich that got Baylor working on doing the transplants. And we convinced Dr. Reiki to get involved. But you see, it's the first hundred in the world, 27 of them were done in Houston in the world. And so it was a very dramatic era. And it also saw the first implementation of a total artificial heart. So this is where the field really started mechanically. And this was the heart that Leota made. And look at these valves, right? These little valves here, those are called the Cooley-Wada valves. And this is how the FDA started, because these valves were a big improvement over the ball valves that were obstructive prior to that time. And Cooley started putting them in right and left in the late 60s, early 70s. The only problem was after about six months, they flew out. They popped out. And the patients died, of course. And so he immediately, when they figured out that this was done, was what was happening. The company, which was called the Cutter Labs, which made the valve were sued. And it went to the Congress. And they realized they'd never done an animal test on this valve. They'd never did a calf or a pig or anything. A calf would have knocked this valve out in less than a month. But they didn't do it. And that's when the FDA started. The point of that is the FDA is Food and Drug Administrative. Doesn't say anything about medical devices. Anyway, Cooley, this was in the Houston paper at that time. It was sued for $31 million. And his response was, he hoped he didn't lose because he might have to dip into his savings account. I didn't think that was really what the public wanted to hear. But he was actually dropped from the suit, eventually. And of course, and that, as I said, really is how the Cutter Labs did it. So, now, this bump that we worked on with Domingo Leone were at Baylor when I was a medical student. This happened when I was in Vietnam. He took you out of the hospital and put in the first one. One of the reasons he put it in, he was trying to get out of Baylor. He couldn't just quit. But it doesn't make you fired him. Well, he got fired. Well, so that was the best way for him to get out of it. And he also, he showed this heart in in 34 minutes. He's the best technical surgeon I've ever lived. We could never, when we were doing the animals over with Dr. DeBakey, they would be on the heart-loan machine eight hours. And they all died, you know. And because they said it wouldn't work, because it couldn't work. If you leave a calf on a heart-loan machine eight hours, it'll all die. You don't even don't open their chest, they die. So anyway, so this started this controversy. Dr. DeBakey didn't speak to Dr. Cooley for 30 years, you know. That's all. But this guy woke up. This is right after the surgery. He was awake and taking fluids and anyway. And he really, the pump worked like a gem. They didn't know anything about immune suppression those days. They were way over immune suppressed him. When he actually was transplanted, his white count, they started the azothioprine before, his white count was 2000. And he died of overwhelming sepsis. Cooley of course wrote it up. You notice that Dr. DeBakey's name is nowhere there. And again, possibility has now been established as a reality. The fact that Mr. Karp has regained organ function in terms of cerebral function and kidney function indicates that its mechanical heart is a feasibility. But there's much to be done now. It's much like embarking on the space program. We know that a rocket will do up off the surface of the earth, but we haven't set foot on the moon yet. But we did set foot on the moon in July of 1969. But a real meaningful total artificial heart, we still haven't solved that problem. But again, we got a lot more research was devoted. All these are transplants that Dr. Cooley did and they all were dead within one year. One of them lived more than one year this patient. And so the transplants then were just done at Stanford and a few at the Medical College of Virginia. And the problem was that, of course, for the balloon pumps, as well as these pumps, the balloon pumps, we put in 34 balloon pumps and they all died. And this was in a two-year period here. And we finally, and Dr. Cooley, of course, I remember him throwing Jack Norman out of the office, out of the operating room one time because he was putting a pump in around this time. And he said they all died and the Mayo Clinic didn't have one, which was true. And of the first 34 patients, they all died, but they were just so sick that by the time they put it in, there was nothing going to save them. And we finally started putting them in patients that would live and we had the biggest experience with this. And we had a conference just on balloon pumps in 1979 here, and which Cooley was a keynote speaker. And he said that anyone that doesn't use these balloon pumps and does heart surgery goes to a malpractice. And I asked him about it later. And he said, well, you remember saying what he did to Jack Norman, but this was his response. You can be wrong, but never in doubt. And there's some meaning to that if you're a surgeon. Anyway, these pumps were mainly used for failure to wean from bypass. And of the first 26 LVADs that were put in, left ventricular assist devices, they all died too. But the pumps worked. And the real key to it was cyclosporin because we rode the back of cyclosporin in this field once we, these first three LVADs in the world are heart replacements in the world were done here at St. Luke's. And they all died after they were transplanted of sepsis because they couldn't take a contaminated patient and get away with it. And so the thing that helped us was the cyclosporin because it spread the non-specific immune system and allowed us to go ahead and have patients that could survive the LVADs. And of course, as so, you know, we rode the back of transplantation, but transplantation was limited. It's limited. Not only in the number you can do, one thing we don't talk about too much is the long-term survival. Now, there are 147 centers doing heart transplants in America. There were 17 that did two or less. This was in 2017. So it's just ridiculous to have all these centers. And not only do they have a limited application, but, you know, the bulk of them centers do less than 10. And the limitations are not only the availability, but the durability of these patients. We did this in 1987, five years after. And I did 38 children between 1982 and 1990. And this is the only one alive. And he's had three heart transplants. So you generally condemn patients to a premature death if you do a heart transplant. If they're 60-year-old men, they've got a good chance of being 70, but they're not going to live to be 80. And if you do a 20-year-old, they're not going to live to be 40. You can just bet on that. But we do have, we did the youngest patient in the world at that time. I did. And the oldest in the world. And this was in the 80s. And this man lived 34 years with no, he had no rejection at all. And his donor was a red-headed, freckle-faced kid from San Antonio that was robbing 7-Eleven stores. And I remember specifically because he was shot in the head by the 7-Eleven guy. And the 7-Eleven stores had just given us a bunch of coolers to carry his heart back and forth in. So he had, that was his last meeting with the 7-Eleven. But this man, he had no real connection to him in any way. He didn't reject. He died of prosthetic cancer 34 years later. At the time, he was the longest living heart transplant. And the patients that we've done 20 years ago, there are 92 still living, they've lived over 20 years, which is, you know, pretty good. But as I said, it is, that's about 12% of them will live 20 years. So the, the, the bridge to transplant couldn't be done until we had Cyclops 4. And as I said, we did the first successful bridge to transplant with these pumps. And we also, I did the first 23 with the first pump to be approved. This was Columbia, finally got involved in 1990. And these patients did, you know, remarkably well. And they had a better survival after transplant than the patients we had a control group. And they had a much better survival. So at any rate, that's how these devices really got into the game. We rode the black, the back of, of transplantation. And they had a much better survival after transplant, had a 90% one year survival after transplant. And this, of course, is one of the problem. This is a paperwork it took to get that approved. But that was the first LVAD approved by the FDA. We also had the first electrical LVAD. And again, but the problem with these pumps was they were, they were not durable. They were available, but they weren't durable. But they were so big, they only fit in a few of the patients. And I mean, they had to be a certain size. And one of the things they, they said, well, women are discriminated against because they didn't get as many. Well, of course, you don't want one of these things unless you're dying. And but they were discriminated against, but it was a size factor. It had nothing to do. You know, any surgeon will do anything they get paid for. So they, if they had insurance, they would get it. But, but they just had to be of a certain size. And that was one of the reasons that I wanted to get into the continuous flow pumps. And I always felt a bit like Cassandra, because when I started with the pumps, nobody thought they would work. And certainly when I started with the continuous flow pumps, nobody thought they would work because Cassandra is in the Greek is the myth that she was cursed by Apollo because he wouldn't respond to his affections. And she could predict something accurately, but nobody would believe her. So I had a little bit of that Cassandra effect. I remember them laughing at this big conference when I told them in 2005, they would be no more postal Elvis. There were actually no more about 2012, they quit making them. And the continuous flow pumps, which I started discussing in the 80s, the limitation was the, I don't go through it some way again. The limitation was the, the speed, the RPMs would cause a molasses. And if you had an implantable pump, you had to have a bearing and you couldn't have a non lubricated bearing. And we actually did all the work here in our lab with a guy from Sacramento, Rich Wampler and Jarvik in New York. And we developed all these pumps that would work. Still the physiologic problems were the bare receptors. And because we, the bare receptors respond to the pulsatility. If you decrease the pulsatility, they'll think you're in shock and they'll make you hypertensive and they'll have strokes. Well, that happened, of course, and it's still not, but it wasn't a limiting factor. The real thing that I was criticized for, the renin would go up because we decreased the flow of the kidney. We did renal artery bypasses all the time in Houston. And, but in fact the renin, the renin doesn't go up. And I really don't understand why the, we don't have renal hypertension, but we don't. Anyway, these, and of course, the other problem, as I said, you had to have a 20, 2500 RPM before you could pump enough blood to be of any consequence. And evidence was that that would cause homolysis. And I was in all these debates on this. And we actually solved the problem with the Hemopump, which you now call the Impella, Impella is an offshoot of the Hemopump and the Jarvik pump. And these pumps work very well. And now, you know, as I told you, the Pulsul pumps only lasted about two years, but there've been 404. This is just with a Hormate II alone. Patients over eight years, 71 patients over 10 years and six patients over 14 years. And as I said, these, these axial flow pumps, this was done by Rich Wompler. And we did the first patient in the world to survive with this thing and the Hemopump. And of course, Jarvik, as I said, we solved the bearing problem with Jarvik. And they don't, it's still the only pump that doesn't need lubrication. So the, those are the advances that made continuous flow elvads possible. And as I said, there's a lot of those used in the world. And the hardware was the first centrifugal force pump. And we, we started that also. And there've been over 50,000 of these pumps implanted worldwide. And they, it's a great act of funds. The young family of Rich Wompler tests have been for five years, and it's been four or five years. Now, I think that's something that's, that's still another hard function you can't remember. And I think that's something that the cardiologists are going to have much more on. And this patient, we put a pump in 14 years ago, and he's had a pump for 14 years. He has trouble taking drugs and not drugs, taking his anticoagulant. So we've had to change his pump a couple of times, but he's still, he works every day and he's still in good health. This is the most amazing. This is a kid in, and Texas Children's. It was four years old and came in over there and heart hearted stopped. And just in desperation, they put this hardware pump in, which I thought would fit in smaller patients. But I never thought it would fit in a four-year-old. He's seven years old now and he's going to school and they're just going to try to leave the pump in as long as they can. So as far as, and as I approach my 80th year to heaven, I just have two more projects that I want to finish and just touch base. This one is a minimally invasive pump. And I got this idea a lot from what Pranoff was doing with his tandem heart and just crossing the left atrium or the septum and unloading the left atrium. The only place the atria are joined is at the foramen. So you have to go through the foramen and put the pump into the left atrium to unload the ventricle enough to bring it back into a Starling's mechanism. And I think we'll have this. We've been working on this for about four years now. I think we'll have it in patients within the next five years for sure. And I think this would be something you can do without opening the chest. Not forget verbid, but the cardiologists may end up having to do it or doing it in the cath lab. So I don't know. That's worrisome, but we're going to run it into the subclavian artery and just partially unload the heart enough to bring it back into a normal Starling's mechanism, which you can do. And that's what the continuous flow pumps do now. As far as the total heart, this is one thing I really want to see as I started out as a medical student working on this with Dr. Devaki. And we first started doing this in 2005. I remember telling Billy Cohn about it. And once again, like everybody, Billy said, well, this sort of will never work. You can't die. You won't use you're going to screw up all the circulation. It'll never work. And the first animal I did in 2005, we just replaced the heart with two Jarvik pumps. And this ended up with excellent Christ, I'm sure, but with just continuous flow. And this young Australian engineer saw this, my reports, his father had died of heart failure. And so he wanted to work on it. We'd made the first implantable total heart, which was the Abucor. But he started working on this and he had the pump. This pump will pump about 15 liters. And you can put it in your hand. It only has one moving part. This one is magnetically suspended rotor. And it only it pumps to both the pulmonary circulation and the systemic circulation. Quite a remarkable pump. We've been working at it sometime now and we have animals now in our lab. By this time next year, we'll be ready to put it in patients. And we still see patients that have to have a total heart, not a lot, but there are a number of them. And we're seeing more with right heart failure after implantation of the L-Bad. And as I said, this is small. It'll fit in patients. We could power these things for 80 years with a plutonium battery. We did that in the 70s, but we didn't have a pump that would lie. As I said, there's just this one moving part and it pumps to both the pulmonary circulation and the arterial circulation. And it has a starling response, which is hard to understand. But if you see, we put the calf on the treadmill and you can see the right-sided flow go up as he, about 11 liters while he was not doing anything. And once he started exercising, this is no change in the RPM. You're not changing the speed of the pump at all. But as we start exercising, you see the flow, there was 11 liters going up to 14, and it actually goes up to 15 liters without any change in the speed of the pump. And you can also make this pulsatile just by changing the RPM. And that may be important long-term to have, it's not a pulse. We don't have a word for it because a pulse is something you feel at the risk, but you don't feel anything with these patients with these continuous flow pumps. Anyway, and Billy has been a big help on this thing. But of course, Billy was one of these guys that said it couldn't be done. Now, and if you read ticker, you nearly think it was Billy's idea. I don't begrudge him for that, but that's the way everything is. Everybody's against you to start with. And I've always used this phrase from the Confederacy of Johnson's with Jonathan Swift. If you have an idea and you think it's a good idea, and all your colleagues say, well, this is a great idea. It's probably not a good idea, otherwise somebody would have already done it. But if they all tell you how ridiculous it is, how bad it is, which everybody told me when I started with a continuous flow, it may be worth something. And as I never took much science, and I was with this Irish singer a few years ago, and he never took music lessons, it turns out he just started playing with his kids in high school. And that's how this group started this Irish singers. And I've forgotten. Bono, Bono or Bono or something. He's a nice guy. But one of the things we discovered that is in common, and certainly can agree on, if you can't be creative looking backwards, because if you're doing something that hadn't been done before, you can't look backward and do it. You've got to have some sort of fortitude to try to move things forward. And you can't be creative if you're looking backwards. We should be able to develop a pump, mechanical pump, that will substitute for the heart. And I'm convinced this can be done. He was convinced that we could do it. This was, again, 1963, 1964. And we can do it, but we didn't have the technology to do it then. Now we have the technology. I asked this kid, this Australian engineer, how can the flow, the amount of blood that's pumped increase without changing the RPM? You seem like you'd have to speed it up if you were going to pump more. And he said, well, Dr. Frager has to do with the distance between the spinning part and the housing. And it has the housing. The computer tells it exactly where it should be, and it'll pump more the closer it is to the housing. And I was just telling Pranoff, I always remember when I came back from Vietnam, the Fragers were all a bunch of reprobates, gunfighters and killers. And my father was the first one to ever go to college. But my mother's father was a very distinguished chemist. And he was the first organic chemist in Texas. And he was head of the Department of A&M from 1905 to 1945. Anyway, when I came back from Vietnam, when he was 96 at that time, or 94. And I asked him, what he thought if I don't land on the moon? And he said, oh, they didn't land on the moon. So what do you mean they didn't land on the moon? They landed on the moon. And he said, no, they faked it somehow. I don't know how they did. This was 1970. And I said, I don't want to even hear you say that, you know, they landed on the moon. He said, well, maybe they land on the moon. But you remember, I drove Mules to Oklahoma in the land rush. He did. It was 14 years old. And I volunteered for World War One, but I was too old, too old for World War One. And I can't tell you my astonishment when I saw the first airplane fly over. And he said, maybe they just landed on the moon, but I just don't want to think about it. And I asked this Australian engineer how this pump could pump more and according to his position. And he tried to explain that to me. But then I said, you know, I still don't understand it. But I said, well, how does it know where it has to be? And he said, well, it has data points, Dr. Frazier. It has 22,000 data points a second tell it where it should be. I said, come on, 22,000, what, a second? That's ridiculous. You know, you mean an hour or a day or a week? No, it's not for you, 22,000 data points a second. And I immediately thought of my grandfather, you know, who said, well, it's just it may be so, but I just don't want to think about it. And I feel the same about this. I don't it works. All I know is it works just like you saw that animal walking and we still have some we've got a calf down there now with the pump. And anytime anybody wants to go down there, you can just contact me. I'll be happy to show it to you. But I do think in this time, next year, we'll be putting this in patients. And it has the other thing we can power this without penetrating the skin at all. That's never been a big problem. But and there are more and more patients that we're seeing with right heart failure after they've been supported with these left sided pumps. So I don't know. I'll see it take over heart transplants entirely. But I think most of the people in this room have said if Trump doesn't blow us all up, we'll live to see this replace heart transplants. Okay, thank you.