LOUISVILLE — Dr. Robert Dowling called his brother the night before he implanted the first self-contained artificial heart in a human being on July 2.

        “I told him I just couldn't wait,” said Dr. Dowling, a heart surgeon at the University of Louisville. “I told him the whole team is just so ready. I said I never felt more prepared for anything in my life.

        “I told him I felt like the batter coming up to the plate in the bottom of the ninth in the World Series and you know you're going to hit a home run.”

        Two weeks later, the AbioCor device is still sustaining the life of the unidentified recipient, described by Jewish Hospital only as a man in his 50s with diabetes and a history of heart problems.

        Dr. Dowling, 42, and Dr. Laman Gray, 61, also a U of L heart surgeon, said in interviews with the Courier-Journal that their implant team spent more than three years preparing for the historic seven-hour surgery.

        They spent hundreds of hours putting the device in 40 calves and a smaller number of pigs. Along the way, they sharpened their techniques and became a cohesive surgical unit.

        Dr. Gray and Dr. Dowling met the patient just five days before the procedure. He had been living outside the Louisville area, taking three drugs intravenously to try to strengthen his failing heart.

        Doctors gave him one month to live without the procedure. Both sides of his heart were failing, and in addition to diabetes, he also suffered from kidney problems. He had grown so weak, Dr. Gray said, that he could barely walk and was unable to eat or digest protein.

        To make sure the patient had no other options, Dr. Gray said, the man was admitted and treated to see if his condition could be im proved enough to make him a candidate for a transplanted human heart.

        When it was clear that wasn't possible, Dr. Gray said, the team started thinking about when to do the AbioCor implant.

        The implant candidate, family members, Dr. Gray and an independent patient advocate supplied through Abiomed talked at least four times.

        Finally, the surgery was set.

        The operation started like any other open-heart procedure with the cutting of the breastbone.

        When the chest was open, Dr. Gray, who was in the operating room looking at electrocardiograms of the patient's chest, joined the others.

        The heart he saw “was huge, just a very big, huge heart,” enlarged by its struggle to keep pumping, Dr. Gray said.

        First they cut the heart away from the surrounding organs and tissue, a very difficult process, Dr. Dowling said, because it's easy to unintentionally punch a hole in the heart.

        When the heart was free, the doctors implanted an electrical coil that is used to keep the AbioCor's internal battery charged, and also put in the battery and a controller that regulates the heart's rate.

        They then moved on to the bypass, routing the blood through a heart and lung machine so the heart itself could be excised, Dr. Dowling said.

        Dr. Dowling said he had visualized the surgery over and over in his head before doing it. Sometimes it went perfectly, sometimes it didn't.

        At one point in the operation, he said he told Dr. Gray, “That's not how it happened the last 20 times I did it.”

        “I didn't mean to say it. It slipped out,” Dr. Dowling said. “I thought he was going to give me a hard time. But he said, "You mean the times you were doing it in your head?' and I said, "Yeah.' He just laughed.”

        Finally, the time came to snap the artificial heart into place, and the team began transferring the patient from the heart-lung machine to the AbioCor.

        It's a tricky procedure, Dr. Dowling said. The surgical team has to start the artificial heart to get the air out of it, and then gradually transfer the circulating blood from one machine to the other.

        If air gets in the bloodstream, it could cause brain damage, he said.

        The process continued and the heart took over, pumping blood through the patient's body for the first time.

        In the 13 days since the operation, the patient has been recovering in cardiac intensive care at Jewish Hospital.

        He has been on and off a breathing machine and required more surgery to have fluid drained around the internal battery.

        The patient is still listed in critical but stable condition. But he talks to his family when he is off the breathing machine, and he is able to sit in a chair.

        He still faces medical challenges, but his artificial heart has not missed a beat since the surgery.

        Dr. Dowling said he called his brother again the night after the implant.

        “I told him, "Home run. Bottom of the ninth. We win.'”

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