In better days, Greg Rathe fished, welded yard ornaments and toys, and drove a front-end loader for a living.
Living was his only concern Wednesday when the Nebraska Medical Center introduced Rathe, 42, as the first person to receive an artificial heart in Nebraska.
That med center surgeons used a total artificial heart, a last-resort strategy never used before in the state, was a measure of how gravely ill the Weeping Water, Neb., man was.
Typically, failing hearts can be supported by a smaller gadget, a left-ventricular assist device. It is placed alongside the heart to boost the ailing left ventricle.
But for Rathe (pronounced RATH-ee), a device to support the left ventricle wasn't adequate because both left and right ventricles — major heart chambers — were failing.
“It's not very common,” Dr. Ioana Dumitru, medical director of heart failure and cardiac transplantation at the med center, said of Rathe's two failing heart chambers.
Dumitru said the med center was pleased that the procedure went well and may implant up to 10 artificial hearts a year in the future.
Dr. Deepak Gangahar, who retired this year as Nebraska's best-known heart surgeon, said total artificial hearts are used only as a final effort.
“Most of the time, the right side does not fail,” Gangahar said. When both fail, it's an extremely critical situation, he said.
The left-ventricular assist device is used whenever possible, he said, because it's smaller, meaning less foreign material in the body and less cutting to implant.
But with a man in his 40s and both chambers failing, Gangahar said, surgeons do whatever it takes to keep him going.
Drs. John Um and Mike Moulton implanted the artificial heart in hopes that Rathe becomes stronger in the weeks to come so he can be ready for a heart transplant.
Dumitru said the med center wanted an expert to observe the surgeons' work on the artificial heart implant and brought in Dr. Jack Copeland of San Diego. Moulton had worked with Copeland when both were in Arizona.
Copeland is renowned in heart surgery and artificial hearts, having pioneered the use of the artificial device as a bridge to transplantation.
Rathe received a heart transplant in 1996, but that organ failed this year. Getting 17 years out of a transplanted heart is good, heart transplant experts say.
This time, donor hearts have become available twice, but they weren't a good match for Rathe. “We need a specific match,” Dumitru said. “We need a perfect match.”
Dumitru said the match must be exceptionally good because Rathe's immune system is overactive from the initial heart transplant. Finding a superb match may mean a longer wait.
United Network for Organ Sharing data indicate that patients in Rathe's age range wait about a year for a heart transplant. Last year, 429 patients from 35 to 49 years of age received heart transplants.
There are 3,488 patients of all ages on the waiting list for a heart. Last year, 2,378 received hearts, according to the network's data.
The Nebraska Medical Center transplanted 23 hearts in 2012.
More than 1,100 artificial hearts like those implanted in Rathe have been used worldwide, said a spokesman for SynCardia, the firm that makes the device. Don Isaacs said hospitals purchase the device for $124,700. That includes the heart and the console that powers the device.
Isaacs said a study a decade ago indicated that 79 percent of patients who received the artificial heart survived to transplant.
“We get the sickest of the sick patients,” Isaacs said.
A competitor, Abiomed, has stopped marketing its artificial heart after only about 15 patients received them. Thoratec, a leading maker of left-ventricular assists, says more than 13,000 patients worldwide have been implanted with its device.
Improvements are gradual. Isaacs said SynCardia awaits FDA approval for a mobile unit to power its artificial heart. The mobile unit would enable those with the SynCardia heart to go home. The console to which Rathe is attached is about the size of a dormitory refrigerator.
And Gangahar said left-ventricular devices are becoming smaller and smaller.
“But it's a very expensive proposition,” Gangahar said of tweaking the technology, “and it takes a long time to bring a product to a commercial level.”
Rathe appeared exhausted Wednesday at a press conference. He started to nod off.
Nevertheless, he said he feels better than he did before the device was implanted.
“More energy,” he said. “Alertness.”
Contact the writer: 402-444-1123, email@example.com, twitter.com/rickruggles