StarTalk Radio - Matters of the Heart

Episode Date: March 28, 2013

From Aristotle's misguided meanderings to modern open heart surgery. Subscribe to SiriusXM Podcasts+ on Apple Podcasts to listen to new episodes ad-free and a whole week early.

Welcome to StarTalk, your place in the universe where science and pop culture collide. StarTalk begins right now. Welcome back to StarTalk Radio. I'm Neil deGrasse Tyson. I'm an astrophysicist and director of New York City's Hayden Planetarium. In this special edition of StarTalk, in celebration of Valentine's Day, we're calling it Matters of the Heart. And I have with me in the studio a cardiac surgeon, Dr. Daryl Hoffman. Thank you.

How many of these you do a year? A couple of hundred. Yeah, so is someone not getting operated on because you're here in the studio with me now? No, no, I have a great crowd of colleagues who are taking care of things this weekend. Oh, that's good. Worry me about that. I noticed you have an accent. Where do you hail from?

South Africa originally via Scotland and then the Bronx. The Bronx. The Bronx. Bronx in the house. You know I'm from the Bronx. I do. Yeah. So are you from the enclave where ex-patriot South Africans landed in the Bronx?

That's the one right around Einstein and Morris Park Avenue. So there is such a place, apparently. So we want to talk about the heart not only as this perceived organ of emotion, but also as a functioning part of the human body. You know, it goes way back. Some people might remember either from the history class or from their philosophy class that Aristotle, I don't know if he started it, but he certainly was influential about all that he said as the heart being the seat of intelligence and of emotion and of sensation. And clearly, I mean, it's all wrong. Aristotle was wrong on a lot of stuff, especially when it came to physics and astronomy. But apparently he's also wrong there, right? Well, yes.

It wasn't only Aristotle. Unfortunately, Galen described two circulations, and they were sort of in parallel. They didn't mix. And the idea was that the heart was the seat of emotions and that the brain actually provided cooling for the heart, a really extraordinary notion. But it was believed by the church,

and until the Middle Ages, that was an inarguable fact. So what made it an inarguable fact, that two smart guys like Aristotle and Galen said it, or that it somehow resonated with church dogma? I don't think it resonated with dogma. It just was accepted, and human experimentation was obviously not an option. And despite animals being widely available, dissection just wasn't properly practiced. Well, plus, why would anyone believe that other animals had anything to do with humans? That's an excellent point.

Yeah. I mean, especially mammals, as close as they are to us, they're just some other creature on the earth. And they can't have anything possibly to do with us. Even though they had two eyes, a nose, a mouth, a head, shoulders, arms, elbows, legs, hips, toes. Well, I guess there weren't too many great apes around there either, so the animals they had were all four-legged and they bore no resemblance to

mankind. So the great apes being our closest genetic relative, the chimp among them at the top of that list. Absolutely. And they're all in Africa, not in wherever Galen and Aristotle practiced, right? Yeah, not in the Mediterranean basin, I don't believe. Yeah, that would be a different situation if apes were running around town. I wonder what they would have said about that.

You know, we have our – intermittently, we have our sort of comedic contributor, Brian Mallow. He's actually the science comedian. He tweets under the science comedian. And he – every now and then, we ask him to reflect on the subject of our show. And this time, he actually, he's funny as always, but he gets a little sensitive, because in fact, he has firsthand experience with the heart. Let's find out what he has to say. Although I love my girlfriend, when I think of the heart, I don't think of love and romance.

I don't say I love you with all my heart, because I know it's all in my head. The brain is the seat of consciousness. But that's not to play it down. The brain is the most advanced piece of biological technology ever dreamt up by natural selection. It's the most important organ. Well, according to itself. Full of mystery and possibility, the brain may be the final frontier. But where would we be without the heart? The body's rhythm section, the pump that powers

the circulatory system. It sends food, oxygen, and chemical messages to every part of the body. Then it picks up the waste and carries it away, comes back around again. With proper maintenance, you might get seven, eight, maybe nine or ten decades out of it. But comes back around again. With proper maintenance, you might get seven, eight, maybe nine or ten decades out of it. But there's no guarantee. When I think of the heart, I think of my father. My senior year in college, he had his first heart attack. That's not a phrase you ever want in your vocabulary. My first heart attack. I got to know St. Luke's Hospital in Houston much better than I care to. It famously has a McDonald's on the lobby level, as if to guarantee a flow of new patients.

Now, I'm as old as my dad was when he had his first heart attack. And what's brewing inside me? I don't know. Now, he was overweight, a heavy smoker, and a workaholic. And frankly, I'm none of those things. But how much is genetic and how much environmental? He had a second heart attack 10 years later. Then he received an implantable defibrillator, essentially making him a cyborg. You know the defibrillator. It's those paddles. They yell clear and then they shock you back to life.

Well, this is a smaller version that goes inside you. It's a little computer pack, ironically about the size of a pack of cigarettes, and it's attached to your heart, or his heart. If it detects arrhythmia, an abnormal heartbeat, it sends a little jolt of Frankensteinian electricity to the rescue. For a couple years, my dad was on the heart transplant waiting list, slowly moving his way up to the top. The hospital gave him a pager. If it went off, it meant my parents had to get to the hospital immediately so he could have his heart removed and replaced with another. Because the new heart, his new heart, would only be viable for a few hours.

And several times the pager went off. My parents called in only to discover it was a false alarm. How's that for someone who already has a heart condition? In the end, they got the genuine call. My dad lived the last five and a half years of his life with somebody else's heart beating inside him. And we were grateful for that extra time. So I guess my Valentine's Day message is, for you and your loved ones, take care of your heart and all your organs. Your body is a machine that needs proper maintenance.

Treat it right and be an organ donor. For StarTalk Radio, I'm Brian Mallow. That was Brian Mallow. Amen to everything that he said. It was really great stuff. Heart transplantation works. There aren't enough organs out there. Electrical technology, mechanical pumps, these are all great things. We've made huge steps forward, but we still need organs for transplantation, and everybody should be aware of organ donation and sign their organ donor card. Sign their organ donor card.

So if there aren't enough organs to donate, does that mean we should repeal the helmet laws for motorcycles? Some people have argued that. It doesn't seem entirely moral to do that. But in the United States every year, there are 2,400 heart transplants done. Many more people than that die on the transplant waiting list awaiting an organ. And 40,000 people die on the highways of all ages. Absolutely. So it's easy to do.

The back of your driver's license in New York State, just get it and sign it. Let your family be aware of it. And if something awful happens, you can save one and in frequent cases many other lives by donating your organs. And it's probably not only in New York where that signature enables it on the back of your driver's license. So check it in case you never looked. Often you have the occasion to look at the back of your driver's license. So Dr. Darrell Hoffman, cardiac surgeon. While we were listening to Brian Mallow's sensitive yet comedic take on open heart surgery and transplants.

You whisper to me that you just installed a defibrillator in your mother-in-law. Yeah, and I like my mother-in-law. We have to establish that fact first before we continue the story. Full disclosure, I put it in. I put my father-in-law's pacemaker in as well. They let you do this? I thought you're not allowed to operate on family. Well, you're not supposed to operate on blood relatives.

And if it was a more complicated operation, I wouldn't have done it because I would have been concerned. But under the circumstances, I was comfortable doing those things. So your mother-in-law. So this puts you in good forever, I guess. I'm hoping. That might be what it takes because the rest of us are still struggling on this one. It's great technology. It's like buying an insurance policy.

It watches your heart. And if you have an arrhythmia that is life-threatening, instead of them coming as they do on television with the paddles and whacking them on your chest and yelling clear and giving you a massive electrical shock outside the body, this gives a small shock inside the heart. But that makes such good TV to do that. Oh, I know. If we just say, oh, we have a little thing inside you that did it, there's no scene to film. I'm just saying. You're right. But it's sad that television and popular media have been able to distribute these messages

and yet haven't gotten home the idea that there's more that people can do about prevention and that patients should come forward and donors should come forward. Well, let's look at some of the statistics. Before 1900, very few people died of heart disease. Now, it could be because they died of other things. Absolutely. People died of infectious disease in that era.

The average life expectancy was around 30 or 35. Well, not in the 19 – I'm saying before 1900. So the 1800s, it wasn't at 35. We're talking cavemen, 35. Well, if you – no, if you average – absolutely not. If you average it out, you'll find out that – You have to average in all the infant mortality, it wasn't 35. We're talking cavemen, 35. Well, no, if you average, absolutely not. If you average it out, you'll find out that- You have to average in all the infant mortality, I guess. Yeah, absolutely.

Okay, fine. But those who survived infantdom surely died of other things. But back then, hardly anyone was leading the sedentary lives that we do today. They didn't have elevators. They didn't have escalators. They would clean their rugs by hand by beating i mean look at all the chores yeah they walked miles to school in the snow absolutely uphill both ways you know nowadays it's downhill both ways so so do you do you lament

that modern culture does not have built into it ways to keep our heart healthy? Well, what you're saying is very important, and it starts at an early age. I've read studies which were done during the Vietnam era where young men who died in the conflict had autopsies, and they were already showing signs of atherosclerotic heart disease in the aorta. Which means? In people who are 20 years old. That's the precursor of the disease that goes on to block your coronary artery. Now, how does that happen by the time you're 20?

Well, are they eating too much ice cream? Because ice cream had to be invented. What a great invention that was. And what an efficient way to get saturated fats into your bloodstream. Well, we don't understand enough about this. We know some of the risk factors, and the most important ones are genetic, and you can't pick your parents. So once you're stuck with those, maybe the day will come where we can. Well, that probably is here now with genetic engineering. But on the other hand, there are things that we

know that you can modify. Cigarette smoking, diabetes, diet, exercise, stress. These are all things that high blood pressure are significant contributors and can and should be modified by people and their doctors. So I heard that stress, like abrupt stress to your psychological state, not just physical stress, but psychological state can actually have an adverse effect on the stability of your heart, possibly leading to a heart attack, which means you can die of a broken heart means you can die of a broken heart. You can die of a broken heart.

That's absolutely true. It's been documented. It's extraordinarily rare, and we don't understand the mechanism. So it doesn't happen nearly as often as the retold stories of love in fiction would have us believe. No, absolutely not. The common or garden reasons why people die from heart disease are really preventable. Some of them, of course, are inherited abnormalities.

The heart is a very complicated pump, and in development, there are a number of stages at which things can go wrong. Holes can develop in the heart. Valves can be… I always hear about there's a hole in the heart. What's that about? Well, in a complicated situation in the uterus, the fetus has to have blood circulating, and the blood can't go to the lungs particularly because there's no air going in and out of the lungs. So that blood has to find a way to be shunted from the right side of the heart to the left side. Normally, the right side would pump blood to the lungs.

It would come back to the heart, and then the left would go to the rest of the body. I see. So in the fetus, you're not breathing because you're just sitting there in this fluid. And so other things have to work out. If it doesn't, it fails. It fails in utero. Right. So there's a shunt of blood from the right to the left side.

And after birth, that shunt should close. It sometimes does not, and that creates an atrial septal defect. Very bad birth defect. does not, and that creates an atrial septal defect. Very bad birth defect. Very bad, but entirely manageable by a simple operation, and now even manageable by catheter-based techniques. When we come back, I want to bring on to StarTalk Radio somebody who just had open heart surgery.

And I'll talk to him to find out what that was like on StarTalk Radio. I'm Neil deGrasse Tyson, your host. Welcome back. Today's subject is matters of the heart in celebration of Valentine's Day. We're going to talk about the heart, not only as an organ of emotion, but as an organ that keeps you alive, as a pump, and some milestones in cardiology. Most of what we know and understand about the heart has only happened in the last couple hundred years. Given that the heart's been around for several hundred thousand, at least the heart in a human being, it's kind of embarrassingly late in our understanding of how things go on. 1628, William Harvey, an English physician, first describes blood circulation. 1706, Raymond de Vucins, a French anatomy professor.

Did I pronounce that right? Vucins, French anatomy professor, first describes the structure of the heart's chambers and vessels. That's an important advance right there. 1733, Stephen Halas, an English clergyman and scientist, first measures blood pressure. That's good because you need, in fact, the physics of the phenomenon before you can even say that it's going on inside your body. The concept of pressure itself was new at the time. 1816, René Lennec, a French physician, invents the stethoscope. Where would we be without the stethoscope?

It's the doctor's necklace. That's how they prove to you they're a doctor, as they walk around the halls of the hospital. Where would they be without that? 1903, the year the Wright brothers first took flight with heavier-than-air craft. William Eindhoven, a Dutch physiologist, develops the electrocardiograph. Electricity was relatively new in the early 1900s. And the good medical doctors figure out how to use that to understand what's going on in the human body. 1912, James Herrick, American physician, describes heart disease resulting from hardening of the arteries.

That's an important result right there. And that's not even 100 years old. 1938, Robert Gross, an American surgeon, performs the first heart surgery. I'd hate to have been that first patient. In fact, what you never learn about are all the patients where heart surgery was attempted. They just never survived. They don't show up in the encyclopedia. Only the ones who survived.

That was 1938. 1951, Charles Hufnagel, an American surgeon, develops a plastic valve to repair an aortic valve. Plastic was coming online as a new material. And so, good thing to know that medical doctors are exploiting the technologies of material science to find out how their craft can be improved. 1952, John Lewis, an American surgeon, performs the first open-heart surgery. Crack the chest, get in there, and see what's going on. 1953, John Gribben, an American surgeon, uses a mechanical heart and a blood purifier. 1961, J.R. Jude, an American cardiologist, leads a team performing the first

external cardiac massage to restart a heart. These are all milestones. We have on our show Dr. Darrell Hoffman. He is a cardiologist, a heart surgeon. We'll get back to him in a moment, but I first want to introduce a friend who, was it only two weeks ago, was under the scalpel having his chest cracked open as they did new plumbing on his heart. Let me introduce to StarTalk listeners 58-year-old Glyn Wood. Glyn, welcome to StarTalk. Thank you for having me on. And you are alive?

I am. Ridiculously so. What day was your surgery? It was actually three Fridays ago, so it's three weeks and two days. And you're walking around and kicking? You're not? I'm doing marathons. And you're in the zipper club. How big is your scar?

Let me show it to me now. I'll describe it to everyone on Star Talk. No, don't show me a photo. Show me. Pull up your shirt, then. Here it comes. It's past his belly button now. There it comes. It's past his belly button now. There it goes.

It's about 10 inches long, and it's clean right down the center. Good job. I'm very pleased with it, I have to say. What kind of smoking and drinking were you doing that they had to perform this operation on you? Well, funnily enough, my hedonistic lifestyle up to now has not had anything to do with what they had to do to my health. So you just got the bad genetic lot in life. I got the duff heart in the first place. The aortic valve was a bicuspid instead of being a tricuspid.

So you're a genetic anomaly, but you've known this your whole life then? Since I was two, apparently, yes. So why choose now to do it and not when you were younger? Because my heart was about to expire. It was getting very bored with with the excess work so as long as you're alive and kicking and not dying there's no reason to actually put your life at further risk by doing the operation well it got to the stage where um the risk of the surgery uh was less than the risk of not doing it i say so that's a that's sensibly conceived that way yes so i'm Yes. So they repaired the valve.

Did they repair it or did they swap it out with new parts? I now possess part of ermine trude. I have a cow valve going on inside. You have part cow? You're part cow. I am part cow and grass is looking extremely tasty.

Is that right? I don't know that they added extra stomachs to your... So you got a cow valve. Wow. So could they have gotten that valve from other animals or something about a cow that worked perfectly for you? I was given no choice whatsoever and I have absolute faith in my cardiac surgeon. Was it that a cow valve finally came available?

I think they actually have fair old stock. Because once they carved you up a bit and removed the old bit, and I did ask if I could keep the old one. I don't think they let you keep stuff that they take out of you. Which is sad. There's something wrong. There's something wrong about that. And it was mine. It couldn't be more mine, could it really?

It could not be. But I wanted to take it away and have it set in clear resin. Just, you know, I also wanted a video of the operation. They don't give you that either. No. Because the doctors, they want to keep it a secret. In fact, let's get to the bottom of this. Let's bring back on Dr. Darrell Hoffman.

He's a heart surgeon based at Beth Israel Hospital here in Manhattan. So, Dr. Hoffman, we have a man sitting to your side who just underwent open heart surgery, the kind of surgery that you do. Yes. Why don't you give people the videotape so they can put it on YouTube? What's going on there? Well, in some rare circumstances, you might do that. Most operating rooms aren't equipped to record the entire operation. In this country, there are concerns about medical people.

That is so lame an explanation because people with a video camera will record anything, anytime, anyplace. We even have aliens on tape. You're right, and when we try and record operations to teach people, we find out how difficult it is. If you use a head-mounted camera, which is one way to do it, every time you move your head, everyone who's viewing the picture gets nauseous because you move your head so much.

Turns out it's very hard to film an operation accurately. You know, I think that's still lame, but I'll accept it for now because I'm being polite. Glenn, when you got this operation, did you feel any different coming out of it? Did you feel like, oh, my heart is fresh and lively and I have greater capacity for love because my heart is intact. Whereas before I was heartless. I mean, what? No, I remain stone.

I have a love business. And tell me, what's your profession? Do you have a profession that is not good for the heart? What do you do? I'm a concert sound engineer. I tour the world with rock bands. That sounds like code for groupie, concert sound engineer. You chase groups around.

No, no. You're not a groupie? No, I have groupies, but that's a different thing altogether. Are you a roadie? No, I'm not a roadie either. So are you the ones who trash hotel rooms after concerts? If necessary, if they require trashing, of course. Have you stayed in a hojo?

If that's necessary. I see. So, I like this valve thing. Dr. Hoffman, do you have preferred valves? What kind of animals do best for valves to beg on humans? There are different kinds of valves. Broadly speaking, there are valves that are made out of mechanical components and those valves will last forever

but require the patient to take blood thinners which have their own problems. Otherwise, valves can be used from pigs. They can be used from the lining of the cow's heart. I would bet not at the Beth Israel Hospital, though. They would not use pig parts. No, it's perfectly kosher to use a pig valve to save someone's life. Is that right?

Absolutely. Good to hear that. Other things that you can do, you can actually take a human valve and use it. Of course, the original owner might object. So a valve from a dead human or from a human who's getting a new heart for a heart transplant. And the subject of dead humans, we could have learned about the heart long ago if there wasn't some taboo to prevent you from digging cadavers up. You're absolutely right. The church held certain inviolable beliefs and Galileo and others got locked up and interrogated for breaking those rules.

But ultimately, William Harvey, as you point out in England, discovered the circulation of the heart and then lots of new ideas replaced previous dogma, experimentation took off. So medical students, how would they learn? In those days, they learned from books and the drawings in those books were very inaccurate. I bet if I had a grave robbing business, I'd do very well. Well, absolutely. So even in the 1820s, roughly, in Edinburgh, which was one of the leading medical centers in the world at the time, bodies were used for dissection.

Students learned by cutting up dead bodies. Is this before there was a day when you would donate your body? No one did that back then. Absolutely. There was no presumed donation. And a couple of guys called Burke and Hare would steal bodies from the graves and sell them in the back door of the medical school. Young gentlemen who were not medical students were interested in this,

and they'd come to the dissection halls as well. And Burke and Hare realized that they needed to increase their business, and so they started actually murdering people because there weren't enough usable dead bodies. I hate to laugh, but this is England for you, right? I'm reminded of why we fought a war to get away from you guys. And now here we are again. Yeah, I'm the only one with an American accent on this show. Yes, I'd spotted that too.

Glenn, your accent hails from where? Manchester, England. I've lived here for 11 years. All I know of Manchester is the. Glenn, your accent hails from where? Manchester, England. I've lived here for 11 years. All I know of Manchester is the football team, soccer team. They actually do have two. You were right first time. Football, a game played with the feet. I do want to answer the question you asked me earlier.

Do I feel different? Well, we'll have to get back to that because we're about to go to break. Okay. Plus, I happen to know that sometimes you can be quite cantankerous and at the end of the break... Surely not. What, me? Of course not. We've got to take a quick break, but more StarTalk when we return. This is a special Valentine's Day show on Matters of the Heart. I'm your host, Neil deGrasse Tyson.

Welcome back. So we have with us in the studio Dr. Darrell Hoffman. He's a heart surgeon, cardiac surgeon. We have also Glenn Wood, a recent recipient of a heart valve. Just three weeks ago, he's alive and kicking in the studio. He's a cantankerous Brit who's been in America for 11 years. And we have dinner with him all the time. We're always fighting about something.

But they're lovable fights. Glenn, were you cantankerous with the nurses and doctors in the hospital? They loved me. Oh, you loved? I loved them. Believe me. I would marry my surgeon in a heartbeat. He's just the most adorable person.

Do they feel the same about you? He's made me very, very, very alive, and I fully appreciate that. And afterwards, where did you convalesce? I went and had the good fortune to stay with a couple of very dear friends out in Montauk. Montauk, the end.

The end. Yes, the tip of Long Island, which is just called the end. Yes, next stop, Portugal. And they looked after me fabulously. And, you know, we did our homework on this, and we found out who it was that took care of you. It was none other than Claire Schoenheimer. And we went and got her, and she is in the studio. Claire, welcome to StarTalk Radio.

Thank you. Hello. And what possessed you to take care of Glyn? Because I've been in his company. Ten minutes is pretty much all I can tolerate. Looking back on it, I don't know. He was a nightmare. He cried like a girl most days.

I was glad when he went home. It was a pain in the ass. He was awful. Well, now, you are not a nurse. No, and I never will be after that experience. Nightmare. Glenn, what did you do in her home? I belched, and I was actually completely sweet and lovable.

He's lying. I know he's lying. I spent most of the time in bed, I can tell you, which is very nice. Well, let's find out. So, Glenn, did your feelings change after this surgery? Were you a different person? Well, I am a different person afterwards. I've had this Duff heart all of my life.

Duff, that's British for bad heart. Crapola, yes. I kind of was used to it because it was what I was born with. But it feels like somebody just drove a tractor through your chest when you have this surgery. So for the first couple of days afterwards, no, I felt pretty bloody rough, the truth be known. Bloody. That's a curse word in England.

But not here. Yeah, here it's just the word bloody. Yeah. Okay. You can say bloody. It seems very appropriate at the moment. Bloody's not in the list of seven forbidden words here. I'm going to try and curtail those.

So, Claire, did you have to wait on him hand and foot, presumably? No, I am not a natural carer. I did nothing. I have to be honest. My husband, Dan, did all of it. And that is the truth. And that is the truth. But, although I'd love to rag on Glyn for hours, he was actually a good patient.

I know we don't want to hear that, but he was. I mean, the flatulence was a nightmare. The burping was literally shocking at one point. Mm-hmm. They said I had to do it. He kept, as they say, his cracker up. We have to ask. We have a doctor here.

Dr. Hoffman, what is with the flatulence and the burping? Is that a normal consequence of open-heart surgery? Well, it must have been a particularly strange cow, and he must have been chewing the cud. I was concerned it was simply an excuse. This is the cow part that he got, the cow valve. So we're wondering if the cow flatulence somehow rubbed off. Well, the problem was as well it made him laugh, and he's not supposed to laugh.

That was when we left the hospital. Because laughing puts stress on your chest cavity. A heart-shaped cushion they gave him at the hospital, which was dead cute, that he has to hold as a brace. So he would fart and then he'd laugh. Then I would laugh, even though it's not funny when men do that at all. But it seems to be for a moment. It is if you're in sixth grade. Yeah, but you see, there you go.

If you're like 11 years old. But the best thing was when we were told, when he was leaving hospital and we were told all the things that he was and wasn't allowed to do, like, you know, no laughing, no drinking, no walking, no this, no that. But he was allowed to have sex as of that day. Really? So my worry was going to be... Sex but not walking? Yeah, no walking.

What doctor prescribed this? An excellent doctor. This is why you wanted to marry your doctor. So I fear that he was going to be trawling the bars of Montauk, and trust me, you don't want to go there even when you are. I didn't know Montauk had the baths. They have baths. It's like the baths of Rome. No, bars, not bars.

Oh, bars. Excuse me. This is America, Jack. You see, we're going to take the colonists back if you carry on speaking like that. Okay, so not the baths. The bars. The bars. The bars of Montauk. Bars of Montauk looking for talent, so I wouldn't let them out.

I did inquire whether it was available on my health insurance, and they said no. I'm curious. But isn't that weird, Daryl? Is that normal that you're not allowed to do anything except... No, absolutely not. Dr. Hoffman, what do you prescribe after you crack open someone's chest? So here's what we tell people. We tell them that by a month after surgery, they should be walking two miles a day.

And they're really very, very few... Now, there's surely a sex equivalent to that. Well, hang on. Very few restrictions. He's done the math. He's done the math. How many heartbeats? Yeah.

So you're allowed to do anything except heavy lifting. And when patients ask, because we don't tell them this routinely, when they ask about sex, we simply say, please wait till you leave the hospital building. So if they've got enough energy to get out of the building, that's good enough. That's it. That's the threshold. The main reason we want people not to overdo it is because of the mechanical stress on the breastbone. We split the breastbone to get to the heart, and that has to heal up like any broken bone. When you say split it, you mean hack saw it open.

Well, we use a saw, yes, absolutely. A reciprocating saw. A jigsaw. A jigsaw. A jigsaw. Not really, like a black and decker. Yes, absolutely. A silver black and decker. No, is it really black and decker. Yes, absolutely. That's disgusting. A silver blackened decker.

No, is it really blackened decker? You get it right in a local hardware store. No, it's much more expensive. You would know that the medical profession has a different word for what it is they're using. They're not going to say it's a Nikita drill. So what do you actually call the device? The saw. No, you lie.

Give me this, give me the saw. And do you have different bits? Do you change the different blades? Yeah, actually, there are two... Can you bevel? No, there are two kinds of blades. There's one kind of blade that we use for anybody who's not had an operation before. If someone's had surgery before,

the part can get stuck to the inside, the back of the breastbone, and so then we wouldn't use that same saw Is that because the healed bone is stronger than regular bone? No, no, it's the same strength But if you don't want to go behind the breastbone This particular saw that was used on you That's used on all first-time people

Has a little footplate that goes behind the bone And the saw goes up and down And that's why it's called reciprocating And it cuts through the bone And you start at the up and down, and that's why it's called reciprocating, and it cuts through the bone, and you start at the bottom and work your way up to the top. But if someone's had an operation before, we use a different kind of bone. A different kind of bone saw.

I see. So now my image of open heart surgery is from the movie, what's the movie, All That Jazz. All That Jazz. Yes. A long time ago. They used actual file footage, and they had this like like, cranking device.

Yeah, a retractor to hold the breastbone open. Yeah, it just feels – I don't even – I can't even – and you just look at this every day. The human heart is one of the most beautiful things to look at. When you see that heart beating, I do it every day, and it's still exciting when I see it. The natural development of that is extraordinary. And, you know, what's happened to Glenn is that he was born with an abnormal valve and valve had two leaflets, not three. And over time, the natural stresses cause those two leaflets to stick together and that narrows. And so the body is forcing blood through this narrow nozzle.

And that's why he was feeling weak and tired and why he feels so energetic after the surgery. So did you knew him from before and you knew him after is he more energetic now it's scary it's like glen on drugs it really is i mean it's really weird the first thing i noticed when i saw him is i thought he was one of those sort of pale british people with the prison pallor you know it's all interesting i think interesting yeah sort of pale and interesting glen and pale as in complexion yeah white as a sheet really okay and when he came out and he looked like frankenglenn i mean he hasn't even shown you the fantastic scar on his jugular it's awesome so he's all chopped up and everything but the color on his skin looked and you know what he said the best thing was he

actually put it down to the wash they make you do before your operation. It's like what you did your head. Oh, okay. So he looks more flushed now. Oh, yeah. No, no. He looks really good. He looks more alive.

Less freshly embalmed. Let's not push it too far. Don't want his ego sort of. Yeah, he looks all right. Potentially more cantankerous. Yeah. Oh, he's always cantankerous. That hasn't changed.

The cantankerous factor is only now enhanced. He's got more energy for the cantankerous behavior. Doctor, normally when I think of people going into a major surgery, you think that afterwards they'll be somehow more frail or more fragile. But you give the kinds of operations where people have a new literal lease on life. They now start the time from zero again. Absolutely. If this operation is planned and undertaken successfully at the right time, the patient really benefits, and the convalescence surprises everyone.

We usually get people out of the hospital four or five days after the operation. Most people don't expect that, and they're pleasantly surprised. In the old days, would you keep him in for a month or something in the old days? Ten days usually. Yeah, but now, when did he leave? I was in four days after the surgery, so five days in total. And you walked out four days later. I walked out.

Well, they make you go in a wheelchair, but I was walking two days after the surgery. And you left the hospital after four days. Yeah. And that's when he would have had permission by your prescription to... Indulge, absolutely. Indulge. We've got to take a quick break, but more StarTalk Radio. Welcome back.

Before we get back to my three guests, let me give you some interesting facts about what your heart does in space. Do you know there's this parabolic trajectory you can take in an airplane where you temporarily go to zero G? And so you can look at the effects of what happens to your heart rate as you go in and out of zero G. And so it turns out when you transition from one G to two G, your heart rate goes up by about 13 beats per minute. And that's kind of understood because it's pumping against a higher, what's the effective force of gravity. But then when you go from 2G back to 0G, when you're actually weightless, because these parabolic trajectories, you go to higher G and then it transitions to 0G because you need to need that buildup in the parabolic trajectory. When it does that, your heart rate drops.

It drops and it can get as low as 20 to 30 beats per minute in zero G. And I find that fascinating because obviously your heart is no longer working against gravity. It doesn't have to work as hard. It's actually, in fact, taking a vacation. Yeah, I assume that the blood gets accelerated by the G-forces, and the heart may not have to pump for that moment. You worry about astronauts passing out under those circumstances. Well, here's what happens.

It turns out your heart is accustomed to pumping up to your head against gravity. So it's really primed to do that. And when you don't have gravity, it's going to pump in the same way, and it actually overpumps blood up to your head. Well, in space, it wouldn't be up. It would overpump blood to your head. And so astronauts tend to have this very flushed look about themselves, very sort of plumpy-headed, flushed, rosy-cheeked look. And so check them out in orbit next time.

Well, they shouldn't let them be upside down so much. And so check them out in orbit next time. Well, they shouldn't let them be upside down so much. Not only can you not hear anyone scream in space, there is no up or down. So listen, listen, Dr. Hoffman. Nowadays, all the people waiting for a new heart, can't they just put in an artificial heart? What happened to the Jarvik heart? Well, the Jarvik heart is no longer used.

And you're right. We've been working for 30 years now to make an artificial heart pump. And there are some significant improvements that have been made in recent years. We still have problems. We don't have the perfect connection device. We don't have the perfect valve. Because you have to connect plastic to biological material. And you need blood thinners to prevent the blood from clotting inside the plastic or metal components of the heart frequently or other blood thinners. Space actually has contributed enormously to this, particularly in regard to miniaturization and to the power sources and battery technology.

So actually we've really had a leap forward, and now there are heart pumps that are available quite freely and will be quite likely changing the technology and the approach to the patient with heart failure. So these aren't completely new hearts. These are auxiliary pieces of your heart that just help it pump without incident. Is that right? There are kinds of mechanical pumps which can be outside the body, and those are like the Javik heart, which you remember is a refrigerator that had to be trundled along behind the patient.

Now they're miniaturized. There's still some that go outside the body temporarily. And just to remind people, NASA likes to miniaturize things because the bigger it is, the more expensive it is to get it into orbit. So the entire miniaturization in the electronics industry was spawned and stimulated by all of our efforts to go into space. I just want to make that clear in case anyone – I want to hear a thank you NASA next time you carry around your – Well, certainly thank you NASA for this and the artificial heart is working. People will have heard that Vice President – former Vice President Cheney has an artificial heart pump. It's been rumored he just has no heart at all.

Well, he certainly didn't have a human one. He now has an artificial one. Okay. So now I just did a special on PBS Nova, Nova Science Now. We did a segment on they're growing. They're not growing. They're using the scaffold of organs to then affix a preexisting organs either from a pig or from some other animal that has a similarly sized heart. But they grow your own tissue onto that. So this is the most exciting idea.

Take a heart, pump some circulation through it, keep it alive, and then change the perfusion fluid to a detergent. The detergent gradually washes out all the cells. What you're left with is the collagen ultrastructure. The scaffolding is like- This is not of a living person. This is a heart taken out of the body. This is a heart taken out of the body of a pig or some other rodent, whatever, maybe a cow.

You cleanse it of all its cells. You cleanse it of all the cells, and then you change the perfusion solution, and in the perfusion solution, you now introduce stem cells. Those stem cells settle on the surfaces of the collagen, and they get the right signals not only from the circulating fluid, but also from the physical forces, which then cause them to differentiate into specific cells, some into muscle cells, some into blood vessel lining cells, and the new muscle that forms begins to beat. Is that the one where you see it in a box and then they pour fluid on? That's the one.

And that's really agrarian Poe, isn't it? Yeah. That is... It's the most exciting development now, not only for heart surgery, but for other organ replacement. So you have an organ on the shelf and you just pluck it off the shelf and you won't you won't reject it because it's not another species it's not even another human heart it's going to have your own self you could make it your own you take out the stem cells from the patient and you inject them into the circulation and uh this ultra structure the

scaffolding reforms a living functioning organ which will not be rejected and could be transplanted it does look like basting, doesn't it? It looks like basting a turkey. Well, from the inside. From the inside. Can I ask a whale-related question? A whale-related? It's got to be a whale of a question. It is a whale of a question. So this big 2,000 pound

whale heart, what's that in real numbers, Glyn? Like half a bus, one bus? How big is that really? Well, it's a ton, isn't it? Alright, so that's really big. It's a heart that weighs a ton. Has anyone ever done any surgery, do you think, on a heart that big? Because a cow valve wouldn't cut it, would it? You'd have to stuff the whole cow in. Yeah, that's part of the problem.

You need another animal that's the size of you to substitute in. Do you think anyone's ever done heart surgery? Can we ask someone? Okay, so, open heart surgery on whales. No. You haven't personally, Daryl. I feel that this is the way that your career could go from now on. I do.

We're winding down on our time. You've been listening to StarTalk Radio. I'm Neil deGrasse Tyson. And as always, keep looking up. Bye.