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As a gentle snow began to fall outside, Clark was wheeled into a specially equipped surgical suite. Already assembled was a 17-member team with Jarvik as an observer. Working quietly and steadily to the hushed strains of Ravel's Bolero, DeVries made a 9½-in. incision from the breastbone to the abdomen and carefully completed the delicate task of connecting Clark to a heart-lung bypass machine that would pump and oxygenate his blood until the plastic heart was in place.
Then DeVries removed the two pumping chambers (or ventricles) of Clark's heart, leaving the two atria, which function as storage chambers for blood. In all, about two-thirds of the heart were cut away. The cavity in the chest of the 6-ft. 2-in. Clark could easily accommodate the Jarvik-7. "There's room enough for two!" said DeVries with delight. The prosthesis is slightly larger than an average heart and too large, in fact, for most women.
Next came trouble. Before the artificial heart could be put in place, Dacron connectors had to be sewn onto the ends of the two atria, the aorta and the pulmonary artery. The heart snaps into these grooved, circular connectors in a manner that DeVries says is "like closing Tupperware." However, when he attempted to install the connectors, he found that the tissue around Clark's heart "would tear like tissue paper." Slowly, gingerly, DeVries managed to attach the four cuffs and finally to snap in the Jarvik-7. The device was primed with blood, but DeVries was dissatisfied with its performance. He resutured the connectors and tried again. Still no good. Finally DeVries decided to install a second left ventricle "that we had on the shelf. It worked beautifully." Clark's blood pressure slowly rose to a normal 119/75, compared with a feeble 85/40 before surgery.
"He's through the worst part," said DeVries after the operation, "but there are many more hurdles to come." Clark cleared one on Saturday when, after he had been taken off the critical list, he was ordered back into surgery for minor repairs. The operation went well, but Clark still faces a high risk of blood clotting, pneumonia and especially infection, which could develop around the tubes that enter his chest; they carry the pulses of air that drive the heart. But the artificial organ does have a key advantage over one from a human donor: since the plastic device contains no tissue, Clark's body is less likely to reject it.
No matter how long he survives, life will not be easy for Barney Clark. He is permanently tethered to 375 Ibs. of equipment that includes two compressors, a back-up compressor, a three-hour supply of pressurized air to operate the heart in case of a power failure, a drier to dehumidify the air, and mechanisms that control the air pressure and heart rate. All of this gear can be placed on what his doctors call a "shopping cart," which must always be within six feet of the patient, the length of the power lines that emerge from just below Clark's rib cage.