1 00:00:05,760 --> 00:00:07,840 You're heart is the most remarkable organ. 2 00:00:07,840 --> 00:00:12,440 In your lifetime it will beat several billion times. 3 00:00:12,440 --> 00:00:16,720 For me, the heart has always been an object of fascination. 4 00:00:16,720 --> 00:00:20,880 It's central to our study of anatomy, and emblematic of life itself. 5 00:00:20,880 --> 00:00:26,800 It starts to beat just four weeks after conception ands it never stops until the day you die. 6 00:00:26,800 --> 00:00:31,200 I think the human heart is as beautiful as it is mysterious. 7 00:00:33,600 --> 00:00:38,560 So this is really the first time I've ever heart a human heart in this context in, 8 00:00:38,560 --> 00:00:45,200 in this way. It's very difficult really to express how amazing it really is. 9 00:00:45,200 --> 00:00:50,560 It tries to do whatever we ask of it and we just assume that it's going to keep up. 10 00:00:52,640 --> 00:00:56,000 At maximum performance, it can eject blood 11 00:00:56,000 --> 00:01:01,280 70 to 80 kilometres an hour and meet, pretty much, every demand we'll ever put on it, 12 00:01:01,280 --> 00:01:04,160 so long as nothing goes wrong. 13 00:01:04,160 --> 00:01:07,120 But it can go wrong and understanding how to mend 14 00:01:07,120 --> 00:01:13,240 it has been one of the greatest challenges of medicines ever-searching journey. 15 00:01:13,240 --> 00:01:18,040 That journey has taken us from antiquity to the frontiers of 16 00:01:18,040 --> 00:01:21,400 modern medicine, and leads us to some of the acute dilemmas 17 00:01:21,400 --> 00:01:24,200 that doctors and surgeons struggle with today. 18 00:01:25,720 --> 00:01:30,480 Across the world, finding a way to mend the heart has become something of a quest. 19 00:01:30,480 --> 00:01:36,760 This man's survival depends on an artificial heart powered by a pneumatic pump in a rucksack. 20 00:01:36,760 --> 00:01:39,800 You can't even just really comprehend 21 00:01:39,800 --> 00:01:42,880 taking your heart out, you know. 22 00:01:44,480 --> 00:01:47,040 Without a heart you're not alive. 23 00:01:47,040 --> 00:01:54,440 And in one of the most ambitious areas of research, scientists are actually growing new hearts. 24 00:01:54,440 --> 00:01:58,280 Now we'd like to think that we've opened a door for building complex 25 00:01:58,280 --> 00:02:00,520 tissues and organs, 26 00:02:00,520 --> 00:02:05,880 and that the world of transplant may change as a result. 27 00:02:06,720 --> 00:02:12,200 Despite all of our research, despite all of our efforts to understand it, much of it remains a mystery. 28 00:02:12,200 --> 00:02:15,840 But millions of us will see our hearts falter and fail. 29 00:02:16,400 --> 00:02:20,560 What I'd really like to know is can you mend a broken heart? 30 00:02:35,080 --> 00:02:39,680 I'm going to meet someone who thinks of himself as being one of the luckiest men alive. 31 00:02:39,680 --> 00:02:44,720 I'm here to play a game of squash, which for me is quite a rare event, 32 00:02:44,720 --> 00:02:47,360 I even had to borrow this racquet. 33 00:02:47,360 --> 00:02:52,360 But the guy I'm going to meet was so unwell that until seven months ago 34 00:02:52,360 --> 00:02:56,520 he was unable to play squash, he never played football, never played tennis. 35 00:02:56,520 --> 00:03:01,840 In fact the things that we take for granted in everyday life, even those were tricky for him. 36 00:03:01,840 --> 00:03:08,080 But all of that's changed now and it's not entirely clear to me who's going to win this match. 37 00:03:08,080 --> 00:03:12,640 I'm playing against 27-year-old Max Crompton. 38 00:03:12,640 --> 00:03:17,400 Until a few months ago, he couldn't play any kind of sport. 39 00:03:17,400 --> 00:03:22,640 And that's because Max was born with a heart that didn't work properly. 40 00:03:22,640 --> 00:03:25,840 The reason he's able to play so well today is that he's one 41 00:03:25,840 --> 00:03:30,960 of the rare people in the UK who's been given a new heart. 42 00:03:30,960 --> 00:03:33,960 And he's clearly making the most of it. 43 00:03:36,360 --> 00:03:38,440 Did anyone point out to you that this 44 00:03:38,440 --> 00:03:41,720 might not be the most sensible game for you to have a go at playing? 45 00:03:41,720 --> 00:03:44,800 You would have thought that I'd go for a less energetic game. 46 00:03:46,680 --> 00:03:49,400 It's everything I've never been able to do. 47 00:03:49,400 --> 00:03:52,360 And what were you worried about that first time? 48 00:03:52,360 --> 00:03:55,080 The strain on my heart, I suppose. 49 00:03:55,080 --> 00:03:58,480 Er, it going really, really, really fast. 50 00:03:58,480 --> 00:04:04,640 I'm seven-nil down against a man who had a heart transplant six months ago. 51 00:04:04,640 --> 00:04:08,760 I don't think I expected you to be like this. 52 00:04:08,760 --> 00:04:12,240 I mean, you know, if I didn't know, I wouldn't know. 53 00:04:15,960 --> 00:04:19,320 Well played, good game. 54 00:04:19,320 --> 00:04:21,960 I think I need to work on my game a bit. 55 00:04:28,800 --> 00:04:33,040 When you look at Max you have to remind yourself that he's alive 56 00:04:33,040 --> 00:04:38,200 because he has someone else's heart beating in his chest. 57 00:04:43,160 --> 00:04:48,360 And, Max you're now the proud owner of a new heart but, you know, how do you 58 00:04:48,360 --> 00:04:53,120 feel, how does it feel different, this heart and your own heart? 59 00:04:53,120 --> 00:04:59,920 It's quite an emotional thing, saying bye to your old heart and hello to a new one. 60 00:04:59,920 --> 00:05:03,800 It really is a lot, it is a lot. Because my heart was very poorly. 61 00:05:03,800 --> 00:05:06,880 And so at the end, it's like you're laying it to rest almost, 62 00:05:06,880 --> 00:05:10,320 you know, like its struggle's over now, you know. 63 00:05:14,080 --> 00:05:17,720 Max's transplant has transformed his life. 64 00:05:19,240 --> 00:05:23,600 But this new heart isn't easy for him to hold on to. 65 00:05:23,600 --> 00:05:27,200 Every day it needs looking after. 66 00:05:27,200 --> 00:05:32,600 Max has to take anti-rejection drugs to stop his immune system from attacking it. 67 00:05:32,600 --> 00:05:34,480 Its longevity is uncertain. 68 00:05:35,640 --> 00:05:38,080 What have the doctors told you to expect? 69 00:05:38,080 --> 00:05:43,400 They give you the official number which is I think ten to 15 years life expectancy after transplant. 70 00:05:45,560 --> 00:05:49,160 It's quite likely that I probably won't get to old, old age. 71 00:05:52,040 --> 00:05:58,280 But at the moment my life stretches certainly years ahead, which is fine, you know. 72 00:05:58,280 --> 00:06:01,600 Even the next ten to 15 years, you know, like that's a long, long time 73 00:06:01,600 --> 00:06:06,560 when you've been living so long under the cloud of, "I don't know if I can make it to Christmas..." 74 00:06:09,400 --> 00:06:13,200 Heart transplants are not a solution for everyone. 75 00:06:13,200 --> 00:06:17,800 There just aren't enough to go around. 76 00:06:17,800 --> 00:06:24,520 And despite improvements in anti-rejection drugs, they still don't last a lifetime. 77 00:06:24,520 --> 00:06:27,320 Max is a pioneer, he's one of the first of a generation 78 00:06:27,320 --> 00:06:30,320 who've grown up and survived congenital heart disease 79 00:06:30,320 --> 00:06:32,520 and in that respect he represents the leading edge 80 00:06:32,520 --> 00:06:35,680 of everything that medicine and surgery can offer us today. 81 00:06:35,680 --> 00:06:40,760 Had he been born a decade or two earlier, he almost certainly wouldn't have survived. 82 00:06:40,760 --> 00:06:46,720 But he's here today, the survivor of a heart transplant, one the greatest medical advances 83 00:06:46,720 --> 00:06:48,120 of the 20th century. 84 00:06:52,840 --> 00:06:58,320 40 years ago, when transplants started, America was awash with hope. 85 00:06:58,320 --> 00:07:00,840 They were a chance for doctors to play god. 86 00:07:00,840 --> 00:07:05,240 But these elaborate operations weren't going to be a solution for everyone. 87 00:07:11,040 --> 00:07:12,880 Because even then donor hearts were 88 00:07:12,880 --> 00:07:18,680 in short supply. And it started to become clear that when it came to heart transplants, 89 00:07:18,680 --> 00:07:20,880 demand would always outstrip supply. 90 00:07:20,880 --> 00:07:24,480 It's in America that the race started to find an alternative to transplantation. 91 00:07:24,480 --> 00:07:27,800 looking for new solutions. It's here in America that 92 00:07:27,800 --> 00:07:31,760 the race started to find an alternative to transplantation. 93 00:07:31,760 --> 00:07:38,040 One of the most obvious questions was could we build an artificial heart? 94 00:07:38,040 --> 00:07:43,240 It was the 1960s and here in America science and medicine must have seemed nearly unstoppable. 95 00:07:43,240 --> 00:07:45,480 They had atomic power... the first men were about 96 00:07:45,480 --> 00:07:49,960 to walk on the surface of the moon and the first human heart transplants had been performed. 97 00:07:49,960 --> 00:07:55,040 So confident were surgeons of their abilities that they had set a date by which they predicted the first 98 00:07:55,040 --> 00:08:00,560 total artificial heart would be perfected and human transplants would be a thing of the past. 99 00:08:00,560 --> 00:08:04,640 That date was Valentines Day 1970. 100 00:08:04,640 --> 00:08:10,120 Four decades later and that goal remains elusive but that hasn't stopped people from trying. 101 00:08:15,600 --> 00:08:16,720 I've come to Oklahoma, 102 00:08:16,720 --> 00:08:24,240 where the misplaced optimism of the '60s has given way to a much more realistic aspiration. 103 00:08:24,240 --> 00:08:31,440 A piece of medical technology which can actually replace the biological heart. 104 00:08:31,440 --> 00:08:33,520 Dr Long? 105 00:08:33,520 --> 00:08:38,680 It's called the SynCardia temporary total artificial heart. 106 00:08:38,680 --> 00:08:44,800 It's made of plastic and weighs 160 grams and is a little larger than a biological heart. 107 00:08:49,440 --> 00:08:55,240 Essentially, it's a heart that's powered by a pneumatic pump that you carry around in a rucksack. 108 00:08:55,240 --> 00:09:01,360 Tell me a little bit about how you went about putting this, er, this remarkable device in his chest. 109 00:09:01,360 --> 00:09:06,680 The first thing is to leave in place the filling chambers but we remove these 110 00:09:06,680 --> 00:09:10,880 working portions of the heart in opened up model here. 111 00:09:10,880 --> 00:09:18,720 Then we re-divide the great vessels up here that go out to the lungs or to the body here and what we're left 112 00:09:18,720 --> 00:09:26,120 with is a cavity. We're looking down in an open chest, er, it's pretty ominous, to be honest, 113 00:09:26,120 --> 00:09:32,520 looking down and knowing that, you know, you've now taken this guy's heart out. 114 00:09:32,520 --> 00:09:38,120 So the failing biological heart is removed as in a transplant. 115 00:09:38,120 --> 00:09:43,760 The total artificial heart is implanted and temporarily replaces the function of the old heart, 116 00:09:43,760 --> 00:09:46,360 until a suitable donor heart can be found. 117 00:09:48,080 --> 00:09:53,120 And that's where you come back in, once Jim's finished all his hard work, it's over to you, isn't it? 118 00:09:53,120 --> 00:09:56,160 Absolutely. And as a cardiologist, to 119 00:09:56,160 --> 00:10:03,280 care for a patient that no longer has the organ that you've spent so much time studying and learning about and 120 00:10:03,280 --> 00:10:07,680 how manipulate and how to care for, no longer do you need to worry about 121 00:10:07,680 --> 00:10:12,360 that and that's really been kind of a remarkable learning process for us as well. 122 00:10:17,520 --> 00:10:22,120 These pumps, which to the casual observer look like, look like a washing machine part, 123 00:10:22,120 --> 00:10:27,480 but that would be to completely misunderstand and under appreciate its complexity and its beauty. 124 00:10:27,480 --> 00:10:33,480 This thing needs to be implanted in a human being, it needs to work seamlessly and reliably for millions 125 00:10:33,480 --> 00:10:38,520 of beats. The valves must never stick, blood must flow over its surfaces without clotting, the pump 126 00:10:38,520 --> 00:10:44,720 must never leak and a person's life totally depends upon it. I am frankly in awe of it. 127 00:10:46,240 --> 00:10:50,480 Doug offered to take me to meet one of the few people in the world 128 00:10:50,480 --> 00:10:53,600 who is living at home with an artificial heart. 129 00:10:56,280 --> 00:11:02,720 Troy Golden was the second person in America to ever leave hospital with one of these inside his chest. 130 00:11:06,520 --> 00:11:09,600 Troy had come to us and had had a long history of heart disease. 131 00:11:09,600 --> 00:11:14,520 He suffers from a disease that he was born with. 132 00:11:14,520 --> 00:11:19,280 Physically he wasn't even able to get out of bed any more, could barely bare weight, could barely 133 00:11:19,280 --> 00:11:24,120 breathe comfortably. Emotionally, mentally, spiritually, 134 00:11:24,120 --> 00:11:31,320 he had reached a point so low that most of us can't even imagine, where literally another day alive 135 00:11:31,320 --> 00:11:37,240 the way that he was, almost any other alternative seemed better than that. 136 00:11:39,400 --> 00:11:42,280 I can't wait to see how his life has changed. 137 00:11:46,440 --> 00:11:51,160 It's awesome to be out of the hospital 138 00:11:51,160 --> 00:11:58,960 and to be able to come back home and to get back to some kind of a normal life. 139 00:12:02,120 --> 00:12:08,160 It's just unbelievable how nice it is to be able to 140 00:12:08,160 --> 00:12:14,120 come home and be with my family, to sleep in my own bed is awesome. 141 00:12:16,720 --> 00:12:22,920 The thing that really struck me was the sound of the pneumatic pump that powers the artificial heart. 142 00:12:22,920 --> 00:12:25,640 We can hear, we can hear the freedom driver now, 143 00:12:25,640 --> 00:12:29,360 are you getting used to that, is that something you're aware of? 144 00:12:29,360 --> 00:12:34,000 Yes, I really have got to the point that I don't even really 145 00:12:34,000 --> 00:12:38,200 notice it, other than it's, you know, it's loud. 146 00:12:43,920 --> 00:12:49,880 I think for my wife she can hear it beating so she knows that I'm alive so it's very comforting 147 00:12:49,880 --> 00:12:51,880 to her. 148 00:12:53,400 --> 00:12:56,880 And then Troy rather surprised me. 149 00:13:00,400 --> 00:13:05,080 He suggested we take a walk over to the chapel where he normally preaches. 150 00:13:08,360 --> 00:13:11,960 It's mind blowing to think that he just doesn't have a heart inside his chest. 151 00:13:11,960 --> 00:13:16,880 And that it's been replaced with plastic and tubes attached to 152 00:13:16,880 --> 00:13:20,360 a pneumatic pump inside the rucksack on his back. 153 00:13:20,360 --> 00:13:24,520 It seems remarkable to me that after everything you've been through, 154 00:13:24,520 --> 00:13:29,920 you were literally at death's door, and yet, you know, with your artificial heart, 155 00:13:29,920 --> 00:13:37,240 you know, we've just had a walk over from your house and you yourself have been here in the church. 156 00:13:37,240 --> 00:13:39,640 You are even at this point transformed from the man that 157 00:13:39,640 --> 00:13:41,680 you were immediately before all this happened. 158 00:13:41,680 --> 00:13:46,960 I had gotten to the point that I was unable to preach. 159 00:13:46,960 --> 00:13:51,400 It's been about a year since I was 160 00:13:51,400 --> 00:13:57,120 been able to, erm, really function at all in the church. 161 00:13:57,120 --> 00:13:59,720 How do you feel now you have an artificial heart? 162 00:13:59,720 --> 00:14:05,440 You can't even just really comprehend taking your heart out, you know... 163 00:14:07,000 --> 00:14:09,360 Without a heart you're not alive. 164 00:14:09,360 --> 00:14:10,880 So, erm, it's... 165 00:14:15,880 --> 00:14:18,360 It's just hard to even think about that. 166 00:14:18,360 --> 00:14:24,040 But once I had come to the point that this is going to give me life, 167 00:14:25,560 --> 00:14:28,160 erm, afterwards... 168 00:14:28,160 --> 00:14:31,040 it's just... 169 00:14:31,040 --> 00:14:37,560 I was just joyful to see myself improve so much, so quickly. 170 00:14:39,160 --> 00:14:41,600 It's really amazing that Troy's alive. 171 00:14:41,600 --> 00:14:46,800 But it's not perfect, you know, I mean that's a huge backpack, 172 00:14:46,800 --> 00:14:51,280 and that constant thrashing around in the background, and even he himself 173 00:14:51,280 --> 00:14:55,360 doesn't feel like he'll get back to 100% just with that pump alone. 174 00:14:55,360 --> 00:14:58,280 But it is a bridge that will get him to transplant, 175 00:14:58,280 --> 00:15:03,200 it is at least that, and it offers hope where there wasn't any before. 176 00:15:06,920 --> 00:15:09,400 But all of this is just temporary. 177 00:15:09,400 --> 00:15:12,080 Replacing a failing heart with an artificial one 178 00:15:12,080 --> 00:15:15,480 isn't the holy grail scientists once thought it was. 179 00:15:17,640 --> 00:15:21,080 To me, this doesn't look like the answer to mending failing hearts. 180 00:15:25,600 --> 00:15:28,560 But cardiac medicine isn't my field. 181 00:15:28,560 --> 00:15:32,240 I wanted to talk to someone who has lived through this changing age of 182 00:15:32,240 --> 00:15:36,200 heart surgery and who might be able to help me find a better answer. 183 00:15:37,840 --> 00:15:43,080 Dr John Elefteriades is one of the worlds leading cardiac surgeons. 184 00:15:43,080 --> 00:15:47,080 Six months ago I saw him bring someone back from the dead in one 185 00:15:47,080 --> 00:15:51,200 of the most incredible heart operations I've ever seen. 186 00:15:51,200 --> 00:15:54,720 We're debating about the exact extent of oure disection. 187 00:15:54,720 --> 00:15:57,320 Gosh it's every bit as impressive 188 00:15:57,320 --> 00:16:00,040 as it is on the scans. 189 00:16:00,040 --> 00:16:04,240 Impressive for you, is intimidating for us. 190 00:16:06,680 --> 00:16:11,240 He has performed over 250 heart transplants and in his working 191 00:16:11,240 --> 00:16:14,960 lifetime has witnessed the evolving science of cardiac surgery. 192 00:16:16,000 --> 00:16:21,040 Over that time he's started to think we might be looking at hearts in the wrong way. 193 00:16:24,680 --> 00:16:30,320 Today I've come to pick his brains while he fixes a different kind of engine. 194 00:16:30,320 --> 00:16:34,040 Have you got the wrench, there? There you go. Thank you. 195 00:16:34,040 --> 00:16:39,880 And John, we've been sort of looking at some very mechanical solutions to the problem of heart failure. 196 00:16:39,880 --> 00:16:44,120 It looks to me like we approach the dream of an artificial heart, 197 00:16:44,120 --> 00:16:47,840 as though it is a big complicated engineering problem. 198 00:16:47,840 --> 00:16:51,400 What do you, what do you think of that approach? 199 00:16:51,400 --> 00:16:54,800 Well, I think it has a lot of merit, but it's not the whole story. 200 00:16:54,800 --> 00:16:58,120 The human body is not just a car, 201 00:16:58,120 --> 00:17:02,640 it has a lot of, er, responsiveness, it has a lot 202 00:17:02,640 --> 00:17:07,520 of hormones, a lot of nerves that, er, connect to the heart. 203 00:17:07,520 --> 00:17:15,560 And there's no doubt that what we do by replacing the mechanical function is an oversimplification, 204 00:17:15,560 --> 00:17:19,360 but that's what we're capable to accomplish right now. 205 00:17:19,360 --> 00:17:23,600 And do you think that the dream of the artificial heart has been 206 00:17:23,600 --> 00:17:30,160 so elusive because we've made that mistake, because we've thought of it as we do your Pantera, as something 207 00:17:30,160 --> 00:17:34,200 that if with enough brute force, we will engineer our way out of it? 208 00:17:34,200 --> 00:17:38,040 I think so, yeah. I think we're thinking of it like a fuel 209 00:17:38,040 --> 00:17:42,160 pump or a water pump, and the human heart is really much more than that. 210 00:17:42,160 --> 00:17:45,440 Now if we step back a little to the present day, what's coming our way? 211 00:17:45,440 --> 00:17:49,200 I think that there is room for... 212 00:17:50,720 --> 00:17:56,480 ..mechanical devices and for novel surgical procedures. 213 00:17:56,480 --> 00:18:00,440 I think we will make substantial progress. 214 00:18:00,440 --> 00:18:07,600 But really I think that the future lies in molecular biology and cell based therapies. 215 00:18:07,600 --> 00:18:09,640 What I do every day is plumbing. 216 00:18:09,640 --> 00:18:14,120 I think it's incumbent on us to raise the standard 217 00:18:14,120 --> 00:18:18,600 of heart care above the mechanical plumbing level, 218 00:18:18,600 --> 00:18:22,240 eventually to a molecular biologic and genetic level. 219 00:18:25,320 --> 00:18:29,920 We draw that analogy, don't we, of the surgeon as the mechanic, 220 00:18:29,920 --> 00:18:34,080 as an individual servicing the machine that is the human body. 221 00:18:34,080 --> 00:18:39,120 And that analogy stands, I think, but only so far. 222 00:18:39,120 --> 00:18:44,400 We need to rise above simple mechanics and embrace the complexity of biology. 223 00:18:48,320 --> 00:18:50,400 When you talk to John, you realise that it's 224 00:18:50,400 --> 00:18:53,200 not a problem simply of brute force engineering. 225 00:18:53,200 --> 00:18:57,440 It's not something we can crack just by chucking money and technology at it. 226 00:18:57,440 --> 00:19:00,640 If it was, we would have found the answer by now. 227 00:19:00,640 --> 00:19:04,040 This is the 21st century. We walk in space, 228 00:19:04,040 --> 00:19:06,880 we collide particles at nearly the speed of light 229 00:19:06,880 --> 00:19:09,960 and we know the age of the universe, so why with all that 230 00:19:09,960 --> 00:19:13,280 science and technology has to offer us have we not come up 231 00:19:13,280 --> 00:19:16,560 with something better than the human heart transplant 232 00:19:16,560 --> 00:19:19,360 as a solution to the completely failing heart. 233 00:19:26,880 --> 00:19:28,480 In my day to day work in medicine, 234 00:19:28,480 --> 00:19:30,760 I've come to better appreciate the heart. 235 00:19:32,760 --> 00:19:36,960 As a medical student, I thought of it as little more than a mechanical pump. 236 00:19:36,960 --> 00:19:42,320 But as time went by, it began to reveal its complexities. 237 00:19:42,320 --> 00:19:48,880 Eventually, this wonderful thing of biology began to unfold before my very eyes. 238 00:19:49,480 --> 00:19:51,680 This is the heart as I first came to know it 239 00:19:51,680 --> 00:19:54,560 in the dissection rooms when I was a medical student. 240 00:19:54,560 --> 00:19:58,400 When you look at it, already there's a hint of the complexity that lies beneath. 241 00:19:58,400 --> 00:20:01,480 These are the muscular walls of the ventricles, 242 00:20:01,480 --> 00:20:03,960 whose job it is to deliver blood to the lungs 243 00:20:03,960 --> 00:20:06,840 and around the heart through these great vessels. 244 00:20:06,840 --> 00:20:08,560 But when you look at it like this, 245 00:20:08,560 --> 00:20:10,560 as an inanimate and long dead object, 246 00:20:10,560 --> 00:20:11,800 it really doesn't do it justice, 247 00:20:11,800 --> 00:20:16,280 you can't really appreciate how beautiful and dynamic it is in life. 248 00:20:16,280 --> 00:20:20,800 You really can't appreciate the wonderful feats of which it's capable. 249 00:20:23,560 --> 00:20:28,640 I want to find out what the human heart can do when we push it to the limits of its capabilities. 250 00:20:30,880 --> 00:20:34,400 So, with some trepidation, I've come to Berkshire, to the training camp 251 00:20:34,400 --> 00:20:36,840 of the British Olympic Rowing team. 252 00:20:39,320 --> 00:20:42,920 Pete Reed and Andy Triggs-Hodge already have one Olympic Gold. 253 00:20:42,920 --> 00:20:45,160 And they're hoping for another. 254 00:20:45,160 --> 00:20:47,760 Have a look what our hearts look like. 255 00:20:47,760 --> 00:20:50,680 These guys have two of the most impressive hearts in the world. 256 00:20:50,680 --> 00:20:56,080 Cardiologist, Len Shapiro looks after some of the top athletes in the country. 257 00:20:56,080 --> 00:21:00,040 And, Len, this is an echo cardiogram that we're doing here, 258 00:21:00,040 --> 00:21:03,560 which in hospital medicine we don't usually do in health. 259 00:21:03,560 --> 00:21:06,600 There's no need, erm, erm, but, but what is, 260 00:21:06,600 --> 00:21:09,000 what information does it give us. 261 00:21:09,000 --> 00:21:12,840 Well, the, the unique, advantage we have here, is, that ultrasound, 262 00:21:12,840 --> 00:21:16,400 or echocardiography will allow us to examine 263 00:21:16,400 --> 00:21:19,960 the structure of the heart and it's function. 264 00:21:19,960 --> 00:21:22,160 What makes the heart so remarkable 265 00:21:22,160 --> 00:21:27,440 and so difficult to mend, is that it is a fantastically dynamic organ. 266 00:21:29,640 --> 00:21:31,680 And it is this ability to change, 267 00:21:31,680 --> 00:21:34,560 in different moments of your day and across your life, 268 00:21:34,560 --> 00:21:37,480 that I've come here to investigate. 269 00:21:37,480 --> 00:21:39,600 Slip the shirt off, lie up on the bed. 270 00:21:39,600 --> 00:21:43,800 The first thing Len wants to check is my resting heartbeat. 271 00:21:43,800 --> 00:21:48,880 Erm, your resting heart rate here is not too bad, it's about 75. 272 00:21:48,880 --> 00:21:53,680 I'm obviously nervous about getting on the rowing machine with Olympic rowers today. 273 00:21:53,680 --> 00:21:56,640 I would be too. And I don't know if you managed to notice 274 00:21:56,640 --> 00:21:59,200 what Pete and Andy's resting heart rates were? 275 00:21:59,200 --> 00:22:02,840 I would think it's well below forty, if we were to record their heart 276 00:22:02,840 --> 00:22:05,840 beats over night, which is done sometimes, 277 00:22:05,840 --> 00:22:08,520 it may well be in the thirties or below. 278 00:22:08,520 --> 00:22:12,000 Now that's incredible, isn't it, if you saw that in an accident 279 00:22:12,000 --> 00:22:15,920 and emergency department, you'd be reaching for drugs and people and help? 280 00:22:15,920 --> 00:22:20,000 Already my heart is showing signs of being quite impressive. 281 00:22:20,000 --> 00:22:23,360 Just lying here, its muscles are working twice as hard as 282 00:22:23,360 --> 00:22:25,800 my leg muscles would be if I were out running. 283 00:22:28,080 --> 00:22:32,360 But I've come here to see what happens when my heart is pushed to the limit. 284 00:22:32,360 --> 00:22:37,320 Pete, Andy. How you doing? 285 00:22:37,320 --> 00:22:40,000 Have the finalised the places in the boat for 2012? 286 00:22:40,000 --> 00:22:42,360 I think I'm an unknown quantity here. 287 00:22:45,720 --> 00:22:50,040 Over the course of a day my heart pushes 2,000 gallons of blood 288 00:22:50,040 --> 00:22:53,560 through 60,000 miles of blood vessels. 289 00:22:53,560 --> 00:22:56,120 If I'm just sitting at home doing nothing, 290 00:22:56,120 --> 00:22:59,520 my heart probably puts out about five litres a minute. 291 00:23:02,160 --> 00:23:07,680 When I get up to maximum exercise, it probably goes to five times that, twenty five litres a minute. 292 00:23:07,680 --> 00:23:09,960 Keep going until you can't take another stroke. 293 00:23:09,960 --> 00:23:14,240 The Gold Medal winners thought I wasn't giving it my all. 294 00:23:14,240 --> 00:23:19,080 Don't stop. Keep going, keep going until you can't take another stroke. 295 00:23:19,080 --> 00:23:20,200 Come on. 296 00:23:20,200 --> 00:23:24,000 Really work it! Last few strokes! 297 00:23:29,440 --> 00:23:32,440 I think that's probably enough. 298 00:23:32,440 --> 00:23:36,560 And so what you're seeing there is... 299 00:23:36,560 --> 00:23:39,600 me repaying my oxygen debt with the... 300 00:23:39,600 --> 00:23:43,640 I have to pay for being so unfit compared to the guys. 301 00:23:45,400 --> 00:23:49,880 You know, what they literally take in their stride... 302 00:23:51,400 --> 00:23:53,720 ..it's me working at full pelt, 303 00:23:53,720 --> 00:23:56,520 full sprint physiology, fight or flight. 304 00:23:58,040 --> 00:24:03,120 And so you know going into this very inefficient metabolism. 305 00:24:03,120 --> 00:24:05,440 And it's kind of like running out of... 306 00:24:05,440 --> 00:24:09,920 coal in your house and burning the sofas to keep warm. 307 00:24:09,920 --> 00:24:13,280 Lots of toxic by products. 308 00:24:13,280 --> 00:24:18,760 My heart rate getting up there to 190 beats per minute. 309 00:24:20,360 --> 00:24:23,040 You know those guys are going to do that for 310 00:24:23,040 --> 00:24:27,320 another eight minutes, they've been doing it for about six minutes. 311 00:24:27,320 --> 00:24:34,280 The glory of the human heart is that it can adapt so rapidly and so often then still recover. 312 00:24:36,840 --> 00:24:39,200 And for trained athletes, it is capable of 313 00:24:39,200 --> 00:24:41,040 truly astonishing change. 314 00:24:44,240 --> 00:24:49,680 SHOUTS OF ENCOURAGEMENT 315 00:24:52,120 --> 00:24:56,960 How you doing, Pete? All right? That's you at full tilt? Yeah. 316 00:24:56,960 --> 00:25:01,640 Len told me that in pushing my heart as far as I could it went 317 00:25:01,640 --> 00:25:05,120 from pumping four litres a minute of blood around my body to 15. 318 00:25:06,640 --> 00:25:11,320 The boy's hearts went from pushing seven litres a minute to 45! 319 00:25:11,320 --> 00:25:16,000 And yet their heart rates only rose slightly while mine more than doubled. 320 00:25:16,000 --> 00:25:22,400 When you are exercising your heart rate rose to 192 beats per minute, and most 321 00:25:22,400 --> 00:25:28,440 of the increase in cardiac output from your exercise, was due to your increase in heart rate. 322 00:25:28,440 --> 00:25:30,840 Your heart didn't get larger to accommodate. 323 00:25:30,840 --> 00:25:35,440 In contrast, the two rowers their heart rates rose much less 324 00:25:35,440 --> 00:25:38,280 and their hearts got larger to accommodate 325 00:25:38,280 --> 00:25:41,800 the increase in exercise, so they were largely made up 326 00:25:41,800 --> 00:25:47,440 of what we call and increased stroke volume and that's the amount of blood pumped on each heartbeat. 327 00:25:47,440 --> 00:25:52,840 So your heart doesn't just speed up and slow down during the day. 328 00:25:52,840 --> 00:25:55,880 It can get bigger, it can grow when you train it 329 00:25:55,880 --> 00:25:59,520 and will keep up with whatever you throw at it throughout your life. 330 00:25:59,520 --> 00:26:07,880 It is an organ in a state of continual change and that's what makes it so difficult to fix. 331 00:26:07,880 --> 00:26:11,520 And so what we're beginning to build is 332 00:26:11,520 --> 00:26:15,200 the picture of this object with layer upon layer of complexity. 333 00:26:15,200 --> 00:26:16,840 And that's before we try to superimpose 334 00:26:16,840 --> 00:26:20,560 ageing and disease and all of the unpredictability that they bring. 335 00:26:20,560 --> 00:26:26,000 That, I guess is, is why it's been so difficult to find a way to repair 336 00:26:26,000 --> 00:26:32,000 or replace it, that's why it remains as one of medicines greatest challenges. 337 00:26:38,360 --> 00:26:41,880 This is what we're up against. 338 00:26:41,880 --> 00:26:44,960 We need to find ways of mending something that 339 00:26:44,960 --> 00:26:48,720 has elvoled over many hundreds of millions of years. 340 00:26:48,720 --> 00:26:55,200 So I've come here to Minnesota to take a rather unusual voyage inside the heart. 341 00:26:56,720 --> 00:27:03,240 To see how scientists are trying to save lives by assisting the hearts function rather tha replacing it. 342 00:27:03,240 --> 00:27:08,560 Because if you want to mend the heart you need to be able to understand its dynamics. 343 00:27:10,280 --> 00:27:16,720 The University of Minnesota has been at the forefront of mending broken hearts for the last 50 years. 344 00:27:20,680 --> 00:27:23,880 Hidden away in its basement, scientists have found a rather 345 00:27:23,880 --> 00:27:31,160 unusual way of looking at the heart and in doing so, have come up with improved ways of fixing it. 346 00:27:31,160 --> 00:27:35,960 Hi, Paul, I'm Kevin. Pleased to meet you, come on in. 347 00:27:35,960 --> 00:27:40,040 Paul Iaizzo is a professor of surgery at the Visible Heart Lab. 348 00:27:41,560 --> 00:27:44,160 He's perfected a technique for bringing dead hearts 349 00:27:44,160 --> 00:27:50,440 back to life giving scientists the opportunity to study the heart in motion. 350 00:27:50,440 --> 00:27:54,720 What we're gonna do now is we're going to cardioplegia his heart, 351 00:27:54,720 --> 00:27:59,520 remove it, just like they would just for a heart transplantation but instead of planting it in 352 00:27:59,520 --> 00:28:02,760 another animal, we're going to put it on the visible heart apparatus. 353 00:28:03,800 --> 00:28:10,320 Paul's been delevoping this technique for donated human hearts that aren't suitable for transplant. 354 00:28:10,320 --> 00:28:13,120 For today's work, they'll use the animal heart that 355 00:28:13,120 --> 00:28:17,120 most resembles ours in size, structure and function, that of a pig. 356 00:28:25,480 --> 00:28:29,480 The heart is taken off to be prepared 357 00:28:29,480 --> 00:28:32,240 and an hour after it stopped beating, 358 00:28:32,240 --> 00:28:34,400 Paul is ready to reanimate it. 359 00:28:39,600 --> 00:28:45,040 And you're about to take this heart, which you stopped 360 00:28:45,040 --> 00:28:50,600 with a...with a solution, some time ago now, and you're going to make it beat again? 361 00:28:50,600 --> 00:28:52,320 That's the hope here. 362 00:28:52,320 --> 00:28:55,360 And that helps you because. 363 00:28:55,360 --> 00:29:00,520 Because now we can really study functional cardiac anatomy. 364 00:29:00,520 --> 00:29:04,840 If they can get this heart beating again it will give remarkable insight into function. 365 00:29:04,840 --> 00:29:09,920 All right, so now we're flushing, it's warming up, 366 00:29:09,920 --> 00:29:13,360 and you can actually see some spontaneous contractions occurring. 367 00:29:13,360 --> 00:29:16,520 Yeah, I see it. A gently fibrillating heart. 368 00:29:19,960 --> 00:29:24,360 To bring it back to life, Paul gives it an electric shock. 369 00:29:30,800 --> 00:29:34,000 So one shock did it. Now we've got... Oh, wow. 370 00:29:34,000 --> 00:29:38,080 ..our pressure developed here, by this heart. 371 00:29:38,080 --> 00:29:43,120 So you can see the ventricular pressures are back, right ventricular pressures are back. 372 00:29:43,120 --> 00:29:45,760 And so, basically, it's a little arrhythmic now, 373 00:29:45,760 --> 00:29:47,680 but, you know, in a few minutes, 374 00:29:47,680 --> 00:29:50,360 um, we'll get back to a more normal rhythm. 375 00:29:50,360 --> 00:29:53,360 Well, that's fascinating. It's really quite amazing 376 00:29:53,360 --> 00:29:55,440 to see a heart re-animate like that, I think. 377 00:29:55,440 --> 00:29:59,320 Now that the heart is beating again, I'm going to be able to look at it 378 00:29:59,320 --> 00:30:01,960 in a way that wouldn't otherwise be possible. 379 00:30:01,960 --> 00:30:07,880 And if we actually dim the lights in the room, I'll be able to give you a tour of this functional anatomy. 380 00:30:11,240 --> 00:30:14,760 Th-that's... That's amazing! 381 00:30:14,760 --> 00:30:18,120 Using a tiny fibre-optic camera, they can get right inside the heart 382 00:30:18,120 --> 00:30:21,200 and examine every aspect of its internal structure. 383 00:30:21,200 --> 00:30:23,640 I'm watching this and I'm reminded of that film - 384 00:30:23,640 --> 00:30:26,400 I don't know if you ever watched it - Fantastic Voyage - 385 00:30:26,400 --> 00:30:28,840 where those guys shrink themselves down 386 00:30:28,840 --> 00:30:31,400 and go flying through the body in this thing 387 00:30:31,400 --> 00:30:33,920 and it's bizarre cos this is the real voyage, 388 00:30:33,920 --> 00:30:37,760 you're really in there with cameras, we are really seeing this stuff. 389 00:30:37,760 --> 00:30:40,640 I agree that it is like a fantastic voyage every time 390 00:30:40,640 --> 00:30:43,040 and it's a different voyage in every heart. 391 00:30:43,040 --> 00:30:45,040 Every heart's anatomy is different. 392 00:30:45,040 --> 00:30:49,840 We look at this functional anatomy - how delicate, but yet complex. 393 00:30:49,840 --> 00:30:52,840 Gosh, you could watch that for ever. That's just amazing. 394 00:30:54,840 --> 00:30:58,960 Seeing the heart like this makes me appreciate what it is we're trying to mend. 395 00:30:58,960 --> 00:31:03,400 These inner workings are like no piece of engineering I've ever seen. 396 00:31:03,400 --> 00:31:08,840 I'm staring right at the anterior papillary muscle here. 397 00:31:08,840 --> 00:31:13,120 You can see the whole length of the muscle coming up to the chordae tendineae, 398 00:31:13,120 --> 00:31:15,960 coming up to those anterior leaflets. 399 00:31:18,200 --> 00:31:22,080 They still look to me very fragile for something that has to do that 400 00:31:22,080 --> 00:31:25,400 72-odd beats a minute, 24 hours a day, 401 00:31:25,400 --> 00:31:29,560 a billion, two, three billion times in a lifetime. 402 00:31:29,560 --> 00:31:35,160 That they can be engineered for that tolerances is incredible. It really is. 403 00:31:37,280 --> 00:31:41,720 This is the result of hundreds of millions of years of adaptation. 404 00:31:41,720 --> 00:31:48,280 And I can only imagine that this has allowed you to gain an understanding of the heart 405 00:31:48,280 --> 00:31:54,960 that just must enable you to design all sorts of devices, all sorts of therapies? 406 00:31:54,960 --> 00:31:59,840 What it gives you too is a new 3D visualisation in your brain 407 00:31:59,840 --> 00:32:02,200 of what that functional anatomy looks like, 408 00:32:02,200 --> 00:32:04,920 so it might allow you to even be more creative 409 00:32:04,920 --> 00:32:07,600 in the fact that you get to understand that 410 00:32:07,600 --> 00:32:10,440 and then to think that you're going to put devices in there 411 00:32:10,440 --> 00:32:12,520 that can be curative for individuals. 412 00:32:12,520 --> 00:32:14,080 It's really rather amazing. 413 00:32:15,480 --> 00:32:17,480 When it comes to mending hearts, 414 00:32:17,480 --> 00:32:22,760 the ambition they have in this lab is more modest than what we've seen before. 415 00:32:22,760 --> 00:32:25,200 By understanding its complexities in this way, 416 00:32:25,200 --> 00:32:29,600 it makes complete sense that we should be helping the heart rather than replacing it. 417 00:32:34,160 --> 00:32:39,000 And it's in bringing biology and technology together that we might just find an answer. 418 00:32:41,200 --> 00:32:45,640 I've heard about a rather unusual collaboration back in London. 419 00:32:45,640 --> 00:32:49,080 Professor Reza Razavi is a cardiologist 420 00:32:49,080 --> 00:32:52,920 and Professor Nic Smith is a biomedical engineer. 421 00:32:52,920 --> 00:32:56,880 Together they have come up with something rather special. 422 00:32:56,880 --> 00:33:01,520 They have combined their skills and designed a virtual heart. 423 00:33:04,640 --> 00:33:09,120 It shows precisely how a patient's heart is contracting, 424 00:33:09,120 --> 00:33:10,840 how blood flows inside it, 425 00:33:10,840 --> 00:33:14,440 and reveals exactly how well it is functioning. 426 00:33:14,440 --> 00:33:16,560 A mathematical model, in many senses, 427 00:33:16,560 --> 00:33:20,080 is just a way of taking all the fantastic imaging data 428 00:33:20,080 --> 00:33:21,400 that's now available 429 00:33:21,400 --> 00:33:24,360 and putting it into one place where we can then start to say, 430 00:33:24,360 --> 00:33:26,560 "What happens if we do this or that?" 431 00:33:26,560 --> 00:33:31,560 In reality, it's just a way of encapsulating everything we know about this particular patient, 432 00:33:31,560 --> 00:33:35,840 allowing us to understand what's going wrong and how we can then make that go right. 433 00:33:35,840 --> 00:33:39,400 And already they're starting to use it to mend broken hearts. 434 00:33:42,520 --> 00:33:46,040 This patient here today is having a pacemaker fitted. 435 00:33:47,760 --> 00:33:52,240 This patient's heart's not working so well, what we call heart failure. 436 00:33:52,240 --> 00:33:57,880 And this pacemaker allows us to resynchronise the contraction of the heart 437 00:33:57,880 --> 00:34:01,080 and help the heart work aerodynamically in a better way. 438 00:34:01,080 --> 00:34:04,200 Pacemakers fail in over a third of patients 439 00:34:04,200 --> 00:34:05,920 because it's not always clear 440 00:34:05,920 --> 00:34:09,120 where to place the wires using a two dimensional X-ray. 441 00:34:10,960 --> 00:34:15,400 What we are doing differently is that when you do this procedure, 442 00:34:15,400 --> 00:34:18,080 you would do it in a standard way in everybody. 443 00:34:18,080 --> 00:34:22,960 But we have taken information from images before we implant the pacemaker, 444 00:34:22,960 --> 00:34:27,000 and use that in real time during the implantation procedure 445 00:34:27,000 --> 00:34:31,280 to help optimise it for that patient and see if that really benefits them. 446 00:34:31,280 --> 00:34:34,280 Thanks to the three-dimensional virtual heart, 447 00:34:34,280 --> 00:34:38,120 the surgeon today is able to see exactly where to place the wires 448 00:34:38,120 --> 00:34:42,200 so that the pacemaker has the best chance of working. 449 00:34:43,840 --> 00:34:48,280 I think the real significance of what they're doing here is something rather grander. 450 00:34:50,920 --> 00:34:54,280 It's something we've never seen before in medicine. 451 00:34:55,920 --> 00:35:02,840 Well, what we see here is the patient that we've just seen this morning being implanted. 452 00:35:02,840 --> 00:35:06,400 It shows the process of how we build a model from that particular data. 453 00:35:06,400 --> 00:35:08,320 So we start off with this MR data 454 00:35:08,320 --> 00:35:10,400 and then after that we have techniques 455 00:35:10,400 --> 00:35:13,680 for segmenting out the parts of the heart which are the tissue, 456 00:35:13,680 --> 00:35:15,960 and then we morph our mathematical model 457 00:35:15,960 --> 00:35:20,280 so that it fits exactly the anatomy of that particular person's heart. 458 00:35:20,280 --> 00:35:22,160 That provides a wonderful platform 459 00:35:22,160 --> 00:35:25,000 to understand and predict what function we'll have. 460 00:35:28,160 --> 00:35:32,080 The information accumulated by the doctors before and after treatment 461 00:35:32,080 --> 00:35:35,320 means that they can create a personalised model of your heart, 462 00:35:35,320 --> 00:35:38,800 capable of being experimented on without harming you. 463 00:35:41,080 --> 00:35:44,280 The models provide an amazing testbed to try options 464 00:35:44,280 --> 00:35:47,640 that we can't try on the patients for obvious reasons, 465 00:35:47,640 --> 00:35:49,200 to find a close to optimal one 466 00:35:49,200 --> 00:35:52,800 before making that particular change in that particular patient. 467 00:35:52,800 --> 00:36:00,600 And this research is more than just an esoteric fascination with all the numbers and all of the science. 468 00:36:00,600 --> 00:36:03,320 It does mean something to patients, doesn't it? 469 00:36:03,320 --> 00:36:06,920 For sure. You know, when we sit in the clinic and the patient walks in, 470 00:36:06,920 --> 00:36:09,920 they're worried about something, they have symptoms, 471 00:36:09,920 --> 00:36:12,840 you know, they're short of breath or they have some pain. 472 00:36:12,840 --> 00:36:16,440 You examine them to try to find out what's going on. 473 00:36:16,440 --> 00:36:21,600 But getting to the bottom of really what is the physiological process 474 00:36:21,600 --> 00:36:24,840 that makes them ill specifically in their own way 475 00:36:24,840 --> 00:36:29,760 requires something much, much more, sort of, deep and well thought out. 476 00:36:29,760 --> 00:36:33,560 These models allow us to do that - they're like a simulation, an avatar, 477 00:36:33,560 --> 00:36:36,160 of what's going on for that individual patient. 478 00:36:37,800 --> 00:36:40,720 If each of us could have our own virtual heart, 479 00:36:40,720 --> 00:36:47,000 doctors could trial medications or procedures on it before applying them to the individual. 480 00:36:47,000 --> 00:36:50,040 This is really exciting stuff 481 00:36:50,040 --> 00:36:52,600 and I think it's the closest thing I've yet seen 482 00:36:52,600 --> 00:36:54,880 to a renaissance in this area of science. 483 00:36:54,880 --> 00:36:57,480 In medicine, so often, we just have to do things 484 00:36:57,480 --> 00:37:01,040 because we know simply that it works on a population basis, 485 00:37:01,040 --> 00:37:04,080 and here actually you can ask the hard questions, 486 00:37:04,080 --> 00:37:06,120 keep asking them all the way down. 487 00:37:06,120 --> 00:37:09,200 That's important because if we're going to understand 488 00:37:09,200 --> 00:37:11,600 how this stuff works, how it's going to make 489 00:37:11,600 --> 00:37:15,320 you as an individual better, we need to understand YOUR heart 490 00:37:15,320 --> 00:37:17,640 and we need to understand the individual, 491 00:37:17,640 --> 00:37:19,840 specifically what we need to do for you. 492 00:37:19,840 --> 00:37:22,520 And this is a good part of the question 493 00:37:22,520 --> 00:37:24,920 and the answer to that question. 494 00:37:26,120 --> 00:37:32,040 This coming together of biology and technology could transform the way we approach cardiac medicine. 495 00:37:33,560 --> 00:37:36,920 Being able to predetermine what would help a failing heart 496 00:37:36,920 --> 00:37:40,800 could help us intervene earlier before any real damage had happened. 497 00:37:45,440 --> 00:37:49,520 But there is a very different way of mending broken hearts, 498 00:37:49,520 --> 00:37:52,080 in some ways the most exciting - 499 00:37:52,080 --> 00:37:55,000 one that draws on the body's ability to fix itself. 500 00:37:57,920 --> 00:38:01,840 This is an area of medicine where mystery and possibility come together, 501 00:38:01,840 --> 00:38:06,840 an area which is teaching us about the heart's healing properties - 502 00:38:06,840 --> 00:38:09,400 properties that have only recently come to light. 503 00:38:09,400 --> 00:38:12,440 That thing beating in your chest from moment to moment, 504 00:38:12,440 --> 00:38:15,720 is capable of some remarkable behaviours. 505 00:38:15,720 --> 00:38:17,680 Behaviour that, until recently, 506 00:38:17,680 --> 00:38:20,400 we didn't realise it was truly capable of. 507 00:38:20,400 --> 00:38:23,560 And so I'm off to meet an incredible little girl 508 00:38:23,560 --> 00:38:25,680 who's something of a medical mystery 509 00:38:25,680 --> 00:38:30,560 and who's living proof of what an enigma the human heart really is. 510 00:38:33,760 --> 00:38:36,640 What's in your bowl, Hannah? What's in there? 511 00:38:36,640 --> 00:38:40,520 A frying pan. A frying pan! 512 00:38:40,520 --> 00:38:47,000 This lively six-year-old girl from Edinburgh is teaching us something about the heart that we didn't know. 513 00:38:48,440 --> 00:38:52,320 In her short life her heart has failed five times. 514 00:38:54,280 --> 00:38:59,720 And each time the doctors treating her have tried every method they can think of to keep her alive. 515 00:39:01,400 --> 00:39:06,360 We've been hearing Hannah's remarkable story. I wonder if you could tell me a bit about that. 516 00:39:06,360 --> 00:39:11,440 I don't know how much I can tell you about her. She's a mystery to us. 517 00:39:11,440 --> 00:39:13,560 Hannah came along 518 00:39:13,560 --> 00:39:17,920 and she was in dire straits, she was in a terrible situation. 519 00:39:17,920 --> 00:39:22,280 She was in heart failure and the only thing we could do was to put her on a Berlin Heart. 520 00:39:24,120 --> 00:39:27,760 The Berlin Heart is an extreme option for a six-year-old, 521 00:39:27,760 --> 00:39:31,040 but was used on Hannah because nothing else was working. 522 00:39:31,040 --> 00:39:37,040 It temporarily took over the pumping action of her heart while she waited for a donor. 523 00:39:39,880 --> 00:39:46,400 But within just a few days, her failing heart did something the doctors did not expect. 524 00:39:46,400 --> 00:39:50,240 But something unusual occurred. 525 00:39:50,240 --> 00:39:53,400 When Doctor Kirk who's our cardiologist 526 00:39:53,400 --> 00:39:58,080 started looking at her heart a few days after her Berlin Heart, 527 00:39:58,080 --> 00:40:02,880 he started to find that the heart was contracting pretty well, 528 00:40:02,880 --> 00:40:05,000 something which we hadn't seen before. 529 00:40:08,200 --> 00:40:11,560 Something completely unexpected happened. 530 00:40:11,560 --> 00:40:17,160 It seemed that in letting her heart rest, it had managed to heal itself. 531 00:40:17,160 --> 00:40:18,280 She was sent home, 532 00:40:18,280 --> 00:40:21,520 but a few months later her heart failed again. 533 00:40:22,840 --> 00:40:25,200 But we could not give up hope on Hannah 534 00:40:25,200 --> 00:40:29,000 and we brought her back to Newcastle 535 00:40:29,000 --> 00:40:31,920 and I put a Berlin Heart in her again. 536 00:40:31,920 --> 00:40:35,560 The heart again recovered, 537 00:40:35,560 --> 00:40:37,600 and, um... 538 00:40:37,600 --> 00:40:39,680 and we took the Berlin Heart out. 539 00:40:39,680 --> 00:40:42,200 So, that was a fourth operation. 540 00:40:42,200 --> 00:40:47,520 We took it out and she managed to make a recovery from this. 541 00:40:47,520 --> 00:40:49,000 And... 542 00:40:51,120 --> 00:40:53,280 ..cross our fingers, she still remains OK. 543 00:40:56,320 --> 00:41:01,680 It's now been a year since the last time Hannah's heart failed. 544 00:41:01,680 --> 00:41:03,400 She's on the transplant list, 545 00:41:03,400 --> 00:41:06,520 but the way in which her heart APPEARS to be able to heal itself, 546 00:41:06,520 --> 00:41:09,440 is something her doctors are banking on for her recovery. 547 00:41:09,440 --> 00:41:13,080 In between her episodes of heart failure, she doesn't need anything. 548 00:41:13,080 --> 00:41:17,160 And her own heart is... you know, it's the best device, 549 00:41:17,160 --> 00:41:21,520 it's been perfectly designed and when it works well, it's a fantastic pump. 550 00:41:23,160 --> 00:41:26,840 She's, you know, not had any trouble for a year or so, 551 00:41:26,840 --> 00:41:31,360 and we certainly don't like to transplant people unless its absolutely necessary, 552 00:41:31,360 --> 00:41:34,440 because a transplanted heart doesn't last for ever either 553 00:41:34,440 --> 00:41:38,880 and brings with it a whole host of other issues that need to be looked after. 554 00:41:40,560 --> 00:41:42,520 It's a big day for Hannah. 555 00:41:44,400 --> 00:41:48,200 She's having tests to find out if she can come off the transplant list 556 00:41:48,200 --> 00:41:50,400 and that's why everyone's a bit nervous. 557 00:41:52,080 --> 00:41:55,320 Everything comes down to the results of this appointment. 558 00:41:55,320 --> 00:41:58,120 So her scan test is good, 559 00:41:58,120 --> 00:42:00,720 so the function has held up, basically. 560 00:42:02,080 --> 00:42:06,200 So it's the sense of us in the unit, 561 00:42:06,200 --> 00:42:10,840 that probably now is a good time to take her off the transplant list. 562 00:42:10,840 --> 00:42:13,920 You know, her functions held up well for a year. 563 00:42:13,920 --> 00:42:15,560 It's good news. 564 00:42:15,560 --> 00:42:18,480 Hannah's heart function has improved significantly 565 00:42:18,480 --> 00:42:21,040 and she's coming off the transplant list. 566 00:42:21,040 --> 00:42:23,600 Well, it's fantastic to see her. 567 00:42:27,440 --> 00:42:31,840 For Hannah's parents, today's results are everything they could have hoped for. 568 00:42:31,840 --> 00:42:34,400 We're very pleased to hear what Doctor Kirk said 569 00:42:34,400 --> 00:42:36,120 about Hannah's heart function. 570 00:42:36,120 --> 00:42:38,960 It's been recovered and it's been doing really good. 571 00:42:38,960 --> 00:42:45,520 And her name is off the heart transplant list, which is very... I mean, an important thing for us. 572 00:42:45,520 --> 00:42:47,840 It is, it's a big relief. 573 00:42:47,840 --> 00:42:52,000 We're obviously very, very pleased that her own heart has recovered, 574 00:42:52,000 --> 00:42:54,360 recovered enough to come off the list. 575 00:42:54,360 --> 00:42:59,560 A lot of people in your situation would be wanting, would perhaps be pushing for a heart transplant. 576 00:42:59,560 --> 00:43:01,800 How do you feel about that? 577 00:43:01,800 --> 00:43:05,160 From day one when she got ill, I would hope and pray 578 00:43:05,160 --> 00:43:07,880 that her own heart would get better, 579 00:43:07,880 --> 00:43:10,880 that always her own heart would get better, recover 580 00:43:10,880 --> 00:43:12,280 and she keeps her own heart. 581 00:43:12,280 --> 00:43:16,960 And I think even to this day, we would still do the same - we would hope and pray for that. 582 00:43:20,720 --> 00:43:24,040 It must take enormous courage to be Hannah and her family 583 00:43:24,040 --> 00:43:27,880 and to have endured what they've had to endure this past few years. 584 00:43:27,880 --> 00:43:31,080 And you begin to realise that if you're going to make progress, 585 00:43:31,080 --> 00:43:34,000 we're going to have to reinvent our concepts of the heart, 586 00:43:34,000 --> 00:43:36,120 we're going to have to find new insight, 587 00:43:36,120 --> 00:43:39,000 we're going to have to build an entirely new paradigm. 588 00:43:42,000 --> 00:43:43,720 There is a new hope on the horizon, 589 00:43:43,720 --> 00:43:48,440 one which everyone's hoping will be the fix-all to broken hearts. 590 00:43:50,440 --> 00:43:56,760 Something which capitalises on this idea that the heart might be able to regenerate. 591 00:43:56,760 --> 00:44:02,360 And in hospitals across the world, doctors and scientists are trying to harness these capabilities 592 00:44:02,360 --> 00:44:06,320 and use them to change the way we mend broken hearts. 593 00:44:06,320 --> 00:44:09,440 That new hope is stem cells. 594 00:44:10,880 --> 00:44:14,000 They're kind of like the body's ultimate spare parts rack. 595 00:44:14,000 --> 00:44:18,440 If your home had stem cells, it would be like being able to reach into your loft, 596 00:44:18,440 --> 00:44:23,320 pull out a lump of plastic and mineral and give it a shake and, on demand, 597 00:44:23,320 --> 00:44:26,600 have it turn into a television or a radio or a toaster 598 00:44:26,600 --> 00:44:29,400 or anything else you'd broken and wanted to replace. 599 00:44:29,400 --> 00:44:35,560 It's that property of renewal that scientists are hoping to exploit 600 00:44:35,560 --> 00:44:38,400 and it's that that makes stem cells so important. 601 00:44:40,200 --> 00:44:45,960 Peter Berry is a man who believes stem cells saved his life. 602 00:44:45,960 --> 00:44:50,160 Before being treated with stem cells, he'd suffered two heart attacks, 603 00:44:50,160 --> 00:44:52,840 leaving his heart irreversibly damaged. 604 00:44:54,720 --> 00:45:00,080 Just tell me a bit about what life was like before you had the treatment. 605 00:45:00,080 --> 00:45:02,640 It was pretty grim, actually. 606 00:45:02,640 --> 00:45:07,800 You know, I was... 607 00:45:07,800 --> 00:45:11,200 just basically, I was surviving and that was it. 608 00:45:11,200 --> 00:45:16,600 If I'd overstretched myself a bit, you know, perhaps I'd done too much gardening, 609 00:45:16,600 --> 00:45:18,840 I suddenly started to get out of breath, 610 00:45:18,840 --> 00:45:24,120 if I'd go upstairs, I'd stop about four or five times when it really got bad, 611 00:45:24,120 --> 00:45:25,880 to reach the top of the stairs. 612 00:45:30,000 --> 00:45:34,040 Peter's heart function had been reduced to just 20%. 613 00:45:35,560 --> 00:45:41,400 The only thing doctors could give him was medication, as he was too sick to survive a transplant. 614 00:45:43,080 --> 00:45:50,160 But five years ago, he took part in a stem cell trial, which he's convinced gave him his life back. 615 00:45:50,160 --> 00:45:53,560 After about seven weeks, I started to feel a lot better 616 00:45:53,560 --> 00:45:56,640 and people said to me, you're beginning to look better, 617 00:45:56,640 --> 00:45:59,560 you've got colour in your face, you're walking better, 618 00:45:59,560 --> 00:46:01,600 I wasn't getting out of breath so much 619 00:46:01,600 --> 00:46:03,720 and it just went on and on. 620 00:46:03,720 --> 00:46:08,400 I can do me gardening, I do decorating, ride me bike round the marshes, 621 00:46:08,400 --> 00:46:12,120 sometimes I'm over there two or three hours riding me bike. 622 00:46:12,120 --> 00:46:13,840 I do most things. 623 00:46:19,000 --> 00:46:22,800 It could be that Peter is one of the triumphs of the stem cell revolution. 624 00:46:22,800 --> 00:46:26,480 I was keen to find out how the stem cells might have fixed his heart. 625 00:46:28,720 --> 00:46:32,040 Peter took me to meet the man who led the trial, 626 00:46:32,040 --> 00:46:33,600 Professor Anthony Mather. 627 00:46:33,600 --> 00:46:38,320 Peter, you're a regular visitor to this hospital now. 628 00:46:38,320 --> 00:46:40,480 Oh, yes. yes. 629 00:46:40,480 --> 00:46:45,480 Professor Mather is trying to unlock the possibilities that many believe stem cells hold. 630 00:46:45,480 --> 00:46:48,600 You're back here a couple of times a year? Yes. 631 00:46:48,600 --> 00:46:54,120 He showed me what Peter's heart looked like before he'd received any stem cells. 632 00:46:54,120 --> 00:46:56,840 So the purple-blue colour up here is normal, 633 00:46:56,840 --> 00:47:00,680 so if you hadn't had a heart attack, this whole picture would be purple. 634 00:47:00,680 --> 00:47:04,080 But in Peter's case, because he's had damage to his heart, 635 00:47:04,080 --> 00:47:07,280 you can see red, and generally red is bad, and here it is too. 636 00:47:07,280 --> 00:47:11,600 The area of interest for us is this green band around the red part, 637 00:47:11,600 --> 00:47:17,520 which is an area that has got perhaps some degree of function but is not as it should be 638 00:47:17,520 --> 00:47:23,840 and that's the target zone that we were injecting the cells into for Peter. 639 00:47:23,840 --> 00:47:29,880 Peter was injected with stem cells from his own bone marrow and it's clear that his symptoms improved. 640 00:47:29,880 --> 00:47:34,040 But his recovery could not be backed up with any traditional evidence. 641 00:47:34,040 --> 00:47:39,760 Much to our surprise, we've seen some quite dramatic improvements in how people feel 642 00:47:39,760 --> 00:47:43,120 such that the stories of how their life has been changed 643 00:47:43,120 --> 00:47:46,800 simply being involved in the trial have been very dramatic, 644 00:47:46,800 --> 00:47:50,400 but, interestingly, very little changes in the pumping action of the heart 645 00:47:50,400 --> 00:47:55,960 and that's now making us reconsider whether measuring the pumping action of the heart 646 00:47:55,960 --> 00:47:58,280 is actually the best way of working out 647 00:47:58,280 --> 00:48:02,240 whether somebody is going to benefit from these new therapies. 648 00:48:02,240 --> 00:48:07,200 Peters scans after the stem cell treatment showed no change in heart function. 649 00:48:07,200 --> 00:48:11,600 So it's difficult to know precisely how the stem cells have worked. 650 00:48:11,600 --> 00:48:14,760 It is, on the face of it, almost a little bit difficult to swallow. 651 00:48:14,760 --> 00:48:16,320 You know, that the only... 652 00:48:16,320 --> 00:48:19,640 We have a few crude ways to parameterise the heart, 653 00:48:19,640 --> 00:48:25,520 and those measures don't obviously improve, but Peter in himself feels better, reports being better. 654 00:48:25,520 --> 00:48:27,240 Absolutely. 655 00:48:27,240 --> 00:48:31,240 The question is now, how has that happened and what is going on? 656 00:48:31,240 --> 00:48:33,960 And so it opens up a whole new field of research. 657 00:48:33,960 --> 00:48:37,120 But the benefit is that somebody has got better. 658 00:48:40,000 --> 00:48:42,280 None of this is very neat, 659 00:48:42,280 --> 00:48:46,640 and it's that state of perpetual uncertainty that has to exist 660 00:48:46,640 --> 00:48:50,920 at the start of any phase of medical exploration, of medical research. 661 00:48:50,920 --> 00:48:54,160 And that's where Mather and his team are at the moment. 662 00:48:54,160 --> 00:48:57,440 They understand that from that initial hope 663 00:48:57,440 --> 00:49:00,120 must follow many, many years of clinical trials 664 00:49:00,120 --> 00:49:04,600 before they get an answer that becomes a therapy and makes everything better. 665 00:49:06,120 --> 00:49:09,840 Stem cell therapy like this does appear to be doing something. 666 00:49:09,840 --> 00:49:13,440 Whether we understand what or how remains unclear. 667 00:49:13,440 --> 00:49:16,080 But the fact that Peter is a changed man 668 00:49:16,080 --> 00:49:18,800 hints at their potential healing properties, 669 00:49:18,800 --> 00:49:23,200 which people like Anthony Mather are seeking to understand. 670 00:49:28,040 --> 00:49:34,880 The last stage in my quest to find a way of mending broken hearts takes me to Spain. 671 00:49:34,880 --> 00:49:39,800 Because it's here that I think some of the most remarkable work with stem cells is going on. 672 00:49:39,800 --> 00:49:44,960 And there's a good reason as to why it's happening in Spain. 673 00:49:44,960 --> 00:49:49,360 It's the country with the highest rate of organ donation in the world. 674 00:49:51,040 --> 00:49:53,680 Every single person you see around you, all of these people 675 00:49:53,680 --> 00:49:57,680 are registered by the Spanish Government as potential organ donors. 676 00:49:57,680 --> 00:50:01,400 And even here, there aren't enough hearts to go around. 677 00:50:01,400 --> 00:50:05,640 But I've come to meet an American who's travelled all the way from Minnesota to Madrid, 678 00:50:05,640 --> 00:50:10,520 because she might just have found a way to mend a broken heart. 679 00:50:15,000 --> 00:50:18,680 The person I've come to meet is Dr Doris Taylor. 680 00:50:18,680 --> 00:50:24,080 I think if anyone deserves to be called a pioneer in science, it's her. 681 00:50:24,080 --> 00:50:28,960 Because she may have discovered a way of using stem cells to build a completely new heart. 682 00:50:30,960 --> 00:50:36,080 She has a very different ambition as to how stem cells might be used. 683 00:50:36,080 --> 00:50:39,800 Doris, we've been looking for a way to mend broken hearts, 684 00:50:39,800 --> 00:50:43,000 and I wondered if you might be able to help us with that. 685 00:50:43,000 --> 00:50:44,680 I hope so. 686 00:50:44,680 --> 00:50:47,000 We've basically developed a way 687 00:50:47,000 --> 00:50:52,880 that lets us take a heart from a cadaver, 688 00:50:52,880 --> 00:50:57,960 drain all the cells, use the underlying scaffold, 689 00:50:57,960 --> 00:51:04,240 transplant your own cells back in and rebuild the beating heart - it's amazing. 690 00:51:04,240 --> 00:51:09,320 And build a new heart is precisely what she's done. 691 00:51:10,840 --> 00:51:17,280 Doris realised that what she needed to make this happen was a framework to put the stem cells on. 692 00:51:17,280 --> 00:51:18,880 You need a scaffold, 693 00:51:18,880 --> 00:51:22,400 you need a place to put those cells so they know that they're a heart. 694 00:51:24,160 --> 00:51:29,760 And so she started by taking a rat heart and removing all its cells. 695 00:51:32,880 --> 00:51:36,720 Then she tried the same thing on a pig's heart. 696 00:51:36,720 --> 00:51:39,200 And here is that scaffold. 697 00:51:40,720 --> 00:51:44,920 The matrix that is left when you've removed all the cells from the heart. 698 00:51:47,240 --> 00:51:51,080 And that we call our "ghost heart". It's beautiful. 699 00:51:53,400 --> 00:51:58,240 And if you think that sounds a bit far-fetched, it isn't. 700 00:52:00,880 --> 00:52:07,080 Even more incredibly, two years ago, she succeeded introduced stem cells to a rat heart scaffold 701 00:52:07,080 --> 00:52:10,480 and made it beat again. 702 00:52:10,480 --> 00:52:14,160 Now we'd like to think that we've opened a door 703 00:52:14,160 --> 00:52:21,720 for building complex tissues and organs, and that the world of transplant may change as a result. 704 00:52:21,720 --> 00:52:25,000 Now she's gone one step further. 705 00:52:25,000 --> 00:52:30,840 She's trying the de-cellularisation process in human hearts with the same ambition. 706 00:52:30,840 --> 00:52:33,200 So this is it. This is your lovely new lab. 707 00:52:33,200 --> 00:52:35,000 When was it opened? 708 00:52:35,000 --> 00:52:37,280 Two days ago, fabulous. 709 00:52:37,280 --> 00:52:41,800 Doris is going to show me the technology that she's invented 710 00:52:41,800 --> 00:52:45,440 to rebuild a human heart with stem cells. 711 00:52:45,440 --> 00:52:48,160 This is our new cell culture laboratory. 712 00:52:48,160 --> 00:52:53,560 It's a process which, for now, begins with a donor heart. 713 00:52:53,560 --> 00:52:59,760 This is a heart that was actually harvested earlier this week. 714 00:52:59,760 --> 00:53:04,520 It's a bit sobering to actually have the opportunity 715 00:53:04,520 --> 00:53:08,280 to be holding a bowl with a human heart in it 716 00:53:08,280 --> 00:53:15,200 and then think that we... somebody enabled us to move this technology forward. 717 00:53:15,200 --> 00:53:18,360 This heart couldn't be transplanted, 718 00:53:18,360 --> 00:53:22,560 but what we learn from it could change the world of transplantation. 719 00:53:22,560 --> 00:53:24,560 This is really the first time 720 00:53:24,560 --> 00:53:28,600 I've ever held a human heart in this context, in this way. 721 00:53:28,600 --> 00:53:36,040 It's very difficult, really, to express how amazing it really is. 722 00:53:36,040 --> 00:53:38,720 I... You know, that is a human heart 723 00:53:38,720 --> 00:53:44,040 and...everything that it represents, really. Exactly. 724 00:53:44,040 --> 00:53:45,720 I think it's quite incredible. 725 00:53:45,720 --> 00:53:50,760 The first thing she has to do is create a ghost heart. 726 00:53:50,760 --> 00:53:54,840 It's a process that involves hanging the heart in the best position possible 727 00:53:54,840 --> 00:53:57,160 to be able to strip it of its own cells. 728 00:53:57,160 --> 00:54:01,880 The idea is that we use the detergent here 729 00:54:01,880 --> 00:54:05,080 to wash all the cells out of the heart. 730 00:54:05,080 --> 00:54:07,600 And so where blood would have once run, 731 00:54:07,600 --> 00:54:12,720 you actually now have detergent running, and that's just to dissolve the cells? Literally. 732 00:54:12,720 --> 00:54:17,480 It takes just three days for the ghostly scaffold to emerge. 733 00:54:21,600 --> 00:54:26,480 We've actually cut this heart to look at the inside, 734 00:54:26,480 --> 00:54:30,360 and it's been in formalin, 735 00:54:30,360 --> 00:54:36,960 but you can see the cells are gone but the structure is there. 736 00:54:36,960 --> 00:54:38,440 That's just incredible, 737 00:54:38,440 --> 00:54:42,800 and this is the dissected scaffold of the heart. 738 00:54:42,800 --> 00:54:44,400 Scaffold of a human heart. 739 00:54:44,400 --> 00:54:45,480 Very beautiful. 740 00:54:45,480 --> 00:54:50,280 I don't think I ever anticipated that after you've got rid of all of the cells, 741 00:54:50,280 --> 00:54:52,240 there's so much structure left. 742 00:54:52,240 --> 00:54:57,880 We can put that back together and it essentially looks like a heart. 743 00:54:57,880 --> 00:55:01,240 Yeah. This really does give you a scaffold on which you can work. 744 00:55:01,240 --> 00:55:05,720 You can just see how that's going to be something that you can just stick cells back on top of. 745 00:55:07,240 --> 00:55:10,480 And it's when stem cells are placed on the ghost heart 746 00:55:10,480 --> 00:55:14,200 that their amazing potential for regeneration can be realised. 747 00:55:14,200 --> 00:55:17,800 Wow. That's quite incredible. 748 00:55:17,800 --> 00:55:24,880 The hope is that the scaffold will allow them to go on and make this heart beat again. 749 00:55:24,880 --> 00:55:32,560 Doris, we know stem cells have magnificent potential, but how do they really know how to be a heart? 750 00:55:32,560 --> 00:55:34,960 We think it's architecture. 751 00:55:34,960 --> 00:55:36,320 If you think about it, 752 00:55:36,320 --> 00:55:37,640 cells in a dish beat, 753 00:55:37,640 --> 00:55:39,560 but that doesn't make a heart. 754 00:55:39,560 --> 00:55:42,360 When we put them back in this scaffold, 755 00:55:42,360 --> 00:55:44,960 they find themselves in the right place. 756 00:55:44,960 --> 00:55:47,280 They're surrounded by the right things. 757 00:55:47,280 --> 00:55:50,640 They know they're in a thin region, a thick region. 758 00:55:50,640 --> 00:55:54,680 And we really think that to build an organ 759 00:55:54,680 --> 00:55:57,520 is not just a combination of cells, 760 00:55:57,520 --> 00:56:00,600 it's cells and architecture and physiology. 761 00:56:00,600 --> 00:56:04,160 What is your ultimate goal in all...? 762 00:56:04,160 --> 00:56:07,800 Where in all of this exploration do you hope to be at the end? 763 00:56:07,800 --> 00:56:12,800 The thought would be that we would take a heart, probably from a pig, 764 00:56:12,800 --> 00:56:16,920 do this process, wash all the cells out, 765 00:56:16,920 --> 00:56:24,800 and then take your cells, and grow enough of them to repopulate this with your cells, 766 00:56:24,800 --> 00:56:27,360 build a heart that matches your body 767 00:56:27,360 --> 00:56:31,280 and have it transplanted into you, that's a home run. 768 00:56:35,040 --> 00:56:38,720 If this works, it will be revolutionary. 769 00:56:38,720 --> 00:56:43,080 It would mean that your broken heart could be replaced with a new heart 770 00:56:43,080 --> 00:56:45,280 built using your own cells. 771 00:56:47,960 --> 00:56:51,440 We should be clear about what we're looking at here - 772 00:56:51,440 --> 00:56:54,560 this is the beautiful gift of a donated heart. 773 00:56:54,560 --> 00:57:00,400 And even though it wasn't suitable for transplant, its journey doesn't end here. 774 00:57:00,400 --> 00:57:03,720 It will go on in this laboratory to have its cells removed 775 00:57:03,720 --> 00:57:10,840 and then to be repopulated with stem cells, and finally, it will eventually beat again. 776 00:57:10,840 --> 00:57:13,760 And in advancing our understanding of the heart, 777 00:57:13,760 --> 00:57:17,640 our understanding of how to build hearts, ironically, 778 00:57:17,640 --> 00:57:22,120 it may not just save one life but go on to help to save millions. 779 00:57:35,800 --> 00:57:39,480 The search for a way to mend a broken heart is the story of medicine. 780 00:57:39,480 --> 00:57:43,480 It's about the war against disease, the incredible courage of individuals 781 00:57:43,480 --> 00:57:46,200 and our search for a deeper understanding. 782 00:57:46,200 --> 00:57:50,040 And everything I've seen makes this feel like a truly exciting time, 783 00:57:50,040 --> 00:57:53,160 like we're on the cusp of something genuinely extraordinary. 784 00:57:53,160 --> 00:57:56,000 Somewhere in all of this lies the answer. 785 00:57:56,000 --> 00:57:59,720 That might be engineering, it might be stem cells, it might be computation. 786 00:57:59,720 --> 00:58:03,520 But whatever it is, you can be sure that science and medicine 787 00:58:03,520 --> 00:58:05,720 will run as hard and as fast as they can 788 00:58:05,720 --> 00:58:10,080 till they find that thing that finally makes a difference for all of us.