The Heart of the Matter

Serendipitous might be how one would describe Michael Harostock's entry into the world of medical research. Son of a cardio-thoracic surgeon in Wilkes-Barre, Pennsylvania, and now a pre-med student at Penn State Altoona, Harostock often visited with the folks at Wilkes-Barre General Hospital where his father worked, watching doctors make rounds and observing surgery.

On a day off from classes at Penn State Wilkes-Barre [where Harostock was enrolled prior to entering Altoona this fall], Harostock was invited to observe the hospital's new heart-lung machine in action. The machine was the first of its kind in the country, so the opportunity was significant. How significant an opportunity this would turn out to be was not imaginable at the time.

The sales representative from Medtronic, the company that developed the machine, also was present. On a whim, Harostock states,"I asked him how many people the machine had been used on. And he looked at the surgeon, the surgeon looked at the anesthesiologist, and the anesthesiologist looked at the perfusionist. It turns out that no one knew how many people had used this machine or the significance of its effects."

Recognizing the importance of this question, the Medtronic representative followed up with his company and discovered that there was student grant money available for research of this kind. Harostock applied for the grant and began assembling the data.

THE HEART-LUNG MACHINE

The heart-lung machine is used during cardiopulmonary bypass surgery (CPB), serving as the patient's heart and lungs while their own are stopped during the procedure. During surgery, blood passes from the patient into the machine, where it is filtered and oxygenated and then is sent back into the patient's body.

Because of an effect called hemodilution, the need for a blood transfusion is significant with CPB. Hemodilution is the dilution or contamination of the blood due to its contact with a foreign surface—in this case, the heart-lung machine. This diluted blood, when placed back into the patient, often is rejected by the body, necessitating a blood transfusion. The transfusion itself carries many risks, including virus and disease transmission as well as rejection of the blood due to incompatibility.

Medtronic's new, or "miniaturized," heart-lung machine seeks to reduce hemodilution by reducing the surface area with which the blood comes into contact. While the conventional machine has a large reservoir that acts as a holding tank for the blood, the miniaturized version has none. Instead, the blood enters one tube, passes through the machine, exits through another tube, and reenters the patient. A further reduction in surface area is the tubing itself; its volume and length is significantly reduced in the miniaturized system. Harostock notes, "They have taken a system that's been proven to work, although it had some consequences, and updated it by making it smaller."

Harostock also notes that the miniaturized system is technologically superior to its predecessor machine. For example, the conventional system requires a perfusionist to take blood out of the patient in order to check important blood levels; with the miniaturized system, the levels can be read straight from the machine. All of these improvements are important, notes Harostock, because "they are taking less blood out of the patient and putting more back, in effect."

Harostock's research centered on the key issues of hemodilution and blood conservation to determine if the miniaturized system had a statistically significant effect on the transfusion rate associated with CPB.

"We were expecting a decrease in transfusions," states Harostock. "We just didn't expect it to be as significant as it was."

The research revealed that, with the miniaturized system, the rate of transfusion went from sixty-three percent to thirty-six percent.

While the miniaturized system carries a price-tag of $150,000, in pure dollars and cents, the cost savings are significant.

Patients treated with the conventional machine received an average of 3.2 units of blood; with the miniaturized version this was reduced to 1.2 units. With a savings of two units per patient, and a cost of $1,000 per unit of blood, hospitals are looking at a cost-savings of $2,000 per patient.

"It makes sense business-wise and it makes sense health-wise … the patient experiences a better outcome while the hospital saves some money, too."
—Michael Harostock

While Harostock notes that "the monetary gains are important for people working with the checkbook, what does this mean to the people working with the patient? It means that a person who needs open-heart surgery and will be maintained on the miniaturized system is at a much less risk of receiving a transfusion, which puts the patient at a much less risk for things like blood disease transmission." So, concludes Harostock, "it makes sense business-wise and it makes sense health-wise [to use the miniaturized system]; the patient experiences a better outcome while the hospital saves some money, too."

OH, CANADA

After realizing the significance of their research, Harostock authored and submitted a paper detailing their findings to the World Society of Cardio-Thoracic Surgery, where it was accepted for publication and lecture at the Ottawa Heart Institute in Canada. Harostock is denoted as the "primary author," while others listed on the paper as "authors" assisted him in his writing, proofreading, and editing for clarity and content.

Harostock and his colleagues traveled to the World Congress meeting in Ottawa during the summer of 2006, where their fellow presenters included undergraduates, graduate and post-graduate students, and physicians from around the world. Harostock states, "The experience was incredible. The presenters were from real hot-beds of international research. I got to hear speeches about subjects like gene therapy, which we didn't even know existed ten years ago and now it's hard to imagine the future without it. It was very humbling, because here we are, just a couple of guys from Wilkes-Barre with just a little comparison paper."

Humility aside, the paper sparked interest and, while they were preparing to leave for Canada, they received a letter from the World Congress that their paper placed in the top ten in the applied research category. Overall, 1,200 abstracts were submitted to the Congress; 700 were accepted. There were six categories of research, each recognizing the top ten abstracts.

Harostock likens his experience at the World Congress to beginning college. "I met some surgeons who are considered to be living legends in their field; some of the people I read about in journals were there. I got to talk to other undergraduate students from around the world about their research. So, it was kind of like college, where you show up and don't know what to expect and are very nervous and out of your element. But then you meet some people who are very nice and it becomes a great experience."

After starting his Biology degree program at Penn State's Wilkes-Barre campus, Harostock had to complete his degree at another campus offering a four-year degree program in Biology. He chose to attend Penn State Altoona due to its small class-size, opportunity for undergraduate research, and the personal attention he received from one faculty member right from the start. "I was trying to make my decision about which campus to attend and I called Professor Winsor to ask about Altoona's Biology program. He spent an hour and a half talking to me on the phone—as much if not more time any professor had ever spent with me!"

Planning to graduate from Penn State Altoona in spring 2008, Harostock hopes to continue his undergraduate research at the college; he has some ideas involving membrane transportation that he hopes to pursue. And he already is looking toward the future. With his eye on medical school, Harostock is leaning toward the Hershey Medical Center. "One of the anesthesiologists that I have worked with graduated from Hershey and had nothing but positive things to say about it. And I'm very pro-Penn State, so I wouldn't be upset at all if I went to Hershey."