By MITZI BAKER

It was nearly 20 years ago that a Stanford team performed the world's first successful implantation of a left ventricular assist device, or LVAD, into the chest of a gravely ill patient to keep him alive long enough to receive a heart transplant. "When I woke up after surgery, it was immediate: no more pain. It was amazing," the patient, Robert St. Laurent, recalled.

The device he received has since become a lifesaver for thousands worldwide. St. Laurent, who was given only 24 hours to live before the surgery, depended on his LVAD for just over eight days in 1984 until a donor heart became available. He has traveled from Florida to join others who received new hearts at Stanford and to reunite with the team that saved his life.

Robert St. Laurent talks with his wife Cynthia and son Randy (above) during the eight-day period when he had his LVAD. Twenty years later, he is one of the longest-surviving heart transplant recipients in the world. The Florida resident is in town for a reunion party. Photos: Courtesy of Peer Portner

Today's annual heart, heart-lung and lung transplant reunion party marks this milestone while celebrating other transplantations that have taken place at Stanford before and since. With more than 1,000 heart transplantations under their belts, and more than 100 each of lung and heart-lung transplantations, Stanford Hospital & Clinic's cardiothoracic surgery team is creating an ever-growing group of survivors with a new lease on life.

In addition to St. Laurent, many of the hundreds of other Stanford transplant recipients will attend the reunion party. Confirmed guests include former San Francisco 49ers linebacker Dean Moore. The evening also will include entertainment highlighting improvisational music talents of former patients, said Mary Burge, a clinical social worker who specializes in the psychological conflicts that transplant recipients face. A longtime Stanford Hospital employee, Burge worked with St. Laurent when he was a patient here two decades ago. Although he does not play a musical instrument, St. Laurent said he's "looking forward to a good laugh at the jam session."

"Robert St. Laurent is an incredible living example of translational research," said Robert Robbins, MD, associate professor of cardiothoracic surgery and director of the heart-lung transplant program at Stanford Hospital & Clinics. "More than 10 years of research went into the development of the device before it was used in St. Laurent, who benefited from both our transplantation program and the LVAD that allowed him to live long enough to receive a new heart."

St. Laurent had been on the waiting list for a heart but probably wouldn't have survived long enough to get one, said Peer Portner, MD, consulting professor of cardiothoracic surgery, who developed the device used in St. Laurent and has stayed in contact with him over the years.

Portner's LVAD had been approved by the Food and Drug Administration two months before St. Laurent arrived here in 1984. "He just happened to be in the right place at the right time," Portner said. "I think a lot of the success of the device has to do with Phil Oyer's great judgment in picking an extremely good candidate." Philip Oyer, MD, the Roy B. Cohn-Theodore A. Falasco Professor of Cardiothoracic Surgery, implanted the device in St. Laurent.

Today, LVADs such as the one illustrated in this cutaway drawing ease the load on a diseased heart, providing a bridge to eventual transplant. Photo: Courtesy of World Heart Inc. & Novacor

Since the LVAD previously had been untested in humans, the only information St. Laurent had to allay his apprehension was a report he received from Burge that the three sheep implanted with the device were going about their business, calmly lying down and chewing their cud, seemingly unconcerned. Burge recalled that Cynthia St. Laurent, Robert's wife, laughed so hard at this unconventional "patient update" that she spewed coffee all over her pink angora sweater.

A little over a week after surgeons implanted the LVAD, he received the heart of an 18-year-old college student who was left brain dead after a car accident -- a poignant twist for St. Laurent who had a son the same age. "All I know is that he must have been a good-living boy because the heart works really well even after all this time," he said.

Not only was St. Laurent the first to benefit from an LVAD to buy time until transplantation, but after 20 years he is among the longest-living transplant survivors. The country's second-longest surviving heart transplant patient is Tony Heusman, who celebrated the 25th anniversary of his heart transplant from Stanford last summer.

Ever since Norman Shumway, MD, the Frances and Charles Field Professor of Cardiovascular Surgery emeritus, and his colleagues performed the first adult heart transplant in the United States in 1968, and Bruce Reitz, MD, the Norman E. Shumway Professor in Cardiovascular Surgery, successfully transplanted a heart and lung for the first time in the world with his team in 1981, Stanford has pioneered advances in heart and lung transplantations. About 50 patients undergo heart transplantation each year at Stanford -- the most of any hospital in Northern California -- with an additional 12 to 20 patients receiving some type of lung transplant.

Understanding LVADs

• LVADs are surgically implanted mechanical circulatory support devices that help an ailing heart pump blood. They move blood from the left ventricle and return it to the aorta by a pump.

• The patient's heart is still intact, remaining partially functional and often improving under its lessened workload. An LVAD can allow the heart to get increasingly stronger; preliminary studies suggest that heart pumps may sometimes reverse the course of heart failure.

• The pumps are slightly larger than a human heart and weigh about 2 pounds. Surgeons implant the device in a pocket they create below the skin within the abdominal wall muscles.

• During placement, doctors tunnel two conduits through the diaphragm from the pump, one leading to a hole cored in the apex of the heart's left ventricle, the other to the ascending aorta. A tube with about the same diameter as a cigar carries control and power wires out through the patient's skin to battery packs.

• The batteries, which last for about four hours, and controller weigh about 4 pounds and can be tucked into a vest pocket, worn on a belt or carried in a shoulder bag. The recipient can also run the device by plugging it into a wall socket.

• LVADs emit a distinct ticking sound likened to a grandfather clock or the clip-clop of horse hooves on cobblestone.