Published: February 21, 2011
What Was Once Just a Bridge Takes Over as Long-Term Rescue for Failing Hearts
STANFORD, Calif. - (BUSINESS WIRE) - Donna Jackson was not a spry youngster when she began to notice she
tired more easily. But she could still carry her own groceries in from
her car and she loved her daily water aerobics class. Her doctors told
her they thought it was bronchitis, then pneumonia and, then, allergies
that were slowing her down. She was 67, after all, and she had
spent many years nursing her husband before his death.
Jackson knew something was going on with her health. Her medical
treatments weren't having any impact and her breathlessness continued to
worsen until one day she couldn't make it from her car to her front door
without stopping to rest. "I got so tired I wanted to sleep all the
time," she said.
Then, in July 2010, she went to the doctor again. This time, she was
given an echocardiogram, a test that tracks measures the heart's
activity. The result was alarming - her heart was working so feebly that
with each beat it was pumping only 12 percent of the blood in her heart,
only one-fifth of the oxygenation her body needed. Within days, Jackson
was at Stanford Hospital & Clinics. Her new physician was cardiologist Dipanjan
Banerjee, MD. His diagnosis was unexpected and drastically
life-altering: Jackson had congestive heart failure. But he couldn't
tell her why. Sometimes heart failure has no obvious cause. Jackson's
heart valves were working, her arteries were clear, her cholesterol was
normal, and so was her blood pressure.
Yet the left ventricle of her heart, the muscular chamber that
constitutes half of the pumping needed to keep blood flowing around the
body, was failing, rapidly. The standard treatments, those that address
problems like clogged arteries and faulty valves, would be pointless.
What Jackson needed to survive was a heart transplant. It didn't make
her feel better that Banerjee told her he'd never had a transplant
candidate as healthy as she was.
First, however, she had to agree to a transplant, and for days her
answer was no.
"I had a really hard time," she said. "I didn't want to put my kids
through the thing of me having a transplant. Somebody would have to take
care of me. And I'm thinking that I'd rather leave a heart available for
someone younger who has a life ahead of them. And if I had a transplant,
then I'd have to take immunosuppressants that would mean I wouldn't have
been able to be with my great-grandchildren if they were sick. I just
didn't want to go through all that."
A Different Option
Heart disease includes a long list of conditions. Heart failure, which
specifically covers the heart's ability to pump blood, has become more
and more common. A National Heart Discharge Survey showed that hospital
admissions involving heart failure rose from more than 1 million in 1979
to 4 million in 2004. In addition, fewer hearts are available for
transplant. The number has not risen since 1999, and the gap between
available organs and people waiting is increasing. Last year, 3,000
patients were on the list and 2,000 heart transplants were completed.
But Jackson had another option, an existing device approved for a new
function by the FDA a couple of months earlier. And Stanford had earned
a special advanced designation from the Joint Commission, the
accrediting body for American healthcare facilities, as a hospital with
a high level of excellence in working with that device, the left
ventricular assist device, commonly called the LVAD.
It's a small mechanical pump that takes over what the ventricle can no
longer do. For the last decade, physicians have used it as a bridge
"when patients need it now," Banerjee said, for people on
the transplant list, helping to keep them alive for the days, weeks or
months until a heart became available.
Jackson was a good candidate for an LVAD because she was sick enough to
need it to survive, but not so sick that she wouldn't survive surgery.
The LVAD is part of the family of mechanical devices built to sustain
the heart, either as a temporary support during surgery or as a complete
substitute for its function. The first cardiopulmonary by-pass machine
emerged in 1954. In 1982, a Seattle dentist named Barney Clark, who
suffered from congestive heart failure, lived 112 days after surgeons
implanted an artificial heart in his chest. The device was intended to
be permanent, but the 400-pound air compressor that powered it was
clearly an obstacle to anything approaching a normal life.
Almost three decades later, the current LVADs run on 10-hour batteries
that weigh a pound each and a 2-pound controller- not light, but
certainly portable. The LVAD also stores a record of its activity that
can be downloaded for review.
Better Mechanics
Only recently, however, has the technology and reliability of the device
improved enough for the FDA to approve it to be implanted not only for a
short time, but for years, as a long-term alternative to transplant. Its
value rises with each year, Banerjee said. "We can see the writing on
the wall - the number of hearts available each year has not risen since
1999 and the number of people needing a heart is rising every year. The
gap between them is getting larger," he said. "We are blessed to have
the LVAD, and in some cases, it's better than a transplant."
Life after a transplant comes with a long list of must-do's. At the top
of the list are the immunosuppressants Jackson knew about, medications
needed to keep the body from rejecting the transplanted organ.
Life after an LVAD has its downsides, too. Its primary battery and
back-up batteries must be worn at all times, carried in a
specially-modified harness or vest. A controller goes around the waist.
It can't handle exposure to moisture, for obvious reasons. It does put
certain limits on physical activity. And because it's a mechanical
machine that's driving a delicate human organ, its settings must be
adjusted to just the right force and speed.
Jackson considered. "Everyone kept telling me, 'Mom, it's your life,
whatever you want to do.' They left it up to me," she said.
"We were just grasping at straws for anything to keep her alive," said
her daughter-in-law, Cheryl. "But it had to be her decision." But
waiting and watching was hard, said Fred Jackson, one of her two sons
and Cheryl's husband. "She was going downhill so quick."
One night, Jackson said, "I was lying in bed, kind of crying and I said,
'God, I can't take this anymore, whatever you think I should do, I'll
leave it up to you.'"
She had also had a conversation with her 6-year-old great-granddaughter,
Peyton. The little girl reminded Jackson that in that last couple of
years, she'd lost two grandparents and a great-aunt "and she wanted me
to be around," Jackson said.
A New Life
That was enough to persuade Jackson to okay the LVAD. Her care was
directed and supported by a large, multidisciplinary team of
professionals. It was not an easy surgery; her recovery took weeks. But
her family was with her, helping so much that the Stanford nurses joked
that Jackson's daughter-in-law, Cheryl, should be given an honorary
nurse's license. Peyton and her brother, 8-year-old Mason, have become
her unofficial guardians, reminding her about her diet, especially not
indulging in salty foods. Peyton is even more connected to Jackson.
She's learned how to help her great-grandmother test the batteries and
the monitor that is also a part of the LVAD system.
What excites cardiologists like Banerjee is the possibility that, with
the LVAD taking the strain off, some patients' hearts might recover
enough to have the LVAD removed. The next step in heart care may be
something that's more of a repair than a replacement, Banerjee said, "a
ventricular device that would allow us to keep as much of the original
tissue and native heart function as possible. It's always better to have
what Mother Nature gave you."
The LVAD became a part of Jackson's life in late September, and Jackson
has a life that includes most of her previous activities. She reads on
her computer, does laundry, changes the sheets on her bed and when the
weather is good, goes for a daily walk with her best friend, Betty
Birdsong. Sometimes they go shopping. "I do everything for myself," she
said. "I've gotten used to all the equipment and stuff. And I'm planning
a trip to Hawaii next year."
She sees Banerjee regularly and couldn't speak more highly of him and
all the professionals at Stanford whom she came to know during her
treatment. "I could not find one doctor who had a bad bedside manner!"
she jokes. "And the nurses treated my family really nicely."
She would like to go to her water aerobics class again, and has
suggested to Banerjee that perhaps a wet suit might work. He's looking
into it, she said. A friend is putting together a backpack for the
batteries that's a bit more feminine than the black one she currently
wears. "Everything's been going good," she said, and, with a bit of
pride, "Dr. Banerjee keeps saying, 'People aren't in your shape after
having this!'"
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of
complex disorders in areas such as cardiovascular care, cancer
treatment, neurosciences, surgery, and organ transplants. Consistently
ranked among the top institutions in the U.S. News & World Report
annual list of "America's Best Hospitals," Stanford
Hospital & Clinics is internationally recognized for translating
medical breakthroughs into the care of patients. It is part of the
Stanford University Medical Center, along with the Stanford University
School of Medicine and Lucile
Packard Children's Hospital at Stanford. For more information, visit http://stanfordmedicine.org.
Click here
watch video of LVAD patient Donna Jackson.
Stanford Hospital & Clinics
Liat Kobza, 650-723-1462 (Media)
lkobza@stanfordmed.org
Sara
Wykes, 650-721-6263 (Writer)
swykes@stanfordmed.org
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