Surgeon Cuts Out Heart, So Patient Can Live
Increasingly, heart transplants are being delayed, and heart failure patients are being saved by mechanical devices.
Heart disease and other problems like coronary artery disease are becoming increasingly common in the United States, and often lead to heart failure. While medicinal treatments help many heart failure patients, surgical intervention is often required, as well.
Dr. Robert Love is a heart transplant surgeon and director of cardiac surgery at Froedtert & The Medical College of Wisconsin. He says heart transplants are the standard of care after other medical options are exhausted.
But he's seen the number of hearts available for transplant "plateau," with more older donor hearts available than healthy young ones.
"A lot more of the hearts that are offered for transplant are simply not suitable to be transplanted, so the era of mechanical circulatory support is really here," he says.
That support comes in the form of mechanical devices, including ventricular assist devices (VADs), that help maintain the heart's ability to pump blood through the body. Though the idea for artifical heart pumps goes back to the days of Charles Lindbergh, they weren't really developed until the 1960's.
At first the pumps existed outside the body, and later became implantable pumps. These came into wider use in the early 2000s. Love says now the focus is on making them smaller with better technology.
"That's a good thing because hundreds of thousands of people die every year from heart failure and instead of heart transplant being the only alternative to medical therapy, we do have another temporizing device that can get people quality of life, longevity of life and the ability to get a transplant," he says.
There are, of course, dangers with these devices, including the risk of blood clots.
"It's an unnatural thing to have a manmade device inside your heart," he says, "so there are certain limitations that we run up against, just because we're not replacing the tissue failure with an organ that actually works, which would be the ideal, but we're making huge progress."
But sometimes, even those lifesaving devices aren't enough. Last November, Love performed his first "total artificial heart" transplant, on a Wisconsin patient named Kathleen Shores. (We’ll hear her describe her new mechanical heart tomorrow).
Whereas most heart failure patients experience failure on just the left side, both sides of Shores' heart were essentially dead and her body was in shock in the ICU. But there really weren't any mechanical devices available for Shores that could account for both sides of her heart - and her small size.
"We don't have an implantable device that will allow you to keep your native heart and put something in for the right side and the left side that's all inside the body," Love says.
So Love removed both sides of her heart and outfitted her with the total artificial heart. These pumps and valves were connected to her remaining tissue and are powered by a battery pack, which she carries around with her.
Now that she has a working - albiet artificial - heart, Shores is able to live at home, rather than the hospital. She exercises, goes shopping and raises her children, keeping her daily routine as she waits for a new heart. Love says it was the only, if not perfect, solution for Shores.
"You can still see that she is encumbered with some heavy equipment that she's got to push around, and she knows every minute that she's utterly dependent on hearing the sound of those four valves," Love says.
Total artificial heart surgery is a rare option - only about 100 or so patients are currently living with the implanted device at home, awaiting a transplant. For the surgeon, the procedure must be technically perfect.
"(It's) about as big an operation as one can do, complete removal of the heart and replacement with mechanical pumps," Love says. "When you cut out somebody's heart, you can't fix it, you have to fix it with a mechanical device and it's gotta work, or the patient is going to die."
Tomorrow on the show, the series concludes with the experience of Kathleen Shores, one heart failure patient who received a total heart replacement.
Watch Dr. Love below.