Call on matters of heart

How heartsick do you have to be in order for doctors to either replace or mechanically assist your heart?

Sick enough that other available treatment options won't work, and strong enough to survive and recover from the surgery, according to Dr. Stephen Clayson, associate surgical director of the Utah Artificial Heart Program at Intermountain Medical Center.

Clayson will join Marla Fisher, a nurse coordinator with the artificial heart program, to answer detailed questions about the whys and hows of ventricular assist devices and artificial heart implantation Saturday during the monthly Deseret News/Intermountain Healthcare Health Hotline.

Those with questions should call 1-800-925-8177 from 10 a.m. to noon, or send an e-mail to hotline@desnews.com. The hotline number is only operational during hotline hours.

Age is a major consideration for those looking to have the surgery in which doctors open the chest cavity from the top of the sternum to the navel. And "55 is probably around the upper limit," Clayson said, noting that children with severe heart failure or those awaiting heart transplant are eligible for the mechanical devices.

The criteria are much the same for patients put on the transplant list, he said

"We would do a bridge (implant a mechanical device in someone awaiting a heart transplant) with a very sick person and take a chance, but if we see someone at age 62 with no family support, other major health factors and not compliant with medication (routines), we probably wouldn't" implant a mechanical device, he said.

"Sometimes there are external factors beyond the desire" of patients to have an implant.

One major factor is caregiver support, Clayson said, because those who have the VADs ?— most often left ventricular assist devices, or LVADS — must care for the abdominal exit site where the driveline which powers the unit attaches to a power supply outside the patient's body. Without a family member or friend who is dedicated to and meticulous about following sterilization procedures, keeping the exit site clean and changing the dressing several times a week, patients won't do well with a device, he said.

"You could probably live alone with a heart transplant if you take the medications on schedule and get the regularly scheduled blood draws, but with these (mechanical device) patients, if the machine fails for some reason, you have to have a caregiver to slip in new batteries or work a hand pump" to keep the heart beating, he said.