Michael Brandy, Deseret News
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 firstname.lastname@example.org. 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.
Financial support via a good insurance plan is essential, he said, noting the LVAD alone costs about $80,000, excluding the added cost of at least two weeks in the hospital, anesthesiologist, surgeons and other expenses.
The size of the patient used to be a consideration because first generation pumps were so large, they weren't viable for smaller adults, but the second generation pumps now in use are so small "anyone should be able to have it because there's enough space for it" inside the body. "This machine is the size of your fist implanted under the skin — about the size of a couple of D-cell batteries."
Once a patient undergoes an implant and recovers from the surgery, the biggest challenge early on is avoiding infection, Clayson said. "Any time you put a foreign body into the human body, things will get infected." Of all the current medical procedures, an "artificial heart pump is biggest foreign body we place inside a human. The electrical cord that comes out is a port for infection to go in."
Patients also must take anti-coagulation medication so the blood doesn't clot inside the pump, he said.
Those who successfully undergo the implant and recover well "see a profound difference in the quality of their lives," Fisher said. People with late stage heart failure are suffering from a lack of blood perfusion to their vital organs, and are often simply in survival mode physically and emotionally, she said.
Often after an implant, "their personalities just come to life. We've had several when it's been a very dramatic improvement. I like to point that out especially with high school students and young children, it can really be a profound difference. One woman told me, 'I got my husband back,' that's how dramatic it was. He just kind of came back to life."
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