Advanced heart-pump technology provides options for those with end-stage heart failure
UC Davis’ first ventricular assist device recipient reaches out to nurses, new patients
Posted March 7, 2012
In February 2010, Stockton resident Steve Schmidt suddenly realized he no longer had the stamina to work at his construction job. At 52, the nonsmoker and teetotaler found that walking a block made him short of breath. He was also plagued with pain in the back and side and, despite an underwhelming appetite, had gained 60 pounds.
Schmidt went to a local hospital, suspecting he had kidney stones. His diagnosis was confirmed, but there was shocking news to follow: He had congestive heart failure (CHF). That weight increase was actually the result of a buildup of fluid in his lungs, due to his heart’s inability to pump sufficient blood to supply oxygen and nutrients to the rest of his body.
CHF has many causes, the most common being coronary artery disease. Schmidt knew, however, that his heart-disease risk factors were under control and, thanks to a gastric bypass operation years earlier, he had shed 250 pounds and managed to maintain healthy eating habits.
He would discover that his CHF was due to idiopathic dilated cardiomyopathy, a condition of unknown cause in which inflammation of the heart muscle stretches and enlarges the heart cavity. Abnormal heart rhythms, or arrhythmia, blood clots and stroke may follow.
About congestive heart failureHeart failure occurs when the heart’s pumping action becomes progressively weak, causing symptoms like fatigue, swelling, difficulty breathing, exertion intolerance and fluid buildup in the lungs. It afflicts about 5 million Americans, including an estimated 2 percent of individuals aged 40 to 59, 5 percent of those aged 60 to 69 and 10 percent of those over age 70.
The most common causes are high blood pressure or coronary artery disease, which are both linked to unhealthy cholesterol levels or obesity. Any condition that strains the heart can lead to heart failure.
For more information, visit the National Institutes of Health website.
Over the next year, Schmidt had about 10 weeklong hospital stays as his health declined and his ability to walk slumped to a few labored steps. The best treatment for end-stage CHF is a heart transplant, but the prospect of finding a heart that matched his 6-foot 5-inch frame when organ demand vastly outstrips supply was tenuous at best. While medications, a defibrillator and a pacemaker helped control his symptoms, he was told that he probably had a year to live.
Another option for advanced heart failure
But in February 2011, Schmidt went to UC Davis and met with two new cardiac specialists. Cardiologist Kathleen Tong, who directs the heart failure clinic, evaluated Schmidt and then referred him to cardiothoracic surgeon Mona Flores, who heads the ventricular assist device (VAD) program.
VADs offers hope for people of all ages with end-stage heart failure whose symptoms cannot be reconciled with existing therapies.
“With this device, they can lead normal lives and be there for their families,” said Flores.
The team told Schmidt that he could be a candidate for a left ventricular assist device (LVAD), which is an electronic pump designed to take over the work of the heart’s left ventricle, restore blood flow and facilitate breathing. The 10-ounce, 3-inch device is implanted below the diaphragm and attached to the left ventricle and the aorta, the artery that carries oxygenated blood to the entire body. It is powered by two external batteries, which are carried in underarm holsters or waist packs.
“The greatest value of LVAD is the dramatic improvements it can make in the quality of patients’ lives,” said Tong. “They usually tell me that they had forgotten what it felt like to breathe easy and feel well, until the device started doing the work of their hearts.”
While VAD therapy traditionally has been considered an interim treatment for those awaiting transplant, the technology has advanced considerably and can now be used indefinitely. Flores, an experienced cardiac surgeon and VAD expert, was recruited to UC Davis to launch its VAD program. Schmidt was her first patient at UC Davis.
“I listened, and I felt I could trust the expertise and integrity of the team,” said Schmidt. “I was confident with them.”
Schmidt’s physicians were equally comfortable with him as a LVAD candidate. The right side of his heart was working well and he was not too ill to withstand open-heart surgery, which are requirements for the procedure.
“It also helped that he is drawn to gadgets,” said Flores. “For some, using a high-tech approach to their heart care is not appealing.”
Eager to savor every moment
Schmidt underwent the surgery on May 6, 2011. Four days later, he was walking. Within a few weeks, he felt a sense of rebirth, similar but even more remarkable than that first second-chance he got following his gastric bypass when he lost the pounds that weighed him down for much of his life. Today, Schmidt comfortably takes walks with Melinda, roughhouses with their dog, gardens and goes on road trips.
“I’ve always been a mellow person, but now I’m more mellow, and eager to savor every moment,” he said.
His satisfaction with the device has prompted him to volunteer some of his time to working with UC Davis nursing staff, enabling them to get hands-on experience operating the device’s external features. Schmidt shows them how he changes the battery.
“It can be done in about 15 seconds in the Target aisle,” he quipped.
He also has volunteered to work with patients who are candidates for VAD surgery, giving them support and answering questions from a patient’s point of view.
“I am thankful for any opportunity to help. After all, this device saved my life,” he said.
If you are interested in being considered for the UC Davis VAD program, contact the Consumer Resource Center at 1-800-2-UCDAVIS (1-800-282-3284) and request a referral to the heart failure clinic.
UC Davis Health System is a leading referral center for high-risk adult and pediatric patients with complex diseases of the heart, chest, lungs and esophagus. Our cardiothoracic surgery specialists combine extensive experience with the latest technologies and compassionate care to offer complete range of advanced treatment options. For information, visit www.ucdmc.ucdavis.edu/surgery/specialties/cardio.