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Life Goes on with a Temporary Heart
12/10/09

A Pump Inserted in New Jersey Man's Abdomen Keeps Him Alive While He Awaits a Transplant

John Newton needs a new heart. The 53-year-old Wantage, N.J., executive has been experiencing heart attacks since he was in his early 40s. His heart is so badly damaged that he can't live long enough without artificial help to wait for a suitable donor heart – which could take months or even years.

For many patients in a similar situation, that would mean being confined to a hospital bed and tethered to tubes while waiting for a heart transplant operation.

But Newton is not in the hospital. He's awaiting his new heart at home, walking up to 4 miles a day, working via email and living a fairly normal life. He is tethered to a tube, though. It comes right out of a machine in his chest and attaches to a battery pack he wears around the clock. The battery powers a blood pumping machine called a left ventricular assist device, or LVAD.

A "bridge to transplant"

Implanted by heart surgeons at Westchester Medical Center, it's designed as a so-called "bridge to transplant" – a machine that keeps people alive until a matching heart becomes available. The LVAD can maintain adequate circulation for at least two years, and sometimes as long as five years.

In some cases, it has even been found to give the left ventricle – the heart's main pumping chamber – enough of a rest to heal and return to adequate function. Regrettably, that won't be possible for Newton.

High risk for another heart attack

He had always been a prime candidate for a myocardial infarction, or heart attack. His father died of one when Newton was just 7, and he himself had high blood pressure, high cholesterol, smoked, drank too much and held a high-stress job. "My doctor made a list of the five or six top risk factors, and I was high in every one," he says.

Newton suffered his first heart attack in 1988. "It was the day before Christmas," he remembers. "I had chest pain I thought was indigestion, so I took Rolaids. Three months later, driving on I-287, I was sweating and hot, had trouble breathing and knew it was a heart attack. I pulled over and called 911."

He had the first of what are now five stents put in to open his blocked arteries. He was treated with medications. He lost weight and cut back on his bad habits. But his heart continued to deteriorate. "After three or four years, my doctor said it was getting to be more than he could handle," he says.

Referral to Westchester

Newton was referred to Warren D. Rosenblum, M.D., Director of Heart Failure and Pulmonary Hypertension at Westchester Medical Center and an expert in heart-failure treatment. "That was five years ago," Newton says. "He's kept me alive ever since."

"The heart attacks had severely damaged his left ventricle so it couldn't squeeze to pump blood to the body," says Dr. Rosenblum. About a year ago, Newton noticed that his breathing had become more labored and his energy level had dropped. "It got to the point where if I walked to my mailbox, about 350 feet, I couldn't breathe," he says.

In May 2008, he had another heart attack and was rushed to the hospital. At that point, he was listed as a candidate for transplant. But in July, in the middle of a conference with his doctors, he had yet another heart attack.

Newton needed a new heart fast. But several factors were working against him. He is blood type O. That means he can only accept another type-O heart, limiting his choices. He is also a large man – 6'1" and more than 200 pounds – so he would need a heart from a similar-sized individual.

"We knew he might have to wait a year or two for a heart," Dr. Rosenblum says. "The LVAD is a last resort, when we can't support the patient's quality of life with medication. We have been using it for a decade or so and it is a reliable long-term bridge to transplant."

How the LVAD works

The LVAD is essentially a pump about the size of a fist, which is placed in a specially created opening in the abdomen, under the diaphragm. Small tubes connected to the pump take blood out of the damaged left ventricle and bring it directly to the aorta, the main artery sending blood to the rest of the body. A finger-width cable runs out of Newton's abdomen to the battery that sits in a vest he wears at all times.

Transplant coordinator Kathy Brown works with patients such as Newton and their communities to make sure everyone is up to speed on caring for an LVAD recipient. "I do a lot of education sessions with his local hospital's nursing staff, his local EMS responders and of course his family," she says.

She also contacts the local power company. In case he should lose power, which he needs to recharge his batteries, she has the power company make him and other LVAD patients a high priority for repair. Newton comes in for a checkup every two weeks, she says, to evaluate the machine and tend to the line coming out of his body, which is prone to infection.

"He's doing terrifically on the LVAD," Brown says.

Even so, it's not a particularly pleasant experience having a 6-pound motor in your body. It's noisy. It vibrates. It makes bending and sleeping difficult. He has to remember to change the batteries every five hours. And the device has to be kept perfectly dry.

"It would be nice to take a real shower," Newton says. "There are good and bad days, but it's better being at home than in the hospital. It's keeping me alive." And it will continue to do so until Newton gets his new heart. As of January 14, 2009, he says, "I've been on the transplant list 208 days. But who's counting, right?"

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