LVAD

Heart Transplant Q&A

by Columbia Surgery on August 13, 2012

After cardiothoracic surgeon Hiroo Takayama, MD, PhD, NewYork-Presbyterian Hospital/Columbia University Medical Center, was featured on the television documentary series NY Med recently, audience members tweeted several follow up questions. Dr. Tayakama answers these questions, regarding a heart transplant, below.

Hiroo Takayama, MD, PhD

Question: What was that icy looking liquid on the container that carried the donor heart?

Answer: It is preservation solution. The heart is soaked in this solution in a sterile bag, which is surrounded with ice cubes.

Q.: Why was the donor heart yellow and not red as it was taken out of the transport container?

A.: It was the yellow layer of fat that covers and protects the heart.

Q.: How long can a heart be stored?

A.: Only four to six hours.

Q.: How is the “new” heart started after transplantation?

A.: Once sewn in and perfused with blood, most hearts resume a regular beat and contraction on their own, although the new heart usually requires support with medication for a while.

Q.: What is the life expectancy of a heart transplant recipient?

A.: Approximately half of heart transplant recipients are alive at 10 years post transplant.

Q.: What would disqualify someone from being a heart donor?

A.: The absence of the following conditions are the suggested criteria for cardiac donors:

      • prolonged cardiac arrest
      • prolonged severe hypotension
      • preexisting cardiac disease
      • intracardiac drug injection
      • severe chest trauma with evidence of cardiac injury
      • septicemia
      • extracerebral malignancy
      • positive serologies for HIV, hepatitis B or hepatitis C

Q.: How old must you be to donate a heart?

A.: You must be younger than 55 years old although there are exceptions.

Q.: Does blood type factor into the donor/recipient process?

A.: Yes. ABO blood type has to be compatible.

Q.: Will we ever be able to grow or print new hearts from stem cells or cultured tissue?

A.: Researchers have been trying this with some promising findings. Although growth of complete new hearts is still on the horizon, current studies are using stem cells to regenerate myocardial cells and help damaged hearts with or without the additional aid of implantable LVAD.

Q.: When was the first heart transplant performed and where?

A.: South African Christiaan Barnard surprised the world when he performed the first human-to-human heart transplant on December 3, 1967.

Q.: How common is a heart transplant? How many are performed on a yearly basis?

A.: Approximately 3,700 to 3,800 heart transplants are performed worldwide. In the U.S., approximately 2,200 are performed every year.

Q.: How many hospitals in the U.S. transplant hearts? In the world at large?

A.: Over 140 centers perform heart transplantation in the U.S. Over 250 centers report to the International Society for Heart and Lung Transplantation as heart transplant center worldwide.

Q.: Since organ donation is limited or restricted in Japan, how many patients travel to other countries for a heart transplant? Is the organ donation/transplant process in Japan changing?

A.: Because of extremely limited number of donors in Japan, every year several patients with end stage heart failure, especially pediatric patients, travel to other countries such as the U.S. and Germany. In the U.S., the number of donor hearts that can be allocated to foreign recipients is restricted to fewer than five.

Also, don’t forget to catch NY Med Tuesdays at 10:00 PM on ABC!

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Heart Transplantation For HIV Positive Patients

by Columbia Surgery on July 20, 2012

Heart transplant surgeons at NYPH/Columbia achieve success among HIV positive patients, calling for reevaluation of eligibility criteria.

When Mark Sanders suffered a heart attack in October, 2006, it could not have been more of a surprise. Although Mark was HIV positive, his antiretroviral regimen was effective, and he was an active, athletic man who ate well, worked out regularly, led advanced level kayak trips on weekends, and had a successful career in public health in Atlanta, GA. But his heart attack was severe, perhaps due to periodic smoking or perhaps related to his family history of heart disease. Whatever the cause, his left ventricle was completely blocked, and his local doctors did not expect him to live.

But Mark did survive the attack, as well as surgery to place several stents to restore blood flow, and a week later, triple coronary artery bypass surgery. Yet despite those measures, his heart would still need additional support, and he received an implantable left ventricular assist device (LVAD) in February 2008, as part of a study at Emory University Hospital. “After eight months, I was mountain biking again,” he recalls. “I don’t think I would have survived much longer if I hadn’t had the surgery; it was truly my second chance at life.” Indeed, Mark did extremely well – that is, until a simple fall in his home caused a new problem.

When Mark fell in 2010, the LVAD’s drive line (the external power cord) caught on a door handle and pulled the port where the line entered his skin. That fresh wound soon became infected with staphylococcus, a difficult-to-treat infection that recurred six times. Mark grew sicker and was in great pain.

Mark (seated middle, left) was back in the saddle navigating the Ocoee River rapids eight months after his heart transplant.

Mark (seated middle, left) was back in the saddle navigating the Ocoee River rapids eight months after his heart transplant.

The situation was becoming quite serious for Mark. When staphylococcus adheres to metal surfaces inside the body, those surfaces usually must be removed and the infection treated with powerful antibiotics, after which the device can then be re-implanted. If the surface is in a part of the body such as the knee, this is unpleasant but certainly feasible – whereas in Mark’s case, the surface was his heart pump. Without his LVAD, Mark’s heart would fail. The only option would be a heart transplant, and it would have to happen very quickly. “It was literally a race to get a heart transplant before the staph reached my LVAD,” Mark explains.

Mark’s hospital at Emory University would not perform a transplant on a person who was HIV positive. But his doctors nevertheless contributed to saving his life by referring him to NewYork-Presbyterian Hospital/Columbia University Medical Center, the only U.S center that performs heart transplants in patients with HIV infection. The catalyst was a pivotal study published by Dr. Nir Uriel with Dr. Ulrich Peter Jorde in the Journal of Heart & Lung Transplantation in 2009, Heart Transplantation in Human Immunodeficiency Virus-Positive Patients, in which he presented the outcomes of seven HIV positive patients after heart transplantation. Contrary to traditional practice, which excluded HIV positive patients from receiving transplants due to concerns about the immunosuppressant drugs needed after surgery, this study found that HIV positive patients could expect excellent outcomes after transplantation.

Mark came to NYP/Columbia in January 2011 for evaluation for transplantation. By February he returned again, this time with his belongings, prepared to wait for a donor heart. In what some might consider a miracle, his wait was a mere 30 days, and Hiroo Takayama, MD performed the transplant March 1, 2011. The surgery was very challenging; in addition to having to remove the LVAD, the surgical team also found a severe tear in Mark’s aortic arch. His recovery was difficult and fraught with complications. But once again, Mark persisted and recovered.

Mark tells his story in part so that other HIV positive patients might know that heart transplantation can be possible. “My recovery was quite an ordeal, with a lot of pain and discomfort, and difficulty finding the right balance of antiretroviral medications, immunosuppressives, and other medications. But those medications can definitely be used effectively together, and it is clearly possible for HIV positive patients to have successful heart transplant surgery.”

According to Dr. Uriel, HIV positive patients can expect the same life expectancy as non-HIV positive patients, so it seems reasonable that they too should be given the same access to heart transplantation (they already can undergo liver and kidney transplantation in most centers). “Heart transplantation is more challenging when a patient has HIV, but it is doable. We are pushing the envelope, and only select HIV positive patients will be eligible based on the status of their disease at the time. But Mark is having a wonderful life, and I am so glad that we were able to help give that back to him.”

Today, Mark is once again healthy, active, and ever grateful for his transplant. He can not give enough praise and thanks to his physicians, surgeons, nurses, and other members of the team who cared for him. “The medical care I received was outstanding. It was great to have teams of people who covered so many topics so thoroughly, including nutrition and possibility of infection. I also give a lot of credit to the love and support of my family and friends who learned how to care for me during a long recovery period. Most of all, I thank the enormous generosity of my donor and donor family for this gift of life.”

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Cheney’s Heart Transplant Highlights Issues in Heart Transplantation

April 16, 2012

TweetWhen he received a heart transplant March 24, 2012, former Vice President Dick Cheney joined about 2300 Americans who receive the lifesaving gift of a donor heart each year. After a 20-month wait on the organ waitlist, Cheney was fortunate; the shortage of donor organs remains an extreme problem, and many patients die before an […]

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Center for Hypertrophic Cardiomyopathy

April 9, 2012

TweetA new center at NewYork-Presbyterian/Columbia now provides specialized, comprehensive care to adults and children with hypertrophic cardiomyopathy (HCM). HCM is the most common genetic heart disease. It causes the heart muscle to become thickened and stiffened, which impairs its ability to pump blood properly through the body. Under the co-direction of Hiroo Takayama, MD and […]

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NewYork-Presbyterian/Columbia Surgeons Are First in NYC Area to Implant Total Artificial Heart

December 14, 2011

TweetTotal Artificial Heart Improves Patient Survival to Transplant While Reducing Some Risks of Transplant Surgery Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center performed the first Total Artificial Heart implant in the New York City area to replace a patient’s dying heart. “For patients who will die without a heart transplant, the Total Artificial Heart helps […]

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New Ventricular Assist Device, PediMag, Safely Supports Children in Need of Heart Transplantation

September 23, 2011

TweetVentricular Assist Devices (VADs) are small pumps that take over the work of the heart in pumping the blood through the body. Patients who need a heart transplant, but for whom there is no donor heart available, might be given a VAD for what’s called a bridge-to-transplant while they wait for a donor. PediMag, the […]

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Cardiac Device Update: Wireless LVAD in the Pipeline

August 11, 2011

TweetFor some patients with end-stage heart failure, left ventricular assist devices (LVADS) provide a life-saving option. These artificial heart pumps take over the function of the left ventricle in the heart, so that they can be sustained until a donor heart becomes available for transplantation – or perhaps indefinitely. Risks associated with LVADS are significant, […]

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CATCH-UP 2011: Heart Failure, Devices, and Interventions

May 31, 2011

TweetOn May 5, 2011, NewYork-Presbyterian Hospital/Columbia University Medical Center presented CATCH-UP 2011: Heart Failure, Devices, and Interventions in New York. This CME course was intended for cardiologists, interventional cardiologists, cardiothoracic surgeons, internists, and other medical professionals involved in the care of patients with heart failure. Sessions covered the latest clinical trials in heart failure, device […]

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