CHANCE

Living and working in Florida in the mid-1970s, Harry Wuest experienced some unusual pains in his side but was unaware he had a serious heart condition. “You mentally and physically compensate as your heart decreases its ability to work. I sort of adjusted my life to it and didn’t realize what was going on,” he recalls.

Wuest was eventually diagnosed with cardiomyopathy, a disease of the heart muscle that makes it increasingly difficult for the heart to pump blood throughout the body. His condition deteriorated, and his doctor at Florida Hospital (now Advent Healthcare) was Andrew Taussig, who had been chief resident and cardiology fellow at Emory University Hospital. Taussig was familiar with Emory’s then new heart transplant program and sent his patient to Emory cardiothoracic surgeon Douglas Murphy for evaluation. Wuest’s condition was so bad he was flown by air ambulance to Emory, and shortly after his consultation with Murphy, he was in the hospital awaiting a transplant—and miserable. “I was so sick, bedridden, on an IV. I didn’t think about the difficulty of the transplant,” he says. He only knew was the surgery was his best chance at life.

The donor heart of a 19-year-old accident victim was located in May 1985, and Wuest became Emory’s third heart transplant patient. “When I woke up from my surgery, I just knew somehow I was going to be fine,” he says.

The heart turned out to be a remarkably good match, and Wuest is now the longest living heart transplant patient in Georgia—and one of the longest living in the world.

Murphy is now the chief of cardiothoracic surgery and medical director of surgical robotics at Emory Saint Joseph’s Hospital. He is recognized as one of the world’s leading expert in robotically assisted heart surgery.

Almost 37 years later, Wuest, now in his late 70s, lives in Atlanta. He works as a CPA during tax season and plays golf frequently. “I have a great wife and, with 15 grandchildren, I’m always looking forward to something,” he says. EHD work as a team. Everyone’s input is valuable, and the patient and their family come first. We keep that focus,” he says.

Emory’s heart transplant surgeons, who along with Murphy, Vega, and Daneshmand include Tamer Attia and Jeffery S. Miller, work with transplant cardiologists both before and after the procedure to optimize patient care.

The team includes a host of other medical specialists, including transplant infectious disease specialists, arrhythmia experts, transplant coordinator nurses, nutritionists, physical therapists, imaging experts, and others, all working to bring collaborative and individualized care to patients before, during, and after their transplants.

Combined Expertise

A patient’s diagnosis of heart failure does not mean someone is necessarily headed for a transplant, says Divya Gupta, medical director for Emory’s Advanced Heart Failure and Transplant program. Medication, diet, and lifestyle changes can often help prevent progression of the disease.

“Approximately five percent of heart failure patients develop end-stage heart failure, and that can happen at any point within their disease trajectory,” says Gupta. “We don’t have a great way of predicting who is going to progress and how quickly they are going to progress. However, with adherence to current guideline-based recommended medications, there is a greater chance of feeling better and living longer with this disease.”

When a heart failure patient at Emory is a potential transplant candidate, Gupta and her colleagues do an assessment to make sure the person is able to survive a transplant. They also ensure the patient has no other health problems that would likely worsen with the transplant.

Heart failure patients waiting for transplants are supported with medication and, if needed, temporary mechanical devices to help their heart. Throughout the entire process, from evaluation through post-transplant follow-up, heart transplant coordinators—nurses with extensive specialized training in the field—are key.

They manage the wait list for heart transplants, follow transplant patients in the period immediately following their surgery, and coordinate care after patient discharge and throughout the patients’ lives.

Virtually all patients who reach advanced cardiac failure will have arrhythmias, sometimes dangerous irregular heart rhythms. Doctors on the transplant team, like Anand Shah, an electrophysiologist, or heart rhythm specialist, treat these patients to help optimize their cardiac function and help keep them healthier as they await transplant.

“We coordinate our approach with other members of the transplant team to understand where the patient is on their heart journey and what therapies might be most appropriate and what therapies the patient can tolerate,” he says.

A Lifegiving Measure

“Heart transplant is the ultimate gift,” says Anurag Sahu, who leads the adult congenital heart disease imaging program at Emory. “With ev- ery transplant, somewhere a family going through the darkest of times has donated the gift of life, a loved one’s heart, to someone else they don’t even know. It is not to be taken lightly, and we work toward making sure we honor that gift by taking excellent care of the patient who will receive that organ.”

After pioneering Emory’s heart transplant program, Douglas Murphy turned to another groundbreaking surgical proceedure: robotic cardiac surgery. He is recognized as one of the most experienced robotic heart surgeons in the world.

Rachel Moore’s heart transplant took place in January 2009. “Never in a million years can I say enough thanks to the donor family for that precious gift,” she says. Her story also illustrates the complex, team-based process involved in transplant surgery.

Moore was a 42-year-old cardiac nurse in Chicago in the mid-2000s when she noticed simply walking a short distance made her short of breath. She was diagnosed with cardiomyopathy, and tests showed her heart was weakening. Her doctors implanted a defibrillator to protect her from a potentially deadly irregular heart rhythm and prescribed medication, gentle exercise, and a special diet, but nothing improved her condition.

When a problem with a heart valve was discovered, doctors placed Moore on an LVAD to strengthen her heart for valve surgery to no avail. With her options diminishing, her doctor referred her to Emory and David Vega.

It wasn’t until January 2009, more than two years after being placed on the transplant list, that a donor heart became available.

“The heart transplant changed my philosophy of life. I was given a second chance to live and that’s what I want to do—really live,” Moore says. “I tell people to not be so busy that you don’t look at the sky today, hug your family. When you wake up today, enjoy your life.”

Challenges And Commitments

The financial and emotional costs for prospective transplant patients can be overwhelming. The Emory Heart Transplant program is working to find ways to help people with failing hearts, regardless of their financial situation, receive appropriate care and assistance.

“Our goal is to look for ways to help patients become candidates for advanced therapies like LVAD and heart transplants, if that’s in their best interests and what they want,” Daneshmand says. “We are committed to taking care of the residents of Georgia who need our help, regardless of socioeconomic status or race.”

Heart failure leading to a need for heart transplant can be influenced by one’s genetic make-up or a predisposition to health conditions that increase risk. These factors appear to play a role in African Americans’ disproportionate rates of serious heart failure and may explain why these patients are far less likely, across the nation, to receive needed heart transplants.

But that’s not the case at Emory, where more than 63 percent of heart transplant patients are Black, Gupta says. “It’s not due to the demographics of Atlanta [but] because our team works extra hard at creating an awareness around disproportionate outcomes, and we’ve become much more aggressive and worked very hard at trying to break these barriers,” she says. “We are dedicated to providing great care for our patients, no matter who they are, and no matter their race. There is no other program of our size that can say that.” EHD