8 minute read
BRIDGE TO TRANSPLANT
Bridge to
TrAnSplAnT
By Ami Felker
Shayla Hendricks combats her debilitating heart disease much the same way she confronts gangs that threaten her community — head on, with persistence, determination and patience.
As a gang intervention counselor for the City of Houston, Hendricks approaches her work from every angle to stop and prevent gang infiltration in the city’s youth.
When she’s not at work, the young career woman is fighting another battle. In 2003, at just 23, Hendricks was diagnosed with stage 4 Hodgkin’s lymphoma and an inoperable tumor on her lungs. After several months of chemotherapy and countless infections and other complications, she finally entered remission. “Chemotherapy was the worst experience of my life, but I took it like a young person,” Hendricks says. “It was rough, but I beat it.”
Sadly, she won the battle, but the war had just begun. Four years later, Hendricks suffered from severe shortness of breath and an abnormal heart rhythm, after which she received a pacemaker and was diagnosed with congestive heart failure.
“I knew my heart was eventually going to deteriorate as a side effect of the chemo,” she says. “I just thought I would be older. I never imagined I would be so young.”
The next three years were full of hospital stays, and her heart eventually became so weak she could no longer walk the
shayla hendricks
short distance from the car to her back door without becoming short of breath and being forced to stop and rest.
Then, she suffered a stroke last year. Her heart could not survive on its own much longer. Just days after her stroke, surgeons at The Methodist Hospital implanted a left ventricular assist device, or lVAD, into her chest. The device helps pump blood through her weakened heart. The only option
“Shayla’s situation was not one we took lightly because of her age and the severity of her heart disease,” says Dr. Jerry Estep, a transplant cardiologist at Methodist. “Only an lVAD or heart transplant could save her, and with her cancer history, transplant was not yet an option.” Hendricks received a third generation lVAD, the most advanced device available. Third generation lVADs are smaller, just 10 ounces, last longer than older pumps, and have continuous flow, which means fewer moving parts that have potential for wearing out.
In contrast to older pumps that typically lasted about a year and weighed about two pounds inside a person’s chest, newer pumps can fit in the palm of a hand and last for years. patients with lVADs are required to carry a bag that holds backup batteries for their devices at all times.
Methodist has been a pioneer in lVAD innovation since Dr. Michael E. DeBakey and his team implanted the world’s first lVAD in 1967. Surgeons at Methodist were the first in the
region to implant a patient with a third generation lVAD, and the team is currently participating in several clinical trials.
“Our goal is to support Shayla’s heart with an lVAD until she has been in remission for a few years and transplant becomes the best treatment for her,” says Dr. Matthias loebe, surgical director of thoracic transplant at Methodist.
“We have remained at the absolute forefront of this technology, and we offer a comprehensive program for heart failure patients through our multidisciplinary approach,” he says. “We meet and decide as a team the best therapy for each patient who comes to us.”
In addition to medical care, the lVAD program at Methodist requires that all patients and their families meet regularly with a nurse coordinator and social worker to ensure they have all the available information. Their medical teams are always updated on their lives.
“patients with lVADs need a lot of support when they are home from the hospital, so we really emphasize the importance of family,” Estep says.
Heart failure treatment options at Methodist include medical therapies, temporary devices that can rescue patients from
drs. Jerry etep and matthias loebe acute issues or serve as a bridge to permanent lVADs and heart transplants. For patients who do not want or do no qualify for heart transplant, an lVAD is the most aggressive treatment for their disease.
“Our inpatient heart failure unit is another unique component of Methodist’s program, where patients stay on a dedicated floor with nurses who are specially trained in medical and device heart failure care,” Estep says. A designated lVAD clinic provides the Methodist team the opportunity to use imaging expertise through echocardiograms to determine proper pump settings and adjust more advanced devices.
Methodist continues to lead the way in lVAD development and heart failure care, offering more than 10 types of lVADs and participating in numerous research studies that may eventually lead to earlier detection of heart disease and minimize disease progression.
Back on the job
Hendricks was released from the hospital a month after receiving her lVAD. She returned to work just two months later.
“Shayla is a striking young woman,” loebe says. “Despite being so sick, she is eager to have a productive life. She couldn’t wait to be back working with young people. She’s remarkable.”
For now, the 30-year-old Hendricks focuses her efforts on taking every step necessary to qualify for a heart transplant.
“I feel so much better since getting my lVAD,” she says. “I was missing work like crazy; I was tired all the time. Today, I’m back at work and I enjoy time with my family.”
relying on teachers and other adults to notify her when they recognize gang identifiers in middle school students, she spends her time presenting to groups, working one-on-one with students and even making home visits.
“I have a heart for at-risk kids,” says Hendricks, who has a bachelor’s degree in criminal justice with a focus on juvenile justice. “They’re impressionable, and I know they have a future. I can scare them straight, make a difference in their lives and set them on the right path.
“I am truly blessed. now I look forward to getting back to a normal life. … just a normal life.” n
What is a left ventricular assist device?
A left ventricular assist device (LVAD) is a pump that helps the
beating heart to propel more blood to vital organs of the body while also unloading the left ventricle of the heart. The device is surgically implanted with sternotomy, a type of open heart surgery. An lVAD is a more permanent type of support, which allows the patient to be discharged and return home.
Ventricular assist devices can be utilized as bridge to transplant, meaning that the lVAD provides support until the patient can receive a transplant; or destination therapy, meaning that the lVAD would be a permanent support.
What is an LVAd made of?
It is made of titanium, which carries no risk for rejection or allergic reaction to the materials. The blood is propelled out of the lVAD to the body through a Dacron graft connecting the lVAD to the patient’s aorta.
How does an LVAd work?
Blood is brought into the LVAD from the left ventricle of the heart through an inflow tube. This blood then passes through the body of the pump and is released into the aorta through an outflow tube and graft. The oxygenated blood travels through the aorta to the organs and the rest of the body. Most new lVADs use an impeller or rotor to operate, similar to the functioning of a jet propeller.
How is an LVAd implanted?
The LVAD is implanted through open-heart surgery under general anesthesia. A dime-sized area of tissue is removed from the heart’s left ventricle, and the inflow tube of the lVAD is then inserted through this space. The lVAD and outflow tube and graft are attached to the ascending aorta (the first section of the aorta leading from the heart).
The lVAD fits under the left ventricle within the left rib cage. The percutaneous lead, also known as the lifeline, is run under the skin to the right side of the abdomen/chest area where another small incision is made for it to exit the body. That line is connected to a controller or transistor that controls functions of the lVAD and transmits alarms. Two power lines connect from the controller to either two batteries or to a central cord that then connects to a direct electrical source. n
left ventricular assist device
LVAd Benefits
n Freedom from hospitalization or recurrent hospital admissions for congestive heart failure (CHF)
n relief from CHF symptoms including shortness of breath, abdominal swelling, and swelling of the legs, ankles and feet
n Freedom from the need for IV use at home
n potentially, correction of kidney failure, which is due in part to the improved blood flow provided by the lVAD
n Improvement and correction of pulmonary hypertension (high blood pressure within the lungs). The patient’s care team also will check for a decrease in heart size as the workload is reduced on the left ventricle. In some cases, if there is complete recovery with lVAD support, the team will discuss and evaluate the patient for possible removal of the lVAD.
risks
n Bleeding before, during or after the surgery
n Stroke, cerebral bleeding or hemorrhage due to blood thinners (a risk reduced with newer and more efficient lVAD support and astute monitoring of anticoagulation at home)
n renal (kidney) failure; infection
n need for prolonged ventilation support (which is reversible)
n risk of death
