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Back To Vidyya Man Taken Off Heart Transplant List After Heart Recovers On Ventricular Assist Device

First Known Case Of Recovery

A patient with severe heart disease who had been placed on the national transplant waiting list was saved not by a heart transplant but by the device University of Pittsburgh Medical Center (UPMC) surgeons implanted to support his heart until a donor organ would be found. The device -- a Thoratec(R) LVAD (Left Ventricular Assist Device) System -- was intended to serve as a "bridge to transplant," but in this case -- believed to be the first for a patient with ischemic heart disease -- the device served as a bridge to his own heart's recovery.

"This case demonstrates that patients with ischemic disease, or chronic heart disease, which accounts for about 60 percent of the transplant waiting list, can recover on an LVAD and not need a transplant. If put into wider practice, there would be fewer patients competing for the limited number of donor organs," said Robert Kormos, M.D., associate professor of surgery in the division of cardiothoracic surgery at the University of Pittsburgh School of Medicine, and director of the Artificial Heart and Heart Transplant Program at UPMC.

The patient, 52-year-old David McCormick of Gary, W.Va., has a long history of heart disease, and recently experienced a severe heart attack for which he was hospitalized at a regional hospital. Physicians there had inserted a balloon pump as a stopgap measure and transferred him to UPMC Presbyterian for coronary artery bypass surgery, where surgeons are accustomed to such high-risk cases. But when during surgery there were additional complications and the patient could not be weaned from the heart/lung machine used during an open-heart procedure, cardiac surgeon Brack Hattler, M.D., had to consider other options for the patient. He was connected to another machine to take over the function of his lungs. And thinking that this patient was now destined for the transplant waiting list, Dr. Kormos was brought in to the operating room to implant the Thoratec VAD, its purpose to provide the patient long-term support of the heart's main pumping chamber until transplantation would be possible.

But a curious thing happened. About four weeks after the 11-hour surgery and the LVAD implant, Dr. Kormos noticed steady improvement in the patient. A series of specialized tests that determine if a heart will recover, developed and performed by UPMC cardiologist John Gorscan, M.D., confirmed Dr. Kormos' and others' suspicions: The patient's heart was indeed getting better on the LVAD. Two weeks later, Dr. Kormos surgically removed the device and took Mr. McCormick off the transplant waiting list. Two weeks after that, he went home.

"The time to intervene is during the bypass procedure. If the patient can't be weaned from the heart/lung machine, why not implant an LVAD with the idea that it could allow the heart to recover. Most would think `transplant list.' But this represents a different way of thinking," Dr. Kormos noted.

While there have been some cases reported of transplant candidates recovering on LVADs, including the Thoratec LVAD, these cases have been in patients with nonischemic disease, which is usually sudden onset in nature.

The UPMC's Artificial Heart Transplant Program is considered one of the most active centers in the United States, having supported nearly 200 patients on assist devices since 1985 with a total support duration for these patients of 2,793 days, or more than 7.5 years of patient days. In addition to its clinical services, the center boasts an international reputation as a leading proving ground for new devices in the early stages of development or clinical phases of study. The Artificial Heart Program is part of the world-renowned transplant programs of the University of Pittsburgh, which have performed more than 10,000 transplants to date -- more than any other center in the world.


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Editor: Susan K. Boyer, RN
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