John Driscoll and his wife, Rose, leave St. Mary's Hospital after he received his left-ventricular assist device. (Photo by nurse practitioner Lisa Austin)
When he was in the hospital a few months ago, Amelia resident John Driscoll would become breathless after taking just one bite of a biscuit.
To see him now, that's hard to believe. The cheerful 74-year-old arrives for a medical checkup, and in his plaid shirt, khakis and warm-up jacket, he looks like the active retiree that he is. The only clue that he's thriving with the assistance of a mechanical heart pump is his waist pack, which contains the system's controller.
Driscoll was diagnosed with congestive heart failure 15 years ago, after he woke up one night with his heart racing and unable to catch his breath. A cardiologist prescribed medication that regulated his heart, and his life largely returned to normal.
But in July 2010, Driscoll had a similar episode.
A test determined that his "ejection fraction" — the percentage of blood in his heart that leaves the organ with each beat — was only 10 percent, compared to the healthy rate of 55 percent, says Dr. Gary Zeevi, medical director of Bon Secours' Advanced Heart Failure Center.
After his doctors tried both medication and a defibrillator/pacemaker unit, Driscoll wound up back in the hospital. He was so weak, Driscoll says, he could barely move, and he had no appetite — typical symptoms of end-stage heart failure, Zeevi says.
In the hospital, intravenous medicine helped Driscoll feel a little better, but the drugs eventually lost their effectiveness — a critical point, Zeevi says. "If we'd let it go much further, he'd have had irreversible liver failure and kidney failure."
On Sept. 20, Driscoll underwent surgery at St. Mary's Hospital to receive a left-ventricular assist device (LVAD). The weekend before the surgery, he opted to stay in the hospital rather than go home. "I was afraid I'd die if I went home," he says.
Without an LVAD, he's not sure he could have waited for a heart transplant, which can take several months.
Dr. Marc Katz, a heart surgeon at St. Mary's, says that about 30 percent of people waiting for a transplant die before they get one. Devices such as the LVAD help them survive the wait and improve their overall health, he says.
"It's important to keep the other organs working so that when they get a new heart, it's living in a nice neighborhood," Katz says.
So far, Driscoll is the oldest of about a dozen patients to have had LVAD surgery at St. Mary's, which started its program in May 2010.
Until last year, the devices were used only as a "bridge to transplant" for patients who, like Driscoll, were too sick to survive waiting for a donor organ. But in January 2010, the FDA approved long-term use of the devices, giving patients the option of deciding against a transplant.
So far, six years is the longest a patient has lived with an LVAD, Zeevi says. But he adds that engineers estimate the devices will last at least 10 years, and lab tests indicate they could last much longer.
Initially, Driscoll was on a transplant list, he says, but he took himself off.
"At first, I thought I wanted to get a transplant," Driscoll says. "But reading about it discouraged me."
Driscoll was concerned about the possibility that his body might reject the new organ and about the need to take immunosuppressive drugs. The medications decrease the chances that the body will reject a transplanted organ, but they also lower resistance to infection and can increase risk for certain types of cancer, while causing other side effects, such as high blood pressure and kidney damage.
Now that he's experienced living with the LVAD, Driscoll says he's happy to stay with it. A retired director of student information systems at Virginia Commonwealth University, Driscoll works out at a gym three times a week. He can do most of what he wants to do, including household tasks such as mowing the lawn, though the bulk of the medical gear he wears makes jobs such as changing the oil in his car difficult for him. He also has to protect the equipment from getting wet.
Though he's not yet tried throwing a football with his grandson, he says he's looking forward to being able to do that again.
The LVAD, the size of two D-cell batteries, sits in a pocket the surgeon makes underneath the heart. One end goes into the left ventricle, the heart's main pumping chamber, Zeevi says. The pump sends blood from another tube to the aorta, the body's largest artery. A cord that comes out of the abdomen connects to a system controller that the patient carries around the waist.
The system is powered by two rechargeable batteries, which fit into side pockets attached to a shoulder harness. Zeevi says that patients go home with four sets of batteries; each set lasts 10 hours. At night, patients connect the controller to a power module, which plugs into the wall (and contains an internal battery).
"I think the next couple of years are going to be dramatic," Zeevi says. In the next 12 to 18 months, both the LVAD system controller and the batteries it uses are expected to become smaller. "The Holy Grail is to implant all of this internally," he says.
Zeevi says that Thoratec, the manufacturer of the HeartMate II LVAD that Driscoll has, is working to improve sensors to adjust blood volume to the heart when a person exercises.
Although getting accustomed to the device took time, Driscoll now considers it a godsend. "There's no question," he says. "If I didn't have this, I would have died."