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					Bridge to
TrAnSplAnT
By Ami Felker




S
         hayla Hendricks combats her debilitating heart dis-   “Chemotherapy was the worst experience of my life, but I took
         ease much the same way she confronts gangs that       it like a young person,” Hendricks says. “It was rough, but I
         threaten her community — head on, with persis-        beat it.”
         tence, determination and patience.
                                                               Sadly, she won the battle, but the war had just begun. Four
As a gang intervention counselor for the City of Houston,      years later, Hendricks suffered from severe shortness of
Hendricks approaches her work from every angle to stop and     breath and an abnormal heart rhythm, after which she re-
prevent gang infiltration in the city’s youth.                 ceived a pacemaker and was diagnosed with congestive
                                                               heart failure.
When she’s not at work, the young career woman is fighting
another battle. In 2003, at just 23, Hendricks was diagnosed   “I knew my heart was eventually going to deteriorate as a side
with stage 4 Hodgkin’s lymphoma and an inoperable tumor        effect of the chemo,” she says. “I just thought I would be older.
on her lungs. After several months of chemotherapy and         I never imagined I would be so young.”
countless infections and other complications, she finally
entered remission.                                             The next three years were full of hospital stays, and her heart
                                                               eventually became so weak she could no longer walk the



26   methodisthealth.com
                                                                          “I look
                                                                          forward to
                                                                          getting back
                                                                          to a normal
                                                                          life. … just
                                                                          a normal life.”
                                                                                               shayla hendricks




short distance from the car to her back door without becom-       Hendricks received a third generation lVAD, the most ad-
ing short of breath and being forced to stop and rest.            vanced device available. Third generation lVADs are smaller,
                                                                  just 10 ounces, last longer than older pumps, and have con-
Then, she suffered a stroke last year. Her heart could not sur-   tinuous flow, which means fewer moving parts that have po-
vive on its own much longer. Just days after her stroke, sur-     tential for wearing out.
geons at The Methodist Hospital implanted a left ventricular
assist device, or lVAD, into her chest. The device helps pump     In contrast to older pumps that typically lasted about a year
blood through her weakened heart.                                 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
The only option                                                   with lVADs are required to carry a bag that holds backup bat-
 “Shayla’s situation was not one we took lightly because of her   teries for their devices at all times.
age and the severity of her heart disease,” says Dr. Jerry Es-
tep, a transplant cardiologist at Methodist. “Only an lVAD or     Methodist has been a pioneer in lVAD innovation since Dr.
heart transplant could save her, and with her cancer history,     Michael E. DeBakey and his team implanted the world’s first
transplant was not yet an option.”                                lVAD in 1967. Surgeons at Methodist were the first in the



                                                                                                          Volume 5, number 3   27
Bridge to
TrAnSplAnT


region to implant a patient with a third generation lVAD, and       acute issues or serve as a bridge to permanent lVADs and
the team is currently participating in several clinical trials.     heart transplants. For patients who do not want or do no qual-
                                                                    ify for heart transplant, an lVAD is the most aggressive treat-
“Our goal is to support Shayla’s heart with an lVAD until she       ment for their disease.
has been in remission for a few years and transplant becomes
the best treatment for her,” says Dr. Matthias loebe, surgical      “Our inpatient heart failure unit is another unique compo-
director of thoracic transplant at Methodist.                       nent of Methodist’s program, where patients stay on a dedi-
                                                                    cated floor with nurses who are specially trained in medi-
“We have remained at the absolute forefront of this technol-        cal and device heart failure care,” Estep says. A designated
ogy, and we offer a comprehensive program for heart failure         lVAD clinic provides the Methodist team the opportunity to
patients through our multidisciplinary approach,” he says.          use imaging expertise through echocardiograms to determine
“We meet and decide as a team the best therapy for each             proper pump settings and adjust more advanced devices.
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
                                                                    “Only an LVAD or heart
a nurse coordinator and social worker to ensure they have
all the available information. Their medical teams are always        transplant could save
updated on their lives.

“patients with lVADs need a lot of support when they are             her. … Transplant was
home from the hospital, so we really emphasize the impor-
tance of family,” Estep says.                                        not yet an option.”
Heart failure treatment options at Methodist include medical
therapies, temporary devices that can rescue patients from          Methodist continues to lead the way in lVAD development
                                                                    and heart failure care, offering more than 10 types of lVADs
drs. Jerry etep and matthias loebe                                  and participating in numerous research studies that may
                                                                    eventually lead to earlier detection of heart disease and mini-
                                                                    mize disease progression.

                                                                    Back on the job
                                                                    Hendricks was released from the hospital a month after re-
                                                                    ceiving 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 tak-
                                                                    ing 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 fu-
                                                                    ture. 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


                                                                    to learn more about methodist’s lVad program,
                                                                    call 713-441-8900.
28   methodisthealth.com
What is a left ventricular assist device?                                       LVAd Benefits
A left ventricular assist device (LVAD) is a pump that helps the                n   Freedom from hospitalization or recurrent
beating heart to propel more blood to vital organs of the body while                hospital admissions for congestive heart
also unloading the left ventricle of the heart. The device is surgically            failure (CHF)
implanted with sternotomy, a type of open heart surgery. An lVAD is
a more permanent type of support, which allows the patient to be dis-           n   relief from CHF symptoms including
charged and return home.                                                            shortness of breath, abdominal swelling,
                                                                                    and swelling of the legs, ankles and feet
Ventricular assist devices can be utilized as bridge to transplant, mean-
ing that the lVAD provides support until the patient can receive a trans-
plant; or destination therapy, meaning that the lVAD would be a perma-          n   Freedom from the need for IV
nent support.                                                                       use at home

                                                                                n   potentially, correction of kidney failure,
                                                                                    which is due in part to the improved
What is an LVAd made of?                                                            blood flow provided by the lVAD

It is made of titanium, which carries no risk for rejection or al-              n   Improvement and correction of pulmonary
lergic reaction to the materials. The blood is propelled out of the
                                                                                    hypertension (high blood pressure within
lVAD to the body through a Dacron graft connecting the lVAD to the
                                                                                    the lungs). The patient’s care team
patient’s aorta.
                                                                                    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,
How does an LVAd work?                                                              the team will discuss and evaluate the
                                                                                    patient for possible removal of the lVAD.
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,           risks
similar to the functioning of a jet propeller.
                                                                                n   Bleeding before, during or after
                                                                                    the surgery

How is an LVAd implanted?                                                       n   Stroke, cerebral bleeding or hemorrhage
                                                                                    due to blood thinners (a risk reduced with
The LVAD is implanted through open-heart surgery under gen-                         newer and more efficient lVAD support
eral anesthesia. A dime-sized area of tissue is removed from the                    and astute monitoring of anticoagulation
heart’s left ventricle, and the inflow tube of the lVAD is then insert-             at home)
ed through this space. The lVAD and outflow tube and graft are at-
tached to the ascending aorta (the first section of the aorta leading from
                                                                                n   renal (kidney) failure; infection
the heart).

The lVAD fits under the left ventricle within the left rib cage. The percu-     n   need for prolonged ventilation support
taneous lead, also known as the lifeline, is run under the skin to the right        (which is reversible)
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   n   risk of death
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




                                                                                                    Volume 5, number 3   29

				
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