ST. LOUIS - The heart transplant team at Barnes-Jewish Hospital marked two milestones in 2010: the 25th anniversary of the program as well as its 600th transplant.
For those involved in the program’s early years, things have changed a great deal from when the program began in 1985.
“I talk to some of the patients who were transplanted in that early era and back then physicians told them ‘You may live five years or you may live two years,’” says Greg Ewald, MD, medical director of heart transplant at Barnes-Jewish and Washington University School of Medicine. “At that point there wasn’t a track record to know outcomes.”
Those early expectations of survival have been exceeded by many. One of those early heart transplant patients from 1985, Nick Belfiglio, 80, of Chesterfield, MO, says the past 25 years with a new heart have helped him live a “good life.”
“I got to see five more grandchildren and two more great grandchildren, I traveled and went on cruises with my wife and I helped start a transplant support group and met some amazing people I’d never have connected with otherwise,” says Belfiglio.
Belfiglio’s experience is not uncommon. Survival rates for both patients and grafts in the program at Barnes-Jewish exceed or are near national averages.
“From the very early days of this program, our cardiac transplantation surgical results have always far exceeded the national norms,” says Michael Pasque, MD, Washington University cardiothoracic surgeon who has been part of the program at Barnes-Jewish since almost the beginning. “These patients are often very visible, very young, and so very needy of the type of lifesaving surgical intervention that is only made available by the very special and powerful clinical collaboration that we enjoy every day at this institution.”
An example of such collaboration between surgeons, cardiologists and nursing is one of the biggest changes in the program since 1985: the use of ventricular assist devices (VADs). VADs are mechanical devices surgically attached to the heart’s left ventricle and sit over the abdomen inside the skin and assists with heart function either until a patient gets a new heart via transplant or destination therapy. As recently as 2006, only 12 VADs were implanted in patients at Barnes-Jewish annually. However, that number has steadily increased to a point where 52 VADs were implanted in 2009.
“For the first time, we have another viable option for the treatment of severe heart failure,” says Scott Silvestry, MD, surgical director of heart transplant at Barnes-Jewish Hospital and Washington University School of Medicine. “With these devices we can provide years of meaningful therapy to allow patients to return to their lives without the use of immunosuppression.”
The Barnes-Jewish program’s 600th patient is an example of how VADs can be used as a bridge until a donor heart becomes available. Franklin O’Dell, 58, of Noble, IL, had been struggling with heart failure for several years before the use of medications no longer could help him.
Washington University cardiothoracic surgeon I-wen Wang, MD, PhD, told O’Dell he only had a couple of days to live unless a VAD was implanted or a donor heart became available. As the pool of available hearts in the St. Louis region is relatively small (only around 20-25 hearts are transplanted annually at Barnes-Jewish), O’Dell could not survive the wait for a new heart. A VAD was his only choice.
“We went ahead with the pump and it kept me going until transplant,” says O’Dell, who received his heart May 4.
While 600 may be a milestone for the program, O’Dell looks at it another way. “That’s 600 people who got another chance,” he says.
Looking at what the next 25 years may have in store, Dr. Ewald says the issue of not having enough organ donors may be one area where the program may see its biggest change.
“There may come a time where we aren’t so dependent on a donor,” says Dr. Ewald. “Mechanical devices are getting smaller and more durable so they last longer, and whether we’ll get to a place where we can use cells or grow our own organs in the next 25 years … it’s possible.”