With a new mechanical pump circulating blood through his body, Jim Hemphill can again play with his grandchildren and talk without straining to breathe.
He also has no pulse. There’s no rhythmic beating with his new ventricular assist device, just a continuous flow.
Hemphill is the first patient to have the device implanted in his chest at Mission Hospital. The technology saved his life, says Dr. Stephen Ely, the cardiovascular surgeon who performed the operation.
“It’s like rising from the ashes,” Ely says. The 69-year-old Hemphill “has become an entirely different person. He is able to get back to the kind of life that he was living well before all this happened and his heart began to fail. [Hemphill] was just a shadow of his former self, and he had gotten to the point where he couldn’t even carry on a conversation.”
Dr. Benjamin Trichon, a cardiologist and director of the heart-failure program at Mission, says the team has been working hard over the last several years to develop a comprehensive approach. Introducing new technology like the heart pump is a major step.
“It’s a big undertaking for a health system in terms of hiring staff to support the program and educating caregivers and providers on which patients are appropriate to be considered [for implantation of the device],” he says. The demand for the heart pump is only going to grow, Trichon says.
Ely anticipates the Mission heart team will implant the devices in 40 to 60 patients a year.
“There are large numbers and growing numbers of patients who have advanced heart failure who are not doing well on traditional measures,” he says. “And despite the fact that we use medications … that can help [them], they have persistent symptoms of breathlessness and fatigue and low energy during their day-to-day lives. They can also have frequent, unanticipated admissions to the hospital.
“They can also have significantly shortened longevity.”
Many residents of Western North Carolina, upstate South Carolina and eastern Tennessee could benefit from having the procedure available at Mission, says Trichon.
“And we know that, with this type of approach in the right patient with the right support … quality of life can be improved, the chance of admission to the hospital can be lessened, and survival can be increased,” he says.
Hemphill says he was diagnosed with congestive heart disease almost 30 years ago. The Forest City resident believes the condition is likely congenital but might be related to exposure to Agent Orange while he was serving in Vietnam.
In 1998, Hemphill was working as a brick mason when he underwent quintuple bypass surgery.
“I got along through life pretty much OK,” he says. “I was still working; then I had to stop working [in 2002] because they didn’t want me up on scaffolds and ladders, being a heart patient. I gradually got worse and worse and worse.”
Hemphill had been playing golf regularly, even pulling his own cart.
“And then I noticed that I couldn’t walk as well as I used to and play golf and pull the cart, so I started riding,” he says. “Then it got so bad I couldn’t walk from the cart to the green. When I’d walk from the bedroom to the living room I had to stop and rest. I’d lose my breath when I would talk. I was just having a hard time getting oxygen. I was thinking seriously about not being here too much longer.”
All that changed when surgeons implanted the ventricular assist device on Sept. 2, Hemphill says. He spent 17 days in the hospital. Now he’s in rehab three days a week, lifting weights and riding a stationary bicycle.
“I feel energized in the morning when I get up,” he says. “I do things around the house that I couldn’t do before. I get out and walk. I feel like I felt five or six years ago when I had the energy to do things and play with my grandkids and stuff like that. I’m swinging my golf club, trying to get back out there on the course.”
The procedure is reserved for those with intractable end-stage heart failure and no other treatment options, says Ely. Often, as with Hemphill, such patients have had prior surgery for heart disease.
“They continue to have or develop heart failure where the heart just isn’t able to pump enough blood to support their organ system functions,” he says. “The device [takes] over the entire function of the left side of the heart and becomes just a mechanical, artificial heart.”
During the open-heart procedure, a heart-lung machine supports circulation in the patient’s heart. Once installed, the pump siphons blood from the left ventricle and pushes it into the aorta, the main artery leaving the heart. The device allows “patients to have adequate circulation to restore the functions of the rest of their organ systems,” says Ely.
Via an electronic cord that exits the patient’s abdomen, the pump links to a controller for power and speed regulation, he continues. The device can be plugged in or powered by batteries that the patient can carry in a vest, holster or pack strapped to the shoulder.
Patients “can go places and do things and function fairly normally,” Ely says.
He also says that Hemphill was a good candidate for the procedure because he was “essentially dying” from end-stage heart failure.
“He was selected because he met all the criteria for a patient who could benefit from something like this,” says Ely. “Patients have to be vetted by our team, which takes into account their psychological profile, their level of family support, their financial abilities. All kinds of things go into vetting these patients to determine if they are going to be successful living with one of these devices.”
Once Mission and its heart team committed to starting a ventricular-assist program, Ely had to go to Duke University Medical Center and successfully implant 10 of the devices while under supervision, he adds.
As the first patient to undergo the operation, Hemphill will be closely monitored for three months. Ely says the Joint Commission on Hospitals will then review the data, make a site visit to Mission and determine if the program should be accredited and receive Medicare funding.
“In order to serve the vast majority of our Medicare patients, we have to be accredited by the joint commission in order to allow Medicare to financially support those patients for this implant procedure,” he says.
With the establishment of the ventricular assist device program at Mission, patients in the region will no longer have to travel to other areas for the procedure.
“We have sent many patients far afield in order to have these devices implanted,” he says. “You can imagine what a hardship this is for families when they have to be away from home for potentially months at a time. Now they can stay home and get the care that they need both before, during and after a procedure like this.”
The technology has steadily evolved over the past couple of decades, says Ely. Ventricular assist devices were originally designed for temporary use for those waiting for a transplant but have been adapted for long-term implantation. The devices are now considered a viable alternative to a heart transplant.
“Not everyone is a candidate for a transplant, largely because of the fact that there are many, many patients who might need that kind of therapy, but there is a very limited supply of donors that can provide organs for transplant,” he says. “This device can be used for patients who might otherwise need a transplant but either can’t get one or aren’t eligible for one or don’t want one, because heart transplants carry a whole different set of risk factors as far as postoperative care, lifestyle and that sort of thing.” A transplant requires patients to take drugs to suppress their immune systems for the rest of their lives, he adds.
The pump was approved by the U.S. Food and Drug Administration for use as a “bridge to transplant” in 2008 and for patients who are not transplant candidates since 2010, Trichon says.
Hemphill has no detectible pulse because the latest generation of pumps uses continuous flow, Trichon says. Earlier versions mimicked the beating of the heart.
“They propel blood through the circulation at a set speed, which we determine when the pump is implanted,” he says. “The advantage of a continuous-flow pump is that it is reliable. There is only a single moving part.”
Hemphill’s wife, Charlene, says she was initially worried about her husband undergoing another heart surgery, but she’s more than pleased with the result.
“This helped him to get oxygen to his lungs,” she says. “Now he’s really active and perky. He’s humorous and energized. He’s up doing things like he used to do. He’s gaining more independence, and I really like that.”