Medical Center patient first in Pennsylvania to go home with total artificial heart
Before August 2012, if you had asked Bob Phillips of Palmyra, Pa. about his health, he would have told you he’s been nothing but healthy during his 73 years on this earth. No serious health concerns meant he had not been to a doctor in 25 years.
So he never expected to turn 74 amid a five-month stay at Penn State Milton S. Hershey Medical Center or that he would become a milestone in medical history.
Phillips has become the oldest in the United States and first person in Pennsylvania who has received a total artificial heart (TAH) to be discharged to live at home with a portable driver, the external power source for the heart, while awaiting a donor heart.
He never saw it coming.
“I was never sick,” Phillips said. “I was 73 years old and I thought if I had gotten that far I’d be cruising down the main stretch.”
Just a few short months ago, Phillips was returning from a Sunday afternoon trapshoot when he noticed an odd pain in his shoulders and chest. During his 30-minute drive home alone, the pain subsided and he thought nothing more of it. The next morning, he mowed the lawn and took his daily walk. His week continued as normal until Thursday afternoon, when the symptoms returned.
His wife Norma insisted he call a doctor immediately. He did so–reluctantly–and was told to go straight to the emergency room.
The couple learned that Phillips had suffered a massive heart attack. He was initially treated with two stents in his heart. He remained in cardiogenic shock and required therapy designed to give his heart time to rest. This therapy, extracorporeal membrane oxygenation (ECMO), uses a machine to do the work of the heart. An ultrasound later revealed a hole in the center of his heart and a heart rupture that was beyond repair.
His only option for survival was a total artificial heart connected to an external power source at all times.
Phillips was in a state of disbelief. How could his heart be damaged beyond repair?
“I always felt good; always exercised,” Phillips said. “I never dreamed that anything like this was happening to me. I was never doubled-over or short of breath or anything like the classic stuff you see.”
What he did not realize is he had coronary artery disease, and that led to advanced cardiogenic shock. On the spectrum of severity, his heart attack was the highest.
“Many of our patients have ventricular assist devices, small implantable pumps that help failing ventricles,” said Lauren Price, mechanical circulatory support/heart transplant coordinator. “His muscle and tissue damage was too bad to consider this type of device.”
“It was total artificial heart or nothing in his case,” said Dr. Edward Stephenson, cardiothoracic surgery, Penn State Hershey Heart and Vascular Institute.
Many of these options like LVADs and the TAH did not exist 10 years ago, with rapid advances in technology especially seen in the last few years.
The team led by Drs. Walter Pae and Stephenson removed two-thirds of Bob’s heart. The remaining sections were attached to a TAH made by SynCardia, the first and only TAH in the world that is approved by the U.S. Food and Drug Administration, Health Canada and meets European standard (CE). TAH is usually a ‘bridge to transplant’ and not a permanent solution.
The Medical Center is participating in a clinical trial that gives Phillips the option of going home with SynCardia’s Freedom portable driver. This technology allows stable TAH patients who meet discharge criteria to leave the hospital while waiting for a donor heart.
Until now, TAH patients had to stay hospitalized on a driver the size of a standard washing machine, weighing 418 pounds, that dates back to the mid-1980s. The new device, just over 13 pounds, can be carried in a backpack or shoulder bag. The driver provides the patient with greater mobility as well as a way to resume some normalcy during the often-lengthy time between receiving the TAH and a transplant.
“It’s our goal, with this technology to bring the patient back to normal and going home is the first step back to life, back to normal,” said Dr. Aly El Banayosy, medical mechanical circulatory support program director, Heart and Vascular Institute.
Stephenson said that despite the extensive damage to his heart, Phillips’s other organs are healthy. This made him a candidate for the TAH despite being over 65, the usual chronologic cut off age.
“You wouldn’t know he was 70-something on the inside,” Stephenson said. “You would think he’s a lot younger.”
Phillips did remarkably well and met the inclusion criteria for use of the Freedom portable driver. A patient must not have any additional organ failure or organ damage, be infection-free with normal blood pressure and have adequate family support to manage the device and help monitor his progress.
The mechanical circulatory support team provided the required training for his family members, visiting nurses, and local EMS. The training, along with meeting the FDA-approved clinical trial requirements, lengthened his stay.
While there will be limits to what he can do, the device offers better mobility and a closer-to-normal routine at home.
“It improves the psychological wellbeing of the patient and improves quality of life,” said El Banayosy. “Even with the disadvantages, it’s a huge step in the right direction.”
In addition to the driver, he will have a cart to carry the accessories he needs, including a backup driver in case of technical failure. The driver has an approximate battery life of 90 minutes and requires access to an ordinary wall outlet to charge.
The Phillips family is fortunate to live close to the Medical Center since Phillips will be required to visit the outpatient facility here every week for the first three months after discharge. Home care nurses will see him twice a week for assessments and blood draws. These nurses will keep in close communication with the physicians to triage problems.
“He has his homework to be done every day,” El Banayosy said.
For instance, Phillips will monitor his blood pressure twice each day and record the results. He is required to take daily medication and exercise daily to prepare for a transplant.
El Banayosy believes it is all a small price to pay for Phillips’s freedom. While connected to the larger hospital driver, he required the assistance of at least two other people even to do something as simple as getting a cup of coffee.
“Giving the patient this option to be able to stand up alone and to go get his coffee or newspaper — even such minor activities of daily living, it’s tremendous,” he said, “It’s a major step in improving his psychological wellbeing and recovery and helping him cope with the long waiting time for a donor heart.”
“It’s been five months since I saw the house, and you know, you miss the atmosphere, the place, the people, everything about it,” Phillips said. “So when they said you might as well go home and wait there [for a heart to come], I liked that idea.”
While Phillips will have to adjust to his new normal, El Banayosy said the risks for a patient who waits at home for a transplant and one who is in the hospital are the same. Family and nurses are trained to manage potential technical issues with the equipment, and the risk of failure of the TAH is manageable in either place.
If and when a heart becomes available, Phillips will return to the Medical Center to have the TAH removed and his new heart transplanted. It will be a return to many familiar faces.
“I just want to thank them for all their help and caring,” Phillips said. “They were all so good to me, and I just can’t say enough good about them all.”
For more information visit the Penn State Hershey Heart and Vascular Institute website or the Syncardia Total Artificial Heart website.