Newswise – A team of cardiac experts from Hackensack Meridian Jersey Shore University Medical Center recently joined forces to save the life of a critically ill man with advanced heart failure. Armed with the most innovative technologies, including temporary means to keep his heart working, then the surgical attachment of a permanent mechanical heart pump, the team collaborated to reverse the patient’s most severe type of heart failure. that he only had six months or less to live. .
The patient, Michael Riley, is treated by Hackensack Meridian cardiologist Shaddy Younan, MD. “Michael suffered from complex heart disease and his condition was deteriorating rapidly, requiring hospitalization to treat his heart failure,” said Dr Younan.
About 6.2 million Americans have heart failure, 1 which is caused by conditions that damage the heart muscle, such as coronary artery disease, heart attacks, diabetes, and high blood pressure. Advanced heart failure is the most serious stage of the disease. Symptoms of heart failure include shortness of breath, chest pain, fatigue, irregular heartbeat, swelling of the legs, feet, or abdomen, and weight loss without a change in diet or exercise.
Despite maximizing his heart medications and previous stent procedures, Dr Younan concluded that the 63-year-old man’s heart failure had progressed due to advanced disease and multiple heart attacks. “I had suffered from heart attacks and had a pacemaker and a defibrillator, but the congestive heart failure progressed so quickly. I was so weak I couldn’t hold my head straight, ”said Michael Riley, who lives in South Amboy, NJ, with his 40-year-old wife, Susan. The couple are parents of four sons. A former American Baptist pastor and journalist, Mr. Riley understood medical topics but was skeptical of what could be done for him with new technology.
Dr Younan reached out to Deepak Singh, MD, Surgical Director of the Advanced Heart Failure Program, and they devised a care plan for Michael to save his life, using some of the most advanced cardiac technology. This included a procedure called ‘shock wave’ intravascular lithotripsy performed by Dr Younan, a new technology combining a balloon angioplasty catheter with the use of sound waves, similar to those used for the treatment of kidney stones, to open the arteries that supply the heart. . “But, before that happened, Michael needed a temporary left ventricular assist device (LVAD) implantation to support his heart,” said Dr Singh. “This was a minimally invasive surgical procedure that was to be performed in Jersey Shore, with its state-of-the-art cardiac technology, expert staff and dedicated cardiac intensive care unit.”
“Michael was so ill he didn’t have the strength to get out of bed on his own, and his kidney function was deteriorating from the congestion of the heart and the resulting fluid buildup. He hadn’t eaten. and was weak. When he was admitted to Jersey Shore from another hospital, he was in cardiogenic shock, a life-threatening condition where the heart cannot pump enough blood to meet the body’s needs, ”explained Jesus Almendral, MD, FACC, medical director, Advanced Heart Failure Program, Jersey Shore University Medical Center. “Michael’s situation was dire, and in such an advanced disease heart transplants are often indicated, but there are not enough donor hearts to meet the demand. We needed a viable alternative option.
As part of the first stage of his care, Dr Singh placed an LVAD Impella® 5.5, the world’s smallest heart pump, by inserting it into an artery below the collarbone and into the heart. Once in place, the pump was turned on, providing support to the heart while monitoring pumping activity. “This temporary procedure supported his heart function and improved it from a cardiogenic shock standpoint and allowed Dr Younan to perform the shock wave coronary lithoplasty and the placement of an additional stent,” said the Dr Singh. “It also allowed him to walk again and improved his kidney function. Although the shockwave stenting was successful, her heart function did not improve and we had to find a permanent solution. We anticipated this potential and prepared Michael for it prior to stenting.
“The doctors told me that without a permanent LVAD I had a lifespan of only a few months because my heart function was deteriorating so quickly. It was the city of the broken heart. I also had a lot of pain. With the heart pump, they predicted that my life could last for years, ”said Michael.
“Implantation of the permanent HeartMate III LVAD is a high-risk open-heart procedure in patients with cardiogenic shock,” said Dr Singh. “Patients with the most severe form of heart failure have a survival rate of around 20 percent, so there was a lot at stake and Michael needed this type of intervention to survive in the long term,” added the doctor. “We don’t stop the heart for this procedure, but we dig a hole in the apex of the heart, to insert the device, and then connect the pump to the aorta. The pump then takes the oxygen-rich blood from the left ventricle and pumps it to the aorta which carries the blood to the rest of the body. There is also a training line placed under the rib cage, which is connected to an external battery.
“Michael behaved extremely well after the surgery to implant the heart pump,” said Dr Singh. “He was well enough to leave the cardiac intensive care unit and then the cardiac reduction unit in about nine days to go to cardiac rehabilitation. He behaved well in rehabilitation and, thanks to the pump, his cardiovascular function finally began to normalize, allowing him to continue all his activities without shortness of breath. We couldn’t have asked for a better result. “
“I’m still recovering and getting stronger, but I feel so much better,” said Michael. “Despite the tremendous adjustments with the heart pump, it’s worth it. Everyone comments on how healthier I look and how my outlook and mood have improved as well. The pump makes kind of a buzz… so I don’t have a regular heartbeat… I tell people I’m now Iron Man, ”he joked.
“At Jersey Shore, we have a highly collaborative heart team focused on advanced heart failure. In addition to our cardiologists and cardiothoracic surgeons, we have a large group of other specialists who are needed to care for these patients, ”said Dr Almendral. “Treating patients with advanced heart failure really takes a village,” said Dr Singh. “And our team is highly skilled and compassionate. We have a cardiovascular intensive care unit with a full time surgeon, which really makes a difference for our patients. Our work is important, but we are fully committed to delivering the best possible outcomes for our patients and their families. “
“The Jersey Shore team extended my life; I don’t know where I would be now without the care they gave me, ”said Michael. “I would advise anyone with heart disease to make sure they are receiving optimal care and to consider all of their options.”
“This was a great example of the full range of heart failure treatments, starting at Bayshore Medical Center and continuing at Jersey Shore University Medical Center,” added Dr. Younan.
“Carrying out a complex and vital case like Michael’s exemplifies their vast experience and vast expertise,” said Vito Buccellato, MPA, LNHA, hospital president and CEO, Jersey Shore University Medical Center.
For many years, the University of Jersey Shore Medical Center has been one of the state’s leading providers of cardiac services, performing thousands of diagnostic and surgical procedures each year. The University Medical Center offers the only open, minimally invasive heart surgery program in Monmouth and Ocean counties, along with cardiac technology and treatment options that are not available anywhere else in the region. “Earlier in 2021, we launched a $ 45 million invasive cardiovascular expansion project and technology upgrade to help the Jersey Shore cardiac team continue to provide the best care and experiences for patients and their patients. families, ”said Kenneth N. Sable, MD, MBA, FACEP, Regional President, Southern Market, Hackensack Meridian Health. The project is expected to be completed in 2024.
For more information, call the Heart Failure Center at 732-776-4196. For a free referral from a physician, call 844-HMH-WELL.
1United States Centers for Disease Control, 2020