En español | "My heart was failing. I was dying. It was as simple as that," Bill Sowden, 80, remembers. "They told me I had four to six weeks to live. I began to put my affairs in order. I even arranged for the music I wanted performed at my funeral."
Photo by Jenn Ackerman
That was more than five years ago. A recent Monday found Sowden at a three-hour rehearsal for Alive & Kickin', one of four vocal groups he sings in. When he's not preparing for a musical performance or heading out for dinner with his wife, Diane, he's developing a website for a small distribution company he founded.
See also: How does the heart pump work?
Sowden is alive and kicking today thanks to a miniature pump, called a left ventricle assist device, or LVAD, implanted just beneath his heart.
The device takes blood from the lower chamber of his heart and pumps it into the aorta, where it is delivered throughout the body. It's connected via a flexible wire that emerges from his abdomen and hooks into a controller and battery packs he carries in a shoulder holster. Sowden's pump is the same model that former Vice President Dick Cheney showed off on his recent book tour.
To date, more than 8,000 heart patients have received the HeartMate II, according to Thoratec, the California-based company that makes the device. The state-of-the-art pump costs $80,000. Surgical and medical costs associated with implanting it and monitoring patients drive the price tag higher. But both Medicare and private insurers cover the device for eligible patients.
The device offers fresh hope for people with heart failure, which occurs when the heart is no longer strong enough to pump blood normally. More than 5 million Americans suffer from heart failure. Sometimes called congestive heart failure, it's a progressive disease that robs the body's organs of the oxygenated blood they need. "It got so I couldn't walk more than a few steps without being short of breath," says Sowden. "I couldn't walk upstairs. I could hardly lift my arms."
The pump that's keeping Sowden alive is the latest in a long line of devices designed to take over for faltering hearts. The task hasn't been easy. "Early pumps were too big to fit in smaller patients, including many women, and they weren't very durable, wearing out after only about two years," says Andrew Boyle, M.D., medical director of the heart failure, heart transplant and mechanical circulatory support programs at Aurora St. Luke's Medical Center in Milwaukee.
Photo by Gina Levay
"The HeartMate II really changed everything," says Robert Adamson, M.D., medical director of the Cardiac Transplant Program at Sharp Memorial Hospital in San Diego. Unlike previous pumps, this device, approved by the Food and Drug Administration for long-term use in 2010, doesn't pump like the heart, squeezing blood out of a chamber. Instead, it spins like a tiny jet engine, pushing a steady flow of blood through the body. The pump is much smaller — roughly the size of a flashlight battery — so it can be implanted even in very small patients. And it has only one moving part, so it's also far more durable, lasting for 10 years or more in laboratory tests.
Studies show that the risk of infection and other complications has dropped dramatically with the new pump. In one analysis, two out of three patients were alive two years after implantation — an impressive number given that recipients are almost always in the end stages of heart failure. The stronger the patients are, the better their odds. "Most of the deaths occurred within the first few months among patients who were too sick to get through the surgery and recovery," says Boyle. "After those first few months, the curve flattens out, meaning if patients are strong enough to make it through the surgery and recovery, they're alive and doing very well."
Boyle's first patient to receive the device was a 79-year-old man with congestive heart failure who received it as part of a clinical trial in 2005. "A lot of people at the time might have said he was too old," says Boyle. "Six and a half years later, at 86, he's still going strong." Indeed, a recent study that compared results for patients under 70 and those over 70 found almost no difference in survival or quality of life.
Because the device restores normal blood flow to organs throughout the body, in many patients kidney and liver function improves. In some cases, the heart may even repair itself, especially in younger patients whose heart failure was caused by a virus that infected heart muscles, a condition called viral cardiomyopathy. Once the heart is strong enough, the pump can be removed.
When damage to the heart is irreversible, as in most cases of congestive heart failure, the pump can buy time until a donor organ is available for a heart transplant. Before he suffered a heart attack at age 47, Michael-Joshua Morris, of New York City, was exceptionally active. After his heart attack, he couldn't walk more than 10 steps without gasping for breath and leaning on his wife, Anne Marie. Two years ago he had the device implanted. "What the heart attack took away from me, the LVAD gave back to me," says Morris, who still hopes to undergo a heart transplant.
Photo by Maddie McGarvey
But many older heart failure patients aren't eligible for transplants because of complicating medical conditions. A heart pump may be the only option. "Everything was going down quickly," Beverly Thurman, 64, recalls. After years of progressive heart disease, her kidneys and other organs, starved for blood, were beginning to fail. Because she had antibodies in her bloodstream that would attack foreign tissue, a heart transplant wasn't an option. When doctors at Ohio State University medical center suggested the heart pump, Thurman didn't hesitate. "I was so sick, I was willing to do anything to feel well again."
Almost two years later, Thurman says she feels "marvelous." Barely able to walk before the pump was implanted, she's now taking brisk strolls through her Columbus neighborhood at one end of a leash, pulled along by her new puppy. She and her fiancé are planning a trip to Los Angeles. "Everything is just perfect."
Not all heart failure patients qualify for the device. Candidates must be healthy enough to withstand surgery and capable of managing the complex routines of charging the batteries and keeping the site where the wire connects through the abdomen sterile. But for those who qualify, the device can be life-changing. The tiny pump has proved so effective and reliable that many older patients who were once too sick to undergo surgery can go on to have hip replacements or other operations that further improve their quality of life.
To implant the pump, surgeons perform open-heart surgery. Recovery takes two weeks or more in the hospital. The wire that protrudes from the abdomen, connecting the pump to the controller and power source, must be carefully cleaned daily to prevent infection. Heart pump recipients can't swim and must be careful when taking a shower. The newest battery packs provide power for up to 14 hours — a big improvement over earlier models — allowing patients far more independence. Still, there's the reality of having to plan ahead, to make sure batteries are charged and a power source is available. And for older patients especially, the 1 1/2-pound batteries can be heavy to carry around.
But most recipients shrug off the inconveniences. "Sure, you've got a wire coming out of your gut, and batteries to worry about, and all that," says Morris. "I'm a Yankees fan, and someone once asked me if I felt as if my life was at the bottom of the ninth inning, two outs, bases loaded. The way I put it, my life is in extra innings. If I'd had my heart attack eight years ago, I wouldn't be alive. What can I be but grateful?"
Peter Jaret is is a freelance writer living in Petaluma, Calif.