An “artificial heart” the size of a golf ball is keeping a SA businessman alive while he waits for a donor heart.
The revolutionary heart pump was implanted into 51-year-old Willie Koetzee, who was so ill that doctors didn’t hold out much hope for him.
Koetzee was admitted to the Netcare Christiaan Barnard Hospital at the beginning of last month with cardimyopathy – a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently.
His heart deteriorated to the point where it retained only 3.5 percent of its function and could pump less than a third of the five litres of blood that a healthy heart pumps.
The businessman, from Heidelberg in Gauteng, desperately needed a heart transplant and was put on an emergency organ donor list, but could not find a donor.
But he has been helped, thanks to a heart pump called the HeartWare Ventricular Assist System (HVAD). The small device is implanted into the heart and is designed to restore a normal blood flow into and out of the heart. It keeps the patient well while awaiting a heart transplant.
It draws the oxygenated blood from the left ventricle of the heart and propels it into the aorta for distribution into the body. The right ventricle of the heart is responsible for pumping deoxygenated blood into the lungs, where it is oxygenated.
While the technology is widely used in Europe and the US, the city hospital became the first in Africa to implant it, three weeks ago. Koetzee is the hospital’s second patient to have it implanted.
Dr Willie Koen, who is head of the transplant programme at the hospital and operated on Koetzee, said the device took on the full function of the heart once inserted. He said the device worked only if the right ventricle of the heart remained operational. If not, the artificial heart known as Berlin Heart was used. But this required full-time hospitalisation.
Inserted during open-heart surgery, the golf-ball sized device is surgically implanted directly next to the heart. A cable of the battery-powered controller then exits the patient’s skin through the diaphragm and connects the implanted pump to the externally worn controller.
Koen said the device enabled patients to wait safely for a new heart, without further deterioration of their health.
“The boost to the heart enables the patients to return to fitness while waiting, and this result in a far better outcome when a transplant is finally possible. The patient is much better and stronger, with fully functioning kidneys and other organs. Patients generally have a good appetite and once can therefore expect an improved result from the transplant,” he said.
Koen said while the hospital was using the procedure as bridge to transplantation, but it could also be used as a bridge to recovery, particularly for patients who had a massive heart attack or if the heart had been seriously weakened by a virus, and needed to regain muscle strength.
And after 13 days of having the surgery done, Koetzee is over the moon to have his heart function back. He can’t wait to go home. “It was a big operation, but I already feel so much better and energetic. I walk around the hospital and staff keep on asking what am I doing out of bed,” he said.
With his fiancée, Maggie Landsberg, at his bedside, he talked of his fear of dying and how he avoided sleeping.
“It was the scariest moment of my life. Not knowing whether you are going to live or die was the most destabilising feeling,” he said.
Koetzee said his next step was to get a heart transplant.
Koen said given the shortage of organ donors in the country, doctors were resorting to mechanical devices to keep patients well and alive while they were awaiting organs.
He said elderly patients also preferred to use the device, which could stay inside the body for up to four years as a bridge to recovery, rather than wait for transplants.
How it works
The HeartWare Ventricular Assist System, otherwise known as the HVAD pump, is designed to restore blood flow by enabling the left ventricle of the heart to do its job – which is to pump the oxygenated blood back to the body through the patient’s ascending aorta.
The pump, which is designed to rest inside the patient’s chest, has only one moving part – the impeller.
Suspended within the pump using magnets and thrust bearings, the impeller’s wide blades are set at an incline.
When the impeller spins, blood flows across the inclined surface of the blades, creating a “cushion” between the impeller and the pump housing.
A driveline cable, which exits the body through the skin in the diaphragm, delivers power to the impeller from a battery-operated controller. The device can be operated at 2 400 and 3 200 revolutions a minute, which generates a pump-flow rate of up to 10 litres a minute.
The controller and batteries are contained in a carrying case that is designed to be worn either around the patient’s waist or over the shoulder. - Cape Argus