New wonder pump that can save a failing heart

ALMOST one million Britons suffer from heart failure. Richard Jackson, 39, from Thornton-Cleveleys in Lancashire, who works in building design, is one of the first in the country to have a new procedure for severe cases, as he tells TINA WALSH.

THE PATIENT

When I was six, I was diagnosed with an inherited heart condition called hypertrophic obstructive cardiomyopathy. My grandmother and mother had it, so I was screened for it. The condition causes the muscle wall of your heart to thicken and can lead to abnormal heart rhythms. It can also make it harder for the heart to pump blood around the body and, left untreated, can lead to heart failure or even sudden death.

It didn’t affect me much at first. But in my mid-20s I had a huge shock.

One evening, I felt spaced out, with my heart beating so fast you could see it moving up and down through my chest.

My now former wife called an ambulance, and the doctors in A&e said I had a resting heart rate of 243 beats a minute. The average for an adult is 60 to 100 per minute. Mine could have been fatal.

They moved me to intensive care and fitted me with an implantable cardioverter defibrillator to restore my heart’s natural rhythm by sending an electric shock when needed.

It worked well, but five years ago my health got worse, so it was upgraded to a biventricular pacemaker, which helps the left ventricle (the bottom left chamber of the heart) function better.

But it didn’t help. A year ago, I started getting really breathless just climbing stairs. I had barely any appetite either. I knew this could be a sign of heart failure — where your heart doesn’t pump enough blood round the body.

You can also get fluid settling on your lungs, and every morning I’d cough terribly, bringing up horrible fluid.

One day last november, I noticed my ankles were really swollen.

The next day, I saw a cardiologist and after tests I was referred to specialist cardiac surgeons at Wythenshawe hospital.

Apparently, the left ventricle of my heart had become so weak it had failed.

This was putting pressure on the right side, raising the pressure in the blood vessels of my lungs.

This meant I wasn’t suitable for a heart transplant — the surgeons said a new heart would have lasted 20 beats before giving up because of the pressure.

Instead, they wanted to implant a new kind of mechanical pump, known as a left ventricular assist device (LVAD), in my chest to take over the heart’s pumping action.

The idea was that this would help my heart and lungs recover, so that eventually I would be fit for a transplant.

DOCTORS

told me about a new device, called the heartmate III. Unlike older pumps, it can mimic a natural pulse — it pumps in a slightly irregular pattern, which is closer to how a normal heart beats.

Apparently, this could help to prevent blood clotting inside the device — one of the problems with previous versions.

The operation took four hours under general anaesthetic. Afterwards, I had tubes coming out of my chest to get rid of fluid and blood, a dressing on my chest and a 90cm long cord — called a ‘driveline’ — that came out of my tummy and was attached at one end to a portable controller about the size of a mobile phone. (I’ll have this driveline for as long as the pump is fitted.)

Apart from fatigue, I didn’t feel too bad, and had morphine for a week for pain. I was discharged three weeks later.

I’m not allowed to drive for six months. During the day I have to wear a holster across my shoulders, with a battery either side.

The controller is hooked on to a belt and attached to the internal pump. A power lead runs from both batteries into the controller.

At night, I recharge the batteries in the mains socket (they last about 18 hours) with a special adaptor — the pump is still working throughout.

My physical movement is quite restricted. I can’t have a proper bath again or a shower for at least six months. The batteries are quite heavy — about 2kg — and I have to carry spares if I’m going out.

But I can lie on my back without my lungs filling with fluid and can walk upstairs without being out of breath.

If the pressure in my lungs comes down, as is hoped, I’ll be eligible to go on a transplant list.

If not, I’ll wear the pump for the rest of my life. Without the pump, I wouldn’t be here today.

THE SURGEON

RajamiyeR Venkateswaran is a consultant cardiac surgeon and director of transplantation at University hospital of south manchester Nhs Foundation Trust. HEART failure is where the heart is unable to pump enough blood round the body.

There are many causes — the most common is damage to the heart as the result of a heart attack, but genetic defects in the heart muscle and valve problems can also cause it. If left untreated, ultimately it can be fatal.

richard would have probably gone into multi-organ failure if he hadn’t had his pump.

Treatments include medication and pacemakers with a cardiac defibrillator.

But if these haven’t helped and the patient is at end- stage heart failure — when there is nothing more we can do — they will be assessed for a heart transplant.

some patients may be too ill for a transplant, because the pressure in the lungs can increase due to blood building up in the blood vessels of the lungs, and a donor heart will not be able to pump against this pressure.

These patients may be offered a left ventricular assist device. It’s known as a ‘bridge to transplant’, because round 90 per cent of patients will become well enough to have a transplant once the pump has reduced the pressure.

The pump is palm-sized and looks a bit like a bath plug with a tube attached. It’s so new that richard is one of just a handful of people in Britain to have it.

These types of devices work by sucking blood from the left ventricle (the main pumping chamber of the heart) and delivering it through a tube to the aorta, the main artery of the body.

The older generation of this pump — the heartmate II — was quite bulky (400g in weight, 4.5cm in diameter and 10cm wide).

The new device is half the weight, at 200g, and is 5cm in diameter and 3cm high. It’s also a simpler operation to implant it, which means less discomfort for the patient afterwards.

Where the new device really differs is that it can mimic the irregular nature of a real pulse, which we think is the key to longterm health as it may reduce the risk of clotting and a stroke.

ANOTHER

first is that all the individual components of the pump are suspended in a magnetic field, so the blood can pass through more easily.

This means there’s no friction between the parts, so the device doesn’t generate any heat, lowering the clotting risk.

First, we opened richard’s breastbone. next, we put him on a bypass machine to take over the job of the heart and lungs while we operated.

Then I made a hole in the left ventricle, stitching the pump inside and attaching its tube into the aorta, the main artery.

This tube was connected to a ‘driveline’, which is tunnelled through the body and comes out through the tummy near the belly button. This is attached to the pump’s controller.

Lastly, we switched off the bypass and turned the pump on.

Pumps are not a substitute for a transplant because their long-term outcome is not yet as good as a human heart.

however, this is still an effective therapy. There is a worldwide epidemic of heart failure and we don’t have enough donor hearts.

The operation costs the Nhs £150,000. Privately, it costs £250,000.