Newswise — A team of cardiac experts at Hackensack Meridian Jersey Shore University Medical Center joined forces recently 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, and then surgical attachment of a permanent mechanical heart pump, the team collaborated to reverse the patient’s most severe type of heart failure when he had only six months or less to live.
The patient, Michael Riley, is under the care of Hackensack Meridian cardiologist Shaddy Younan, M.D. “Michael had complex heart disease and his condition was rapidly deteriorating, necessitating 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 condition. Symptoms of heart failure include shortness of breath, chest pain, fatigue, irregular heartbeats, swelling in the legs, feet or abdomen and weight loss without diet or exercise changes.
Despite maximization of his heart medications and prior stent procedures, Dr. Younan concluded that the 63-year-old’s heart failure had progressed due to advanced disease and several heart attacks. “I had suffered from heart attacks and had a pacemaker and defibrillator, but the congestive heart failure progressed so quickly. I was so weak I could not hold my head up straight,” said Michael Riley, who lives in South Amboy, N.J., with his wife of 40 years, Susan. The couple are parents to four sons. A former American Baptist pastor and journalist, Mr. Riley understood medical topics but was skeptical about what could be done for him with new technology.
Dr. Younan contacted Deepak Singh, M.D., surgical director of the Advanced Heart Failure Program, and they devised a plan of care for Michael to save his life, utilizing some of the most leading-edge cardiac technology. This included a procedure called “shockwave” intravascular lithotripsy performed by Dr. Younan, a novel technology combining a balloon angioplasty catheter with the use of sound waves, similar to that used for treating kidney stones, to open the arteries that supply blood to the heart. “But, before that could happen, 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 had to be done at Jersey Shore, with its state-of-the-art cardiac technology, expert staff and dedicated cardiac intensive care unit.”
“Michael had been so ill he did not have the strength to get out of bed on his own, and his kidney function was deteriorating from heart congestion and resultant fluid build-up. He had not been eating 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 can’t pump enough blood to meet the body’s needs,” explained Jesus Almendral, M.D., FACC, medical director, Advanced Heart Failure Program, Jersey Shore University Medical Center. “Michael’s situation was dire, and in such advanced disease, heart transplants are often indicated but there are not enough donor hearts to meet demand. We needed a viable alternative option.”
As part of the first step in his care, Dr. Singh placed an Impella® 5.5 LVAD, the world’s smallest heart pump, into position by inserting it through an artery under the collar bone and into the heart. Once in place, the pump was turned on, providing support to the heart while monitoring the pumping activity. “This temporary procedure supported his heart function and got him better from a cardiogenic shock perspective and allowed Dr. Younan to perform the shockwave coronary lithoplasty and additional stenting,” said Dr. Singh. “It also enabled him to walk again, and improve his kidney function. Although the shockwave stenting was successful, his heart function did not improve, and we had to come up with a permanent solution. We had anticipated this potential and had prepared Michael for this prior to stenting.”
“The doctors told me that without a permanent LVAD I had a lifespan of only a few months because my cardiac function was deteriorating so quickly. It was heart-failure city. I was also in a lot of pain. With the heart pump, they predicted my life could go on for years,” said Michael.
“Implanting 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 about a 20 percent survival rate, so there was a lot at stake and Michael needed this type of intervention to survive long-term,” the doctor added. “We do not stop the heart for this procedure, but we core out a hole in the apex of the heart, to insert the device and then connect the pump to the aorta. The pump then takes oxygen-rich blood from the Left Ventricle and pumps it to the aorta which carries the blood out to the rest of the body. There also is a drive line placed under the rib cage, which is connected to an external battery pack.”
“Michael did extremely well after the surgery to implant the heart pump,” said Dr. Singh. “He was well enough to leave the cardiac ICU and then the cardiac step-down unit in about nine days to go to cardiac rehab. He did well in rehab, and eventually with the pump his cardiovascular function began to normalize, allowing him to carry on all his activities without any shortness of breath. We could not have asked for a better outcome.”
“I am still recovering and gaining my strength but feel so much better,” said Michael. “Despite the considerable adjustments with the heart pump, it’s worth it. Everyone comments about how much healthier I seem and how my outlook and mood have improved as well. The pump makes a sort of hum…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 cardiac team focused on advanced heart failure. In addition to our cardiologists and cardiothoracic surgeons, we have a great group of other specialists who are needed to care for these patients,” said Dr. Almendral. “Treating advanced heart failure patients really does take a village,” concurred Dr. Singh. “And our team is highly trained 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 high stakes but we are fully committed to delivering the best possible outcomes for our patients and their families.”
“The team at Jersey Shore extended my life; I don’t know where I’d be now, without the care they provided,” said Michael. “I’d advise anyone with a heart condition to make sure they are getting optimal care and looking at all of the options available to them.”
“This was a great example of the full spectrum of heart failure treatments, starting at Bayshore Medical Center and continuing at Jersey Shore University Medical Center,” added Dr. Younan.
“Completing a complex, life-saving case like Michael’s illustrates their extensive experience and expertise,” said Vito Buccellato, MPA, LNHA, president and chief hospital executive, Jersey Shore University Medical Center.
For many years, Jersey Shore University Medical Center has been one of the leading cardiac service provider in the state, performing thousands of diagnostic and interventional procedures annually. The academic medical center provides the only open and minimally invasive heart surgery program in Monmouth and Ocean counties, as well as cardiac technology and treatment options unavailable anywhere else in the region. “Earlier in 2021, we launched a $45 million invasive cardiovascular expansion project and technology upgrade to support Jersey Shore’s cardiac team in continuing to provide the best care and experience for patients and their families,” said Kenneth N. Sable, M.D., MBA, FACEP, regional president, Southern Market, Hackensack Meridian Health. The project is slated to be completed in 2024.
For more information, call the heart failure center at 732-776-4196. For a free physician referral, call 844-HMH-WELL.
1U.S. Centers for Disease Control, 2020