High-tech Heart

The average human heart beats 60 to 80 times per minute. Peter Westrum’s spins at 9,000 RPM.

On Sept. 25, the Branson resident became the first to have a left ventricular assist device implanted in southwest Missouri. While the technology has been around since the late 1990s, the procedure was the first of its kind at Mercy Hospital Springfield, the only facility in the Mercy system to use the device and one of only three hospitals in Missouri.

Mercy cardiac and thoracic surgeon Dr. Sirish Parvathaneni said Mercy has spent more than three years recruiting, educating and assembling a team with this goal in mind.

“This was something we wanted to do, but had to assess the need in the community first and recruit the right people,” he said, noting the hospital met strict regulations from The Joint Commission and the Centers for Medicare & Medicaid Services. “This didn’t happen overnight.”

A last resort for patients in end-stage heart failure, the hospital identified about 400 people in its service area who could potentially benefit from the procedure.

“To put a program like this in place, there needs to be a volume to sustain it,” said Mark McClanahan, Mercy director of cardiovascular development and specialty services.  “The capital costs for equipment weren’t that great, but we had to recruit two surgeons and it will take funding to sustain it with supplies.”

Parvathaneni said a program cost conservative estimate for the area’s largest health care provider would be well over $1 million.

Mercy cardiologist Dr. Gerard Oghlakian said he’s seen clinical patients who might have been candidates, but declined the procedure based on weekly trips necessary to Kansas City or St. Louis. That’s no longer a factor.

“This is a procedure that can extend your life from six months to five years and it was turned down because of travel time,” said Oghlakian, also medical director of heart failure programs for the hospital. “This can make a big difference in who we serve our population as doctors.”

How it works
The team describes the LVAD as a jet engine pump for your heart, giving patients several additional years of life in what’s known as destination therapy or acting as a bridge to transplant for those awaiting a new heart.

“This replaces the work of the left ventricle, but leaves the native heart in place,” said Theresa Witt, Mercy clinical nurse specialist and LVAD coordinator. “But this isn’t a quick fix, it’s life-altering for the patient afterward.”

Roughly the size of half a banana, the device has an electromagnetically suspended turbine anchored on each end with a ruby, the only material capable of withstanding the constant and sustained high-rotation speed. Running on two lithium batteries about the size of VHS tapes, patients, such as Westrum, must carry the external batteries in a shoulder harness and charge them in a DC grounded outlet nightly.

“Once they have the procedure, they can’t be left alone in case it malfunctions or the battery dies,” Oghlakian said. “If the battery stops, your heart stops. You have to take care of the machine, so it can take care of you.”

Witt said the process requires extensive training, not just of Westrum and family, but everyone from hospital specialists who will provide follow-up care, such as physical therapists and dieticians, to his church group and the local power company.

“It takes a community to make this happen,” she said. “I wrote a letter to the power company asking he be made a priority in the event of a power outage. Peter is a missionary and spends a lot of time at church, so I went and taught a group of about 75 about the device. Dr. O also traveled to Branson to teach the ER what to do and how to handle it if Peter came in.”

Because the device pumps blood constantly, it virtually eliminates the user’s pulse, necessitating the need for people, such as first responders, to be trained in cases of emergency.

Going forward
Following its first surgery, the team at Mercy Hospital Springfield is awaiting certification from The Joint Commission and CMS. McClanahan said hospital reimbursement depends on certification and once in place, he estimates the hospital will eventually perform 30 to 40 LVAD operations annually.

Oghlakian said the longest surviving patient utilized the device for eight years, but the small pump could theoretically last 25 years, noting the successful procedure elevates the level of care the hospital can provide.

“We are doing high-end cardio surgery here,” he said. “Rather then send patients to St. Louis for help, we are now the place people send their hard cases.

“However, this surgery is still only for the elite few who fit the need. Out of 10 people who ask for it, nine will be turned down.”

Oghlakian said acceptance is based on health risk factors and other qualifiers such as post-surgery home care.

For the 72-year-old Westrum, he’s expecting to live a few years with the device in place.

“Without the surgery, I might have three more good months, then four months of hospice and then say goodbye,” he said in a news release. “We believed it wasn’t the Lord’s time to take me. We decided to have the insert to give me three to four more years – purposeful years.”

Witt said the technology also aims to enhance the patient’s quality of life.

“He didn’t have to give up his life sitting in a chair watching life go by,” she said. “He’s out there living it.”