Feature

Top Docs 2012: Matters of the Heart

Meet the Top Doctors who keep an eye on the rhythms of the city.

August 2012

A New Ticker

What you don’t know about heart transplants.

If you need a new heart, you’ll have to get in line. At any given time, about 10,000 Americans need new hearts. If you’re lucky enough to get one and you live in Colorado, you’ll likely end up at the University of Colorado Hospital, which is the only institution that does heart transplants in our state. Since 1986, the hospital’s heart transplant department has done 417 of the surgeries and boasts a 90.3 percent success rate—slightly higher than the national average. Those stats are not based on luck. They’re the result of a qualified team of cardiac-care docs. Drs. Eugene Wolfel and Joseph Cleveland—an advanced heart failure and transplant cardiologist and a cardiothoracic surgeon, respectively—work with a group of skilled physicians to battle adult heart failure. It may seem like you hear about heart transplants on a regular basis. But the process of treating heart failure and doing heart transplant surgery is a long journey with many detours. Below, Wolfel and Cleveland offer a primer on this medical issue.

{ DID YOU KNOW }

  • More than four decades after the first heart transplant took place, the surgery still isn’t all that common. In fact, only about 2,000 of the procedures take place each year in this country.
  • Because donor hearts are scarce and there are serious risks associated with any major surgery, the primary goal is to try to treat a patient’s heart failure with medication. For many, meds are successful in controlling their conditions.
  • Americans must sign up to be organ donors. Most cardiac-care docs bemoan the fact that in the United States citizens aren’t presumed to be donors like they are in Europe.
  • The average wait to receive an adult heart ranges from three to 18 months depending on the status of the patient. That means, the sicker one is, the more likely it is that he or she will receive a new heart.
  • A ventricular assist device is a machine that’s partially implanted inside a patient and helps the heart function. About 20 percent of those waiting on a heart transplant get a VAD to help them live until an organ is found.
  • VADs are meant to be temporary, but some patients are not good candidates for transplant. VADs can sometimes be used indefinitely. The longest a UCH patient has lived on a VAD is four-and-a-half years after implantation.
  • The most common reasons—called contraindications in medical terms—a patient cannot receive a heart transplant are old age and lung disease.

A Patient's Story

Collin Johnston loves to hike in the Rocky Mountains. When he moved to Colorado in 2005, he quickly became enamored of the trails that wind through the wilds just outside of Boulder. He spent hours on hiking trails—the physical activity at altitude was no trouble for the fit 22-year-old. But after about a year, Johnston began to notice his hikes weren’t quite as effortless. He was short of breath and coughing, and he noticed he’d been gaining weight.

After making a list of his symptoms, Johnston, then 24, surfed common medical sites in an attempt at self-diagnosis. “Every place I looked said my symptoms were all major signs for heart failure,” he says. Johnston was frightened: His mother had died from the disease 13 years earlier.

Johnston’s family doctor diagnosed him with idiopathic dilated cardiomyopathy, which is an enlarged heart with an unknown cause. The disease can have a genetic link; what it doesn’t have is a cure. After an initial regimen of drugs failed to work for Johnston in mid-2006, his doctor in Boulder sent him to University of Colorado Hospital for what he called “alternative treatment.” After seeing the young man, the advanced heart failure docs—a team that consisted of Drs. Eugene Wolfel, JoAnn Lindenfeld, Simon Shakar, Andreas Brieke, and Larry Allen—at University immediately put him on the heart transplant list in November 2006.

For all of 2007 and most of 2008, Johnston managed well on the medications the docs prescribed. He was in and out of the hospital a few times so that doctors could deal with minor complications, but overall things were going well. “I’d go as far as to say that I felt pretty good in early 2008,” he says. “At one point they even deactivated my transplant list status.”

But the good times didn’t last. In December 2008, Johnston deteriorated. He became fatigued, retained fluid, and had trouble sleeping. The doctors upped his meds to no avail. It was time to reconsider a heart transplant, but Johnston was getting sick so quickly that his doctors opted to explore the idea of putting their patient on a ventricular assist device (VAD). “I was really scared about that,” he says, “even knowing Dr. Joe Cleveland was a pro.”

On April 20, 2009, Cleveland implanted the 26-year-old with a HeartMate II, a device that lives almost completely inside a patient’s chest—minus two battery packs and a control unit. The VAD is clunky to wear around every day—Johnston points out, however, that it’s “better than the alternative”—but the unit improved Johnston’s condition immensely. On October 9, 2009, Johnston even walked the Denver Half Marathon, being extra cautious that his battery unit would last the full race.

But VADs aren’t meant to be a permanent fix: Johnston needed a new heart. In August 2009 as well as on December 24, 2009, Johnston got calls for possible hearts—both of which turned out to be false alarms. Finally, his “gift” came on February 3, 2010. It was a perfect match. And after eight hours in the OR, Cleveland had given Johnston another shot at being a weekend warrior. “I can go hiking again,” Johnston says. “I have a lot of prescriptions to take and I have to get my blood drawn all the time, but I think this heart is better than my native heart ever was.”

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