Artificial Pumps Assist Until Donor Heart Found
Robert Bothe (l) and Dr. Bartley Griffith
At one point, 57-year-old Robert Bothe's vital signs were so low that a doctor said he didn't know what was keeping the Glen Burnie man alive. It was one of several close calls after Bothe suffered a major heart attack in December, which led to acute congestive heart failure. He is a survivor, thanks to implantation of a pair of heart pumps at the University of Maryland Medical Center, which kept him alive until a new heart became available. He had a heart transplant at the medical center on February 19th, and was finally able to go home on March 4th.
Five years ago, while on vacation in Florida, Bothe had a heart attack brought on by a blocked artery. Cardiologists restored normal blood flow with angioplasty and a stent. Routine check-ups with his cardiologist suggested everything was normal. Things changed late last fall, when Bothe thought he was coming down with the flu and stayed home from work. "I didn't have any pain in my chest, but I had a cough, felt weak, and couldn't catch my breath. My regular doctor diagnosed me with bronchitis," says Bothe.
But on the day he tried to return to work, he looked so sick that his co-workers urged him to go home right away. Two days later, feeling worse and occasionally vomiting, he went to the emergency room at North Arundel Hospital, near his home. Bothe says, "I was told that if I hadn't received the treatment when I did, I would have only had but two more hours to live."
Bothe was diagnosed with a syndrome known as cardiogenic or heart shock. The most recent attack had caused extensive damage, eliminating his heart's pumping function.
Doctors at the community hospital quickly realized that he needed help from an advanced cardiac care center. They called Bartley P. Griffith, M.D., who had just moved to Baltimore to become chief of Cardiac Surgery at the University of Maryland Medical Center and professor and head of the Division of Cardiac Surgery at the University of Maryland School of Medicine.
Dr. Griffith, a pioneering heart transplant surgeon, has extensive experience in the development and use of small blood pumps to assist the failing heart. He is the principal investigator on studies sponsored by the National Institutes of Health to evaluate how patients respond to these new pumps, known as ventricular assist devices.
On December 8, 2001, Bothe became the first patient at the University of Maryland Medical Center to receive not one, but two of the devices, to maintain pumping action on both the left and right sides of his heart. "Without the pumps," says Dr. Griffith, "Mr. Bothe would have died from the effects of shock. One of the key things we've learned in the last decade is that if you institute these pumps early enough, you can prevent irreversible damage to the brain, the lungs and the kidneys."
Mr. Bothe remained in the cardiac intensive care unit for about six weeks, while the heart pumps helped him to stabilize and build up his strength. At the beginning of February, he was moved to a regular hospital room, to await a transplant. He says he prayed that he would receive a new heart by Valentine's Day. Five days later, on February 19th, the perfect match was found, and a team led by University of Maryland cardiac surgeon and associate professor of surgery James M. Brown, M.D., successfully transplanted the donor heart.
Today, Bothe continues to recover, and is getting used to the heart of a 27-year-old pumping inside him. He'll return to the hospital twice each week while his doctors check for signs of rejection or infection in the new heart.
Bothe says his family is more important to him than ever before. He's taking everything day-by-day, and looks to the future. "I don't know why everything has happened," he says. "God will reveal that to me." He says he has developed what he calls an "attitude of gratitude," especially for the family members who decided to donate their loved one's heart. "They have extended my life, and the lives of others who may have also received organs from the same donor. I'll always be grateful," he says.
Since Mr. Bothe, two more patients at the University of Maryland Medical Center have also received heart pumps. Dr.Griffith says the pumps are often used as a bridge to transplantation, a way to keep a person alive until an appropriate donor heart is found. However, he says new generations of these machines may be appropriate for long-term use. Doctors can leave these pumps in place indefinitely, although he says they may limit what a person can do once they're attached.
Dr. Griffith is conducting a study to determine if these pumps work well enough to enable the damaged heart to grow stronger and repair itself over time. He says the extent of the damage to Mr. Bothe's heart probably ruled out that possibility. However, in some people, the boost may promote such effective healing that the pumps could be removed, making the need for a transplant unnecessary.
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