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Hunter Holmes McGuire VA Medical Center - Richmond, VA

 

Richmond Docs Extend Lives, Livelihoods of Veterans

by Steve Wilkins, Deputy Director of Communications

Two months ago, Edward Jacobson, an electrician living in the Boston area, received a gift that for so long he never saw coming; life. “The (local) hospitals kept sending him home saying they couldn’t do anything else for him,” said Jacobson’s wife, Darlene.
Jacobson’s heart was failing. The couple couldn’t afford and didn’t have insurance that covered advanced procedures necessary to keep his heart going and the procedures weren’t covered adequately by Medicare.

“They kept taking fluid out of him and sending him home [to die],” wife Darlene shared in Jacobson’s bleak story. That was his story until he spoke to doctors at the Boston VAMC. “They were the first to talk to him about the LVAD,” she said. The VA doctors were able to assess Jacobson’s condition and determine a way forward. They worked with staff at Richmond VAMC to make arrangements for Jacobson to receive a Left Ventricular Assist Device (LVAD) there.

A ventricular assist device (VAD) is a mechanical pump that pushes blood from the lower heart chambers to the rest of the body. VADs can be placed, through open heart surgery in the left, right or both chambers (known as ventricles). Many patients receive VADs while waiting for heart transplants. Others may count exclusively on a permanent assist from the VAD, depending on their transplant candidacy, due to the serious risks involved. The bodies of most candidates for these procedures are so weak already they have trouble moving from one room to another or climbing stairs. Many come with other conditions that may complicate their situations.

Jacobson traveled from Boston to Richmond for his LVAD placement because Richmond is VA’s only in-house heart transplant center. In fact, “there are a couple dozen places that perform the procedure along the east coast,” according to Dr. Gundar Katlaps, the cardio-thoracic surgeon who leads the Richmond center. Katlaps said the center performed its first transplant in 1980 and has done transplants every year since then. Ten transplants were accomplished there in 2012.

The success of Richmond’s LVAD patient survival rate exceeds any published national averages. Since 2008, Katlaps has performed more than 50 procedures using the most recent generation of continuous flow LVADs. He points to patient survival rates in the first three years that rival or better anything published nationally thus far. The ventricular assist device coordinator, Lisa Martin, said everyone in the patient’s life is involved in the placement of the device. “They learn the alarms (for instance, the presence of a pulse means danger! When the device is running properly the flow is smooth and there is no detectable pulse), how to manage each piece of equipment and how to care for the driveline site.” Martin suggests patients introduce themselves to local paramedics so they know who they are and where they live.

The timing of Jacobson’s procedure became an advantage, too. In November 2012 the FDA approved use of a new LVAD design. The new device is expected to reduce risk during surgery and enable quicker healing because it is smaller and fits right on the heart, instead of requiring doctors to make an extra space in an adjoining part of the body. The materials and design reduce friction and wear, so recipients can expect the devices to last longer. The device used at Richmond, as well as most places around the world during the last five years, has a high success rate. “We are in contact with a patient who travels the country and sends us mail to let us know where he is and how he is doing,” boasted Katlaps, who mentioned other patients are able to ride bikes, motorcycles, and drive cars. He added that “they go fishing and hunting. Most of them experience better quality of life than they have had in decades.”

Martin recounted the experience of a 30-something OEF/OIF Marine, who while attending college just months after discharge was diagnosed with an enlarged heart. The situation was serious enough that within months he found himself with an LVAD device and shortly thereafter gained a wife and son. The Veteran reveled in the joys of family and fatherhood for nearly three years before dying following complication after transplant surgery. Without the device he might never have experienced those joys. It seems that Jacobson, who was bedridden for more than a year prior to the surgery, can expect to do well, too. “Already he is walking a little and running short errands,” his wife related.

“I feel good,” he told her. The couple is looking forward to celebrating their next anniversary especially since the one they just celebrated, their 29th, was at his bedside. Katlaps has been with Richmond VAMC eight years and holds a dual appointment at Virginia Commonwealth University. He said he couldn’t imagine anything that would give him better job satisfaction.  “Although most of our work directly helps only one person at a time, the impact is dramatic and the positive feedback is immediate. Indirectly lives of the family members, friends and communities are affected. I feel very privileged that I have been given the opportunity and skills to serve my patients. Every day.”

The cardio-thoracic surgeon performed a second surgery with the new technology in early July and said the patient is walking, off his ventilator after just three days. He added that the procedure and the device are significant improvements over other medically-based alternatives and although it is hard to track expenses, and tougher still to place a value on life, VA officials have stated publicly that with what seems to be a significant cost savings to perform the procedures in-house, they want to expand the availability of transplant centers across the country.
Darlene Jacobson is glad there was at least one when she needed it. “Because of VA [her husband, Edward] is alive today.”