The Arizona Center for Simulation and Experiential Learning at the University of...
Jo Marie Gellerman
The HVAD pump is the smallest, next-generation full-support heart-assist device.
Graciela Uribe’s heart was dying.
The 63-year-old grandmother from San Luis, Ariz., had trouble breathing and walking. Her body filled with fluid and she suffered multiple heart attacks and failed bypass surgeries.
Without a new heart, Uribe faced certain death.
On April 17, Uribe became the first patient in Southern Arizona to receive a HeartWare HVAD Pump, a new-generation, smaller ventricular-assist device used as a bridge to transplant. The tiny device pumps blood for her heart as she awaits a heart transplant.
The HVAD was implanted in Uribe by the cardiothoracic surgery team led by Dr. Zain Khalpey, an associate professor in the University of Arizona Department of Surgery Division of Cardiothoracic Surgery.
A critically ill Uribe was flown to UAMC by helicopter in March.
When Dr. Khalpey met Uribe, she was suffering from heart failure after years of a condition called ischemic cardiomyopathy, which creates a failing heart due to a lack of blood supply over a period of time. Her quality of life was “abysmal,” said Dr. Khalpey, also surgical director of the Heart Transplant and Mechanical Circulatory Support Program at The University of Arizona Medical Center – University Campus.
Because of her small stature, Uribe was an ideal candidate for the HVAD, which was approved as a bridge to transplant by the U.S. Food and Drug Administration in November 2012.
The HVAD pump – a small, full-support circulatory assist device – is a third the size of the Heart Mate II, which is the device Dr. Khalpey would have used if the HVAD were unavailable.
“The unique advantage of this device is that it’s the smallest available on the market. This means that it fits fully within the small space around the heart,” said Robert Poston, chief of the UA Division of Cardiothoracic Surgery.
“You don’t have to open up other body cavities to get this device to fit," Poston said. "This is a beautiful advantage because it reduces overall invasiveness and provides for the first time the opportunity to implant devices using robotic/minimally invasive techniques in the future.”
Dr. Khalpey, who arrived at UA early this year after training at Harvard and Columbia universities, said using the HVAD, which augments the failing function of the left side of the heart, results in less pain, a shorter recovery and less chance of infection, given the right patient.
The device is powered by a light-weight, highly efficient battery that Uribe wears in a pack around her waist. The battery allows her to leave home for up to six hours. Back at home, she plugs into a power source.
As technology improves, devices like the HVAD are helping to save more people, Dr. Khalpey said.
“We are moving forward in large steps,” he said, adding that the smaller device also will help pediatric patients.
“I believe that with the current and future technologies arriving (smaller left ventricular-assist devices and a smaller total artificial heart) it will be possible to expand the pediatric device program at UAMC,” Dr. Khalpey said. “Other devices haven’t been optimal for children. This gives bridge-to-transplant options to children who are in heart failure or have complex congenital disease.”
Uribe can remain on the device until she receives her new heart. Prior to her release, Uribe and her family were educated about the device by the UAMC team.
Her daughter, Ana Apodaca, said Uribe was so ill, her mother had been afraid to go to sleep at night, fearing she would not wake up.
Today Uribe is back home, spending time with her grandkids, going on shopping excursions and having her hair styled as she awaits transplant. Apodaca is having trouble keeping up with her.
“I walk faster than my daughter now,” Uribe said with a smile.
She is looking forward to receiving her new heart.
“We knew we were in the best hands at The University of Arizona Medical Center,” Apodaca said. “I knew her being there meant she would be OK. Thank God for all of these people who helped us so much.”
Within three weeks of surgery, Uribe went from being critically ill to being able to do just about anything.
“She’s really amazing,” Dr. Khalpey said. “Seeing how well she is doing has re-energized me and the team for another 10 years.”
“There are things I will never forget – the doctors, the nurses, the technicians. They have treated me very well,” Uribe said. “Dr. Khalpey takes good care of his patients.”
While she initially was nervous about the procedure, “I didn’t have a choice. The desire to live is greater than the fear. I knew I was in good hands and if I hadn’t had this, I would have died.”
“We are excited about offering this technology to our patients,” said Rainer W.G. Gruessner, chairman of the UA Department of Surgery. “This device allows us to perform a potentially lifesaving procedure for often desperately ill patients with end-stage heart disease.”
Jo Marie Gellerman