New Hope New Hearts
Fighting the effects of the anesthesia, Larry Rockwell struggled to open his eyes. His mind raced to recall the events of the night before. Where was he? When his eyes opened fully, he saw faces staring at him from across the room. They were familiar faces, his wife, his two stepsons, Mohammed Quader, MD, and other members of the heart transplant team. “Hey,” he thought, “I think I made it, because this sure doesn’t look like heaven.” His body numb from surgery, he felt a sudden rush of relief – and gratitude. His wife, Marliss, recalls that although a tube in his throat prevented him from speaking, the look on his face was priceless.
Over a period of 25 years, Rockwell had survived numerous heart attacks that despite several surgeries ultimately led to heart failure, leaving him with a prognosis of less than two years to live. July 8, 2006 marks the day he turned the clock back when he successfully underwent heart transplant surgery at The Nebraska Medical Center.
Rockwell, 54, clearly understands what is meant by a second chance. “I feel wonderful and I feel blessed,” he says. “God’s hand was definitely in this, and now I am waiting and listening for that whisper in the wind when God tells me what to do next.”
Larry Rockwell is one of 18 people who have undergone heart transplants at The Nebraska Medical Center since September 2005. It is the first time that any heart transplant program in the state has exceeded more than 12 transplants in one year.
“The program has exceeded our expectations,” says Kim Duncan, MD, chief of Cardiothoracic Surgery at The Nebraska Medical Center and professor of Cardiovascular and Thoracic Surgery at the University of Nebraska Medical Center (UNMC). “We performed 17 transplants in less than a year,” he notes. “You can’t do any better than that.”
Dr. Duncan says there clearly is a need for such a program in this region. In Nebraska, an average of 10 to 15 patients await a heart transplant. Nationally, on average 4,400 people are waiting for a heart transplant, while only about 2,100 are performed each year. As the average population ages, the necessity for transplantation is expected to grow.
The Nebraska Medical Center also supports several active adult end-stage coronary artery disease programs in Omaha, Council Bluffs, Kearney and Lincoln, as well as an extensive congenital heart program. The Nebraska Medical Center heart failure clinic sees hundreds each month. It is estimated that of every 10 to 12 of these patients, at least one will eventually require a heart transplant. Approximately 20 to 25 percent of congenital heart patients will be candidates for transplantation.
If those statistics continue, Dr. Duncan says, The Nebraska Medical Center could perform as many as two heart transplants each month.
Becoming a candidate for a heart transplant is a patient’s final option after struggling with illness, intense medical care, surgeries and severe physical, emotional and personal stress.
“The beauty of heart transplantation is that it completely reverses the order of survival and longevity,” notes Dr. Quader, who serves as director of Heart Transplantation and Ventricular Assist Device Therapy at The Nebraska Medical Center and assistant professor of Cardiovascular and Thoracic Surgery at UNMC. “Generally, patients who don’t have a transplant survive less than two years. Eighty percent will die within 18 months. A heart transplant reverses those numbers. At two years, survival is 85 to 88 percent. After five years, survival is 70 percent or more.”
Rockwell still remembers that night 25 years ago when he awoke to a sharp and piercing pain in his chest. It was a month after his 30th birthday. He was single and a self-described workaholic. As a United States Air Force flight software engineer responsible for piloting U.S. satellites, he often worked 100 to 120 hours a week, getting five hours of sleep a night – or less.
His first heart attack was followed by a second while waiting for a heart catherization. After a balloon angioplasty, a third heart attack struck just a week later, which led to an emergency coronary bypass. Despite his doctors’ recommendations, Rockwell returned to active duty – and to his high-stress routine. Within six months, he had another heart attack. His lower left descending artery, the one bypassed by the earlier surgery, was 100 percent blocked.
After that episode, Rockwell heeded his doctor’s advice, went on temporary disability and worked light duty. Four years later, he was discharged due to medical reasons. “It was devastating,” he recalls. “I went through all the five stages of grief: denial, anger, bargaining, depression and finally, after that fourth heart attack, acceptance.”
The next 10 years were fairly stable. He moved to Red Oak, Iowa, got married and eventually settled in Council Bluffs, Iowa, where he did volunteer work for the American Cancer Society, the homeless and several local hospitals, and served as a court-appointed special advocate (CASA). He did everything correctly. He exercised regularly, watched his diet and followed his doctor’s orders.
It all simply forestalled the inevitable. Slowly, his heart problems began to catch up with him. Then, at age 49, he was awakened by severe ventricular tachycardia, an abnormally rapid beating of the heart. Rockwell’s heart raced wildly at 250 beats a minute for more than two hours, during which time he suffered another heart attack.
He underwent a series of surgeries, twice receiving an automatic implantable cardio defibrillator, followed by a cardio defibrillator/pacemaker. Along the way, his heart had become severely damaged and enlarged.
He recalls how his conditioned worsened, how it slowly robbed him of the things that were dear such as traveling, exercising, golf, and palling around with his grandchildren, taking them to baseball games and the zoo.
Last May, he was diagnosed with heart failure. That’s when the name “Larry Rockwell” was added to the list of people waiting for a heart transplant.
After a patient is diagnosed with heart failure and it is determined that they need a heart transplant, they still must undergo a comprehensive process to determine whether they qualify, says Ioana Dumitru, MD, transplant cardiologist and medical director of the Heart Failure and Cardiac Transplant Program at The Nebraska Medical Center and assistant professor of cardiology at UNMC. “We don’t want to perform a transplant on someone with other complications,” she explains.
Other considerations are also taken into account. This must be the patient’s last and final option. The patient must be younger than 70. They must not have permanent damage to other organs, any systemic diseases, active infections or cancer. And they must display maturity and show a willingness to do their part to make the transplant a lasting success.
The evaluation process requires a detailed physical, laboratory and psychological evaluations, as well as evaluations of the cardiac, respiratory, kidney and immune systems. This typically takes three to five days but can take several weeks. After the tests have been completed, members of the heart transplant team convene to discuss at length the patient’s eligibility. This group generally includes the transplant cardiologist, cardiothoracic surgeon, primary cardiologist, consultants in infectious disease, pulmonary medicine and nephrology, a social worker, psychologist and an organ donor coordinator.
“I always knew I would be a candidate for a heart transplant at some point,” says Rockwell, “so it wasn’t a big surprise when Dr. Dumitru dropped the news. I was mentally prepared for it. I have total trust and respect for Dr. Dumitru. If she says to do it, I do it.”
The two-week period of tests was a stressful time for Rockwell and his wife. He took steps to organize all of his personal and financial belongings into what he called a “death file,” and even made funeral arrangements. “Marliss was a nervous wreck,” he recalls. “I just left it up to God and concentrated on trying to make everything as easy for her as possible, in case they determined I didn’t qualify.”
Rockwell met the qualifications and was classified as “1B” – the second highest rating in the classification system developed by the United Network for Organ Sharing (UNOS).
To be classified “1A” – the most urgent rating – a patient must be on continual intravenous infusion or require the need for a mechanical assist device to maintain heart function. Some of the considerations to determine whether a person is a match for a particular organ include age, blood type, medical urgency, waiting time, geographic distance between donor and recipient, and the size of the donor organ in relation to the recipient.
One of the biggest obstacles to heart transplantation is the shortage of available organs. Dr. Quader estimates that each year thousands more heart transplant candidates could undergo surgery if there were more organs. The availability of organs in Nebraska is improving thanks to donor awareness efforts.?
Nationally, the wait for a donor heart averages six months. The average waiting time for patients at The Nebraska Medical Center is half that.
Waiting for a suitable donor can be very stressful for patients and families, says Margie Chartrand, RN, BSN, advanced heart failure coordinator. “Facing the reality of having a serious and potentially fatal illness, as well as the uncertainties about whether and when a suitable donor organ will become available, can be overwhelming. We try to support them as much as we can.”
During this period, heart transplant candidates are asked to carry a cell phone with them at all times. Transplant recipients commonly have three to four hours to reach the hospital once they receive the call that a potential organ has been found. This allows most recipients to stay in their hometown until a donor organ becomes available.
Rockwell recalls wondering whether this would be the day he would receive “the call.” At 1:15 a.m. on July 8, just five weeks after being posted on the organ transplant list, his phone rang. It was the transplant coordinator. “We have a heart for you,” she says.
He woke Marliss and grabbed the packed suitcase kept by his bedside. “I was very anxious and nervous,” recalls Marliss. “And though I was eager for it to happen, I was also very scared.”
On the way to the medical center, Rockwell maintained the same philosophy he had followed throughout his life. “Leave it in God’s hands.”
“Some crazy things can go through your head,” he says. “I remember reminding my wife that I had already paid for a year’s gym membership, just in case I wouldn’t be here to use it anymore.”
As the Rockwells headed to the medical center, the heart transplant team was en route to retrieve the donor heart. When an organ becomes available, the lead heart transplant surgeon, Dr. Quader, is called to discuss whether the organ is compatible with the recipient. If he feels it is a good match, the patient is notified and a transplant surgeon is flown to the site of the donor heart to visually inspect and help procure it. When the transplant recipient arrives at the hospital, blood tests are taken, medications are started, and the patient is gowned, shaved and taken to the operating room.
Having the patient ready to receive the new heart is critical, notes Dr. Quader. After the donor heart is removed, preserved and packed for transport, it must be transplanted into the recipient within five hours. Removal of the patient’s own heart begins even before the donor heart arrives. This process is timed closely with the estimated time of arrival of the new heart to minimize the amount of time a heart is absent. “The longer the heart is out, the greater the chance for damage,” says Dr. Quader.
The recipient is placed on a heart/lung bypass machine to oxygenate the blood while the heart transplant is being performed.
“It takes a lot of skill to remove the old heart without damaging other parts,” Dr. Quader says.
This process can take anywhere from 30 minutes to three hours, depending on how many prior heart-related surgeries the patient has undergone. Every time a patient undergoes heart surgery, scarring occurs which makes heart removal more tedious and challenging. In Rockwell’s case, years of heart disease and numerous surgeries had caused quite a bit of scarring. Removal took about two hours.
After the recipient’s heart is removed, the donor heart is prepared and implantation begins.
Once the donor heart has been successfully implanted, the surgical team monitors the patient closely in the intensive care unit. The team makes critical adjustments to medications, blood pressure, fluids, oxygen and blood flow as the body adjusts to the new heart.
“Each heart responds differently,” says Dr. Quader. “This is a very delicate and demanding process. It can take 20 minutes or an entire day. The key is to stay ahead of the game. You don’t want the heart to fail. If it fails, it can take a long time to get it back up to speed again.”
Most patients are monitored in the Intensive Care Unit for two to three days. When deemed stable, they are encouraged to begin getting up and moving around. Careful monitoring is done to ensure the body is accepting the new organ. Patient education about medications and other post-operative issues begin to prepare them for discharge. If all goes smoothly, most patients are ready to go home within two weeks.
Eight days after his transplant, Larry Rockwell was ready to go home.
Rockwell was up and walking two days after his surgery. Three days later he was taking short walks down hospital hallways. By the second week, Rockwell was feeling much stronger – and eager to go home.
“I decided from the beginning that I had spent enough time in hospitals in my life,” he says. “I was going to try to get out of there as soon as I could.”
Rockwell had been a patient of Dr. Dumitru for several years. “He took excellent care of himself,” she says. “He exercised, maintained a positive attitude, is very spiritual and continued to help others even when he was very sick. I contribute his success to his wonderful attitude and the way he took ownership of his disease.”
After the transplant, patients are monitored closely over the first year and must come in frequently for evaluation. Dr. Dumitru, who cares for these patients the rest of their lives, manages immunosuppressant therapy and monitors and treats rejection, infections and any transplant coronary disease. After the one-year anniversary of their transplant, follow-up visits become annual.
“Today, I feel 100 times better,” says Rockwell. “I have more strength and energy and an overall sense of well-being and peace. I don’t get short of breath every time I turn around. It’s a wonderful feeling of freedom.”
He says he is concentrating on his family, his church, exercising and “just feeling good,” something he hasn’t experienced in many years. He wants to help the heart transplant program any way he can. “I have a lot of warmth for the people involved in this program,” he says. “I’d like to be able to give something back by helping other people in similar situations.”
Dr. Duncan says a successful heart transplant program takes the collaboration and commitment of many people and departments, from administration to the numerous professionals involved in the transplant process including the physicians, nurses in the operating room and infusion care unit, perfusionists, transplant coordinators and Donate Life Services staff.
In addition to Drs. Quader, Dumitru and Duncan, some of the other key physicians in the heart transplant team are James Hammel, MD, cardiothoracic surgeon; Ali Khoynezhad, MD, cardiothoracic and endovascular surgeon; Thomas Sears, MD, cardiologist specializing in heart failure; and anesthesiologists Ricardo Cardenas, MD, Michael Fee, MD, and Jenny Geracci, MD.
Because The Nebraska Medical Center already is a major transplant center, the support services to create a world-class cardiac program are in place. “The level of dedication for the program at the institution and among healthcare professionals here is extraordinary,” says Dr. Quader. “I see nothing but continued success.”
For him, the work is demanding but fulfilling. “I would not trade this job for anything on Earth,” says Dr. Quader.
“It is absolutely gratifying when you do something as big as a transplant and see the patient afterwards. These people develop a new appreciation for life and cherish the new life they have been given. You walk away knowing this person is going to live a productive life.”
And quite likely a longer life, measured by each beat of their new heart.
Kim Lombardi shouldn’t be alive to read this. He was told many times by doctors that there was no hope, that if his failing heart didn’t kill him, the aneurysm ballooning from his ascending aorta would soon burst and that, certainly, would put him in a grave.
Lombardi didn’t listen. Like a soldier who faced impossible odds but still had one bullet left in his pistol, he refused to surrender.
On Aug.18, 2006, Lombardi became heart transplant recipient No. 16 for the year at The Nebraska Medical Center. Today, the 54-year-old mainframe computer specialist is eager to get back to work – and to tell his story of faith and perseverance.
“Is my life different? Sure it is,” he says. “I’m a diabetic induced by the medication, but after what I’ve been through, I can deal with that. I’ve got a new heart. I feel like I’m 30 years old.”
Lombardi suffered his first heart attack in 1994. He had been laid off after 18 years at his job. His first marriage was coming to an end. Then, his 16-year-old son was killed in an auto accident. He smoked. He didn’t exercise. He ate all the wrong foods. He slept three or four hours a night.
“It was my lifestyle,” he says. “They say if you live in the fast lane you get to the end quicker. They’re right.”
His second heart attack came a year later, followed by double bypass surgery. He had another heart attack in 1997, and repairs were made using angioplasty. In June 2002, he suffered a massive heart attack that severely damaged his left ventricle.
“Really, up to that point, life had been fine,” he says. “But from 2002 until I got the transplant, things just kept getting worse.” At that time, The Nebraska Medical Center wasn’t performing heart transplants. The program had been suspended in 1999 when the chief surgeon died in an auto accident.
Lombardi’s cardiologist suggested he contact a widely-recognized clinic out of state. He did – and that’s when the aneurysm was discovered. At 7 centimeters and growing, Lombardi and his wife, Jennifer, whom he married six years ago, were told the aneurysm was well past the critical stage.
“They said, ‘Go home and write your obituary. There’s nothing anyone can do for you.’ We begged (them) to do the surgery. We said, ‘If you give us a 10 percent chance of survival, we’ll take it.’ The surgeon got kind of angry with us and said, ‘No. I’m not performing a warm autopsy on you.’”
After returning to Omaha, the couple sent Lombardi’s medical records to clinics across the country. Some gave the same reply they’d already heard. Some didn’t reply at all.
They visited a general practitioner here who suggested a cardiovascular and thoracic surgeon. That visit, in turn, led them to Mohammad Quader, MD, lead transplant surgeon and director of Heart Transplantation and Ventricular Assist Device Therapy at The Nebraska Medical Center, which had resumed its heart transplant program in 2005.
The couple met with Dr. Quader and Ioana Dumitru, MD, transplant cardiologist and medical director of the Heart Failure and Cardiac Transplant Program at The Nebraska Medical Center. By that time, the aneurysm had grown to 8 centimeters. The two doctors gave Lombardi a “30 percent chance, or less” and put his name on the list of patients awaiting a donor heart.
Seven days later, he got the call. He underwent transplant surgery and says he feels better today than he has in quite a long time. “My energy came back right after the transplant.”
His experience underscores the value of organ donation. “My son died at 16, and I wonder, why didn’t I donate his organs? He was a healthy kid. Now, 12 years later, I have been given the heart of somebody else’s son. I don’t know all their circumstances, but I know how they must feel.”
Lombardi says he has advice to share with cardiac patients and healthy people alike. “First, you have to take care of yourself,” he says. “Don’t do the things I did or you’re just asking for it.
“Second, don’t give up. You may run into walls, and people will tell you there’s no hope, but somewhere there’s an answer. When your heart is failing, you’re so tired all the time, so weak that you want to give up the fight, like maybe death is the answer. But it isn’t.
“No matter what happens, you can’t give up hope.”
Kim Lombardi is living proof.
New Hearts Success Stories
Mark Maeder was born with cardiomyopathy, a disease of the heart muscle that can be passed from generation to generation. In the weeks before his heart transplant, he had lost about 90 percent of his heart function and much of his ability to function normally.
Less than a month after being listed for a transplant, he received a call that a donor heart was available. Within hours of the transplant, he was sitting up, talking and ready for a meal. “My wife tells me all the time that the donor family didn’t just save my life - they saved my children’s lives too,” says Maeder. “I couldn’t bear the thought of them growing up without their dad. There is no way to say thank you.”
MARK MAEDER, 34
Sept. 29, 2005
Darrel Kominek has undergone a bypass surgery, has been through five defibrillators and has had his heart shocked back into rhythm 42 times. But in the fall of 2005, neither the defibrillator nor medication were helping anymore. Kominek was given one year to live. At age 69, Kominek received a new heart and a new outlook for a brighter future. “I feel great,” says Kominek. “Before the transplant, walking from the front sidewalk up the steps to my home left me ‘huffing and puffing.’ Now I can walk so far that it makes my legs ache.”
DARREL KOMINEK, 69
Oct. 17, 2005
James Mullen’s heart problems began at 32 years of age when he suffered his first heart attack. That was followed by triple bypass surgery, balloon angioplasties and multiple operations to clear blockages of the arteries. Mullen says doctors told him they had never seen anyone with such severe heart damage. He knew a heart transplant was his only hope of survival. After receiving the heart this past spring, Mullen says he feels like he’s 17 years old all over again. “It’s wonderful.”
JAMES MULLEN, 49
April 12, 2006
Sandra Porter had a long family history of heart problems. About three years ago, while she was riding in Mississippi with her husband, an over-the-road trucker, her body began to swell. After an emergency room visit, she discovered she had congestive heart failure.
Initially, she was told that a heart transplant was not an option because she had emphysema and doctors didn’t believe she could survive surgery. However, doctors at The Nebraska Medical Center were able to adjust her medications, her body responded well and she was put on the waiting list. Before her transplant, she had progressed to the point that she couldn’t complete a short sentence without stopping to take a breath.
“The doctors at The Medical Center have very high marks in my book,” says Porter. “I’m alive today because of them. I can’t say enough about how wonderful those doctors are.”
SANDRA PORTER, 61
Dec. 10, 2005
A heart transplant was Justin Cornish’s final hope. Justin suffered from an extremely rare form of muscular dystrophy called Danon disease, which is characterized by heart failure. The same condition killed two of his brothers at ages 18 and 13. When Justin woke up after transplant surgery, he says he could tell things were different. “I could actually lie back and think of life as going on and not ending,” he says. “I am going to try to live a good life for myself and for my brothers who didn’t have a chance to do that.”
JUSTIN CORNISH, 16
Dec. 30, 2005
Richard Gaube’s triple-bypass heart surgery was only partially successful. After the surgery, he was in and out of the hospital with congestive heart failure. By the summer of 2005, his heart was only 5 percent operative. While waiting for a heart to become available, Gaube received a mechanical assist device to help his weakened heart pump blood to vital organs. Since the heart transplant, Gaube has slowly gained back his strength and is enjoying being a grandpa and taking his grandchildren boating and fishing. “There is no doubt in my mind that I would be gone by now if I had not received a new heart,” says Gaube. “I am so very thankful.”
RICHARD GAUBE, 56
Dec. 23, 2005
At age two and a-half, Chris Collins was diagnosed with Wilms Tumor, a type of kidney cancer that primarily affects children. His kidney was removed followed by chemotherapy. Although the treatment was successful, by age 16, he began showing signs of another problem, cardiomyopathy, which can develop as a result of chemotherapy. With the aid of medications, he was able to get by with a malfunctioning heart. However, by 2005, his heart had deteriorated to the point that he had to have a heart transplant. Collins received a heart in a record-breaking surgery that lasted only three-and-a-half hours. “I beat cancer so I knew I could beat my heart problems too,” says Collins. Just six days after surgery, he was walking six miles a day.
CHRIS COLLINS, 25
Jan. 26, 2006
Council Bluffs, Iowa
Michael Cooley was diagnosed at age 33 with familial cardiomyopathy, a disease of the heart muscle that renders the heart unable to properly pump enough blood to the body. More than 20 years later, his condition had deteriorated dramatically. In April 2006, Cooley received a new heart. “If it wasn’t for the donor, I probably wouldn’t still be around,” says Cooley. “I am so appreciative of the care I received at The Nebraska Medical Center. All of the doctors were so wonderful and kind and made me feel extremely comfortable.”
MICHAEL COOLEY, 50
April 8, 2006
Ben Homan was first diagnosed at age 38 with ischemic heart disease. He underwent cardiac bypass surgery and had multiple repeat interventions in the ensuing years. However, as his heart failure continued to worsen, Homan was placed on the heart transplant waiting list. “The personal care provided by the nursing staff on the 7th floor of the Clarkson Tower at The Nebraska Medical Center was extraordinary,” says Homan. “I owe my life to Drs. Dumitru, Quader and Windle, and the other staff that brought me back home to my family and friends.”
BEN HOMAN, 63
April 20, 2006
Leonard Williams had two triple bypass surgeries in 1995 and for the next 10 years, got along just fine. Then in February 2005, he suffered a severe heart attack. Following the heart attack, he received a heart valve replacement, defibrillator and a pacemaker and was put on heart medication. Williams says he could feel himself going downhill very rapidly. After doing some research on the Internet, he found out about The Nebraska Medical Center’s heart transplant program. Before the transplant, Williams had difficulty breathing, he couldn’t walk and had virtually no energy. All this changed after the transplant. Now he walks three miles every day and worries more about overexerting himself because he feels so good. “I have been in many hospitals over the years,” says Williams. “The quality of care and staff makes The Nebraska Medical Center stand out as one of the best in the nation in my opinion.”
LEONARD WILLIAMS, 60
May 18, 2006
Paul Flies was born with Ebstein’s malformation, a condition in which the heart’s tricuspid valve doesn’t develop properly. Because of his condition, Flies became very familiar with hospitals at an early age. As a child, he had three open heart surgeries including placement of an artificial heart valve. A heart attack in February landed Flies on the heart transplant waiting list. Several months later, Flies received the call that a donor heart had been found. Just seven days after the operation, Flies walked a mile for the first time in his life. “I will never be able to repay the donor’s family in monetary value for giving me such a gift of life,” says Flies. “However, I will try to repay them by living the best life possible.”
PAUL FLIES, 18
July 6, 2006
It was three days before his only daughter’s wedding on Aug. 5, 1998 when Thomas Yilk says the life he had known for 50 years changed. Yilk had a heart attack. For the next eight years, he counted on a defibrillator, pacemaker and heart medication to keep him alive. Then in 2005, his health started to decline greatly. He was no longer able to perform daily tasks and he tired easily. A heart transplant was his only hope. After receiving a new heart Yilk says he felt better immediately. “I feel like I won the lottery,” says Yilk. “Everyday I thank God for the heart donor and the donor’s family and for all the great medical staff at The Nebraska Medical Center.”
THOMAS YILK, 58
June 5, 2006
At 33 years of age, Anthony DeGeorge was hit with the news that he had an enlarged heart. “I was running the bases during a softball game and started really huffing and puffing,” he says. “I knew something was terribly wrong.” Five years later, DeGeorge received a pacemaker.? He made every effort to exercise, eat right and stay in shape. However, in July 2006, DeGeorge blacked out while watching television.? He was told then that he needed a heart transplant. “At first, I was scared at the thought of getting a transplant,” says DeGeorge. “Then I had a life-changing conversation with a local pastor. I knew that my life was in God’s hands and decided to go through with the transplant.” Now living life with a healthy heart, DeGeorge says he is sure he made the right decision. “I’m so thankful to be around to watch my two daughters grow up.”
ANTHONY DEGEORGE, 38
July 24, 2006