Part II: Qiaorong “Joey” Wang nearly died, but now she lives a completely normal life.
Dr. Avery’s hopes came true less than two years later. On December 6, 2010, Joey had an explant. She is one of a very few, lucky people – less than 5% – who recover to the point where they can have their VAD removed.
“Usually, the virus attacks the heart in such a way that the patient dies right away – before receiving medical treatment – or the patient needs a heart transplant or an implanted long term medical device,” explains Avery. “With Joey, she was looking like she was getting better.”
After a few months with her VAD, Joey had been demonstrating excellent exercise capacity. That raised the question “Does she need it anymore?” That led to Haeusslein giving her a series of tests to evaluate the recovery of her heart, such as turning down the pump while she exercised on a bike in the cath lab and finding if her heart could handle the “extra” work on its own. Doctors also tested to find out what the filling pressures were – how much backup of blood there was in Joey’s heart when she exercised. To their surprise, Joey’s doctors found everything to be normal, leading them
to believe her heart had made a substantial recovery.
But there was a hitch: “We discovered she had unusual antibodies in her blood making her unable to be cross matched with anyone else’s blood – in the entire country,” explains Avery. Joey was born and raised in China, which doctor’s attributed as the reason her antibody interaction was so rare in the United States.
“Because a lot of blood is required for this type of procedure, we needed Joey to bank and freeze her own blood. We used Procrit, a medication used to stimulate red blood cell production. Then every couple of weeks she would donate her blood. We got a total of 10 units, eight were frozen and two were kept liquid in preparation for the operation.”
The operation was a success. Joey spent only two weeks in the hospital and was home in time to celebrate Christmas with her family in Daly City.
“Joey is doing fabulous, clinically. She no longer has heart failure and has good exercise tolerance,” says Avery. To be safe, however, her doctors are
practicing preventive medicine. Even though Joey’s heart may not require it, she remains on very small doses of three heart failure medications: coreg, an alpha beta blocker; aldactone, a diuretic to help avoid fluid accumulation; and lisinopril, an angiotensin-converting enzyme inhibitor. This last, an ACE inhibitor, blocks conversion of angiotensin 1, a strong vasoconstrictor, to angiotensin 2, which increases resistance the heart has to pumping.
“There is not a lot of data for how to manage these patients, so we tend to be cautious and treat them like they have heart failure forever,” says Avery.
Nationally, only 3-5% of VAD patients can have the device explanted. Joey is one of only three patients over the past six years in the entire Bay area who recovered enough to be explanted.
“Joey had a short duration illness – she got real sick, real fast,” explains Avery. “She had biventricular failure, strongly suggesting a viral etiology which made us think she might get better.
“Usually, we see patients with a longer history of heart failure. Or, in the case of ischemia, we see patients with evidence of dead muscle extensively throughout the heart. Those patients either need a transplant or we will implant a HeartMate II® VAD as destination therapy.”
“Even after a patient’s virus goes away, they continue to use a HeartMate II® VAD to help keep their heart resting. Only if a patient can recover sufficiently, and their heart can work on its own, can the pump be removed,” explains Doug Crowhurst, who works for Thoratec, the manufacturer of the pump. “But the explant is a delicate, complicated procedure. Jim Avery and Glen Egrie are magicians.”
And how does Joey feel now that her heart works on its own again?
“I’m back to normal – and it feels good! I’m back to work. I can drive a car by myself again. And I am regaining my physicality,” says the now 37-year old, who works at a bedding warehouse. “Eventually I want to get to the gym, but right now I don’t have time to go. So I walk or run.
Concludes Avery: “Joey now lives like a normal person. She is not in heart failure. Her activities are not limited. She is taking minimum amounts of medication and is doing fabulously well. She continues to check in with us every month. She has been put on the track of a person who doesn’t have any major cardiac problem. And, in fact, it is very unlikely this will limit her life expectancy.”