Anti-rejection medications, which heart transplant recipients must take for life, carry several risks, including a compromised immune system that can lead to cancer and kidney failure. But advancements are on the way here, too. Dosages that once required two medications and a steroid, which can cause weight gain and puffiness, have been reduced, and steroids eliminated in many cases.
“Newer medications have much less side effects than before … and we can get a patient home more quickly after surgery in our center,” Pham said. “Here, the median length of in-hospital after surgery is nine days; a decade ago it was months. Three years after a transplant here, the latest data is a 95 percent survival rate compared to the national average of 82 percent.”
More good news: For some patients who are waiting for a donor’s compatible heart, newer, compact versions of the ventricular assist device (VAD) can be implanted. These machines help the diseased or damaged heart pump blood through the body. In most cases, the patient can engage in normal activities while wearing the device. The new VADs are about the size of a cigarette pack, are implanted under the skin, and a wire is exposed from the chest to charge the inner battery.
“Over time these machines have become smaller in size and more sophisticated,” said Dr. Paolo Rusconi, associate professor of clinical pediatrics and medical director of transplants at the University of Miami and Holtz Children’s Hospital at Jackson. “On the machines available today, the patient can stay for months. And in the adult population this machine can be used in patients who are not a candidate for transplant because they have other chronic disease.”
Rusconi cites how the VAD helped Reno Lombrage, a 15-year-old with dilated cardiomyopathy. Reno, who lives in Fort Pierce, had a checkup with Rusconi at Jackson earlier in February.
“This was a perfectly healthy child until he started getting sick with flu-like symptoms and, in a matter of two to three days, had a very large heart, went into cardiac arrest and was transferred to us,” he said.
Reno did not respond to intravenous medications so he was whisked to the operating room and implanted with a VAD. “It’s quite impressive, the rapidity of how he recovered and in a matter of a couple weeks he was out of the hospital,” Rusconi said. “We even took him to a Heat game. Now this child is waiting for a heart transplant from home rather than staying in a hospital.”
Theodore Koby Hercsky, 18, had a pacemaker implanted after suffering severe heart failure about seven years ago because of a hole in his heart. Doctors at Jackson’s Pediatric Heart Failure Program were able to push back his need for a transplant. Theodore, despite taking daily medications, has competed in indoor-surfing in Hallandale, for which he has medaled.
“I’ve been good,” said Theodore, a senior at Felix Verela High School in Kendall. He plans to study pre-med or nursing at Pensacola Christian College.
“Theo’s getting better and better but this doesn’t mean he will never need a heart transplant in the future,” Rusconi said. “But at least we have been able to allow him to get seven years so far during which he was able to have his regular life to go to school and participate in indoor-surfing.”