Heart of the Matter: A Two-Sided Tale
January 17, 2017
Sometimes a patient is so desperately ill that physicians are forced to take a chance and get creative. Davy Hobson is delighted his cardiology team at UT Southwestern did just that.
“If they hadn’t, I would be six feet under,” Mr. Hobson bluntly yet gratefully says.
Suffering severe heart problems, Mr. Hobson, a registered nurse, first came to UT Southwestern on Valentine’s Day in 2013, an irony not lost on Clinical Chief of Cardiology Mark Drazner, M.D., M.Sc., who headed the team that received the new patient.
“He had an inflammatory disease called sarcoidosis, which typically affects the lungs but also can affect the heart, lymph nodes, eyes, and skin,” Dr. Drazner recalls. “Mr. Hobson’s cardiac sarcoidosis had led to major weakening of both sides of his heart muscle as well as serious heart rhythm problems. He’d undergone multiple prior surgeries, including having a pacemaker and a defibrillator implanted, before he came to us, but the bottom line is he was developing heart failure.”
The UTSW team prepared Mr. Hobson for an ablation procedure, which involves running a catheter through a vein to the heart to correct a heart rhythm problem. The ablation had barely started when Mr. Hobson abruptly went into cardiac arrest. The team brought him back, but he crashed again. This was a life-threatening crisis.
“As team members worked to restart Mr. Hobson’s heart, give him multiple transfusions, and keep him alive, we came to a decision,” Dr. Drazner says: “He’d need a transplant, but to keep him alive until a heart became available, we were going to have to try something new.”
The left-right solution
A patient with heart failure who is awaiting a transplant often will be kept alive with a machine that helps the heart circulate the blood to the body. This machine, called a left ventricular assist device (LVAD), is surgically implanted with part of it inside the chest and part of it outside.
“Note the word ‘left’ in the device’s name,” Dr. Drazner says. “In the vast majority of patients with heart failure, it’s the left side of the heart — the powerful chambers that pump blood throughout the body — that’s the problem. But Mr. Hobson’s sarcoidosis had weakened both sides of his heart.”
Dr. Drazner and the UTSW heart transplant team decided to implant two ventricular assist devices (VADs) – one to boost the pumping action of the left side of his heart and one to boost the pumping action of the right side.
“It was an unusual move, but we were faced with an unusual situation, and we needed to be creative,” Dr. Drazner says.
Mr. Hobson’s new heart
What the UTSW team came up with to save Mr. Hobson’s life is known as a biventricular assist device (BIVAD). When the team performed this operation in February 2013, BIVAD implantation was rarely performed in the United States, in part because there was no good VAD for long-term support of the right heart.
After the surgery, Mr. Hobson had two controllers – one for each side of his heart. The specially made device for the right ventricle had been carefully tapered to accommodate the right side’s blood flow, and its RPMs had likewise been adjusted. The team labeled the controllers so everyone would be certain which one went with which VAD.
“Fortunately, the BIVAD procedure worked just as we had hoped it would,” Dr. Drazner says. “The two VADs kept Mr. Hobson going for four months as he waited for a heart to become available. Then, in June 2013, we were able to give him the news everyone had been waiting for.”
UT Southwestern Chair of Cardiovascular and Thoracic Surgery Michael Jessen, M.D., led the surgical team that performed the transplant. It was a complex operation because so much scar tissue had built up around Mr. Hobson’s heart after his many previous surgeries and because there were multiple devices to remove. Despite the intricacies, the procedure was successful.
Mr. Hobson’s recovery went smoothly, and eventually he was able to return to his job as a nurse. These days he works for a college in Fort Worth, training a new generation of medical workers.
For Dr. Drazner and the rest of the UTSW team involved, the true reward came from seeing their patient gain new life as a result of their combined skills and efforts.
“Mr. Hobson was restored to a fully functional life after being so desperately ill,” Dr. Drazner says. “It’s extremely gratifying to know that now he’s able to continue helping other people.”
Physician Referral Information
Dr. Drazner directs UT Southwestern’s Clinical Heart Center, which provides expertise in areas such as general cardiology, heart failure, coronary artery disease, heart valve conditions, heart rhythm problems, onco-cardiology, and pregnancy-related heart disease. To schedule an appointment with a UT Southwestern cardiologist, call 214-645-8300.