Mark Heiner of Culver City reads books, paints artistically, takes walks and does laundry - activities that would be considered routine except for the fact that a four-pound disk implanted in his abdominal cavity is keeping his blood flowing.
The procedure to implant the Thoratec HeartMate XVE was performed in early March by a team led by cardiothoracic surgeon Sinan A. Simsir, M.D., surgical director of the Heart Transplant and Ventricular Assist Device Program at Cedars-Sinai Medical Center.
Heiner's implantation of the XVE may be the first in Los Angeles County. The device was approved by the Food and Drug Administration in 2002 for use in "destination therapy," permanent support for end-stage heart failure patients who are not eligible for heart transplantation.
Heiner, 57, a former prop man in the entertainment industry, has a history of cardiomyopathy, in which the heart becomes enlarged and less efficient. He also was diagnosed in 1999 with non-Hodgkin's lymphoma, cancer of the lymph nodes. When he had a lymphoma relapse in 2005, a course of chemotherapy further damaged his heart.
The combination of ailments left Heiner in a medical Catch-22. His heart was so weak he needed a transplant, but guidelines of the International Society of Heart & Lung Transplantation suggest a patient be tumor-free for five years before being subjected to the immunosuppression that reduces the risk of organ rejection.
"I was very sick. I couldn't even be out of bed for very long. I was in intensive care about nine months ago and I got through that but my heart just never came back," Heiner said. "I was fatigued, couldn't breathe and couldn't concentrate. I just wasn't getting enough blood throughout my body. I was very close to death."
A left ventricular assist device (LVAD), the HeartMate XVE assumes the work of the heart's left ventricle, the main pumping chamber of the heart. The mechanical device can pump up to 10 liters of blood per minute, which is more than adequate for most patients, according to Simsir.
"In lay terminology, we place the device on top of the stomach, underneath the abdominal musculature. This is done during open-heart surgery with the patient on the heart-lung machine. One tube attaches the pump to the left ventricle and another goes to the aorta," said Simsir, who served as assistant professor of cardiothoracic surgery at Duke University Medical School in North Carolina before joining Cedars-Sinai a day or two before Heiner's operation.
The internal device is connected to an external "fanny pack" of rechargeable batteries by thin electrical cords that exit the body through an opening in the skin. Earlier LVADs required patients to always be tethered to a large console, but the HeartMate XVE gives patients like Heiner the ability to move freely and live at home with few restrictions. A home-health nurse visits every other week and Heiner currently sees his physicians at Cedars-Sinai every three weeks.
Heiner, who has the support of his wife and 17-year-old son, said he is still getting acquainted with the device and regaining his strength after surgery and years of poor health. He said he has a good quality of life, feels stronger every day, and already can do almost any routine chore, as long as he doesn't overexert.
"I'm up and around and alert," he said. "I don't have any of the symptoms that I had, and I feel 100 percent better. There's definite improvement, and I hadn't had any improvement in a couple of years."
The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.cedars-sinai.edu.