Thinking outside the box to fix a failing heart

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Lucian Capozzo jokes that he needs one more hospital stay to get his weight down to 160.  One of his last trips to the hospital was a traumatic one for a massive heart attack. The event could have turned life upside down for his children—Frankie, 13, and Marissa Rose, 9. When doctors told him he’d need a heart transplant, his thoughts flew to them. “Am I going to see them graduate from high school?”

Months later, thanks to a surgeon’s innovative work, Capozzo, 48, is back at work and shooting baskets with his kids. He’s planning family trips to Disney World and the Jersey shore, and looking forward to more distant milestones, like sending his children to their proms and dancing at their weddings.

Capozzo didn’t pay much attention to the symptoms that first surfaced during a dinner he hosted for his wife’s family in November 2012. “I felt like I ate fast and the food got stuck somewhere,” he said. “I blamed it on the extra sausage and peppers.” He never felt the classic warning symptom of pressure on his chest, so it didn’t occur to him that he’d had what his doctors later concluded was a massive heart attack.

Misunderstood symptoms

For weeks, Capozzo took antacids to treat what he continued to write off as indigestion.  Then, after finishing a night shift at his job as an IT professional, he sat down to a snack of tuna and potato chips. Again he felt uncomfortable when he tried to lie down and blamed it on what he had eaten—doctors later said this episode may have been a second heart attack.

His sister Louise saw her brother looking sicker by the day. In mid-December she took him to the Yale-New Haven Shoreline Medical Center in Guilford, where an electrocardiogram revealed that his left ventricle was barely pumping. “I’ve never seen so many doctors run toward a patient in my life,” said Capozzo.

“How did you get here?” a physician asked. “How did you get from the car to the emergency room?”

“I walked in,” he said.

“You walked in!”

Later a diagnostic MRI showed Capozzo’s heart before surgery: It was misshapen and filled most of his chest cavity. He had an ejection fraction—a measurement of the amount of blood the heart pumps with each ventricular contraction—of 8 percent. The normal rate is between 50 and 60 percent.

Avoiding the transplant list

Capozzo was diagnosed with heart failure, and the immediate plan called for a heart transplant. He was referred to Pramod Bonde, M.D., for a left ventricular assist device (LVAD), which is usually used as a temporary bridge to transplantation. The device keeps the heart pumping until a donor heart becomes available—if the patient is fortunate.  Several thousand Americans have died since 1995 while waiting for a donor heart.

But Dr. Bonde had an alternative idea. Instead of an LVAD, he proposed to repair Capozzo’s heart using surgical ventricular restoration (SVR), an operation first performed by Vincent Dor, M.D., in France in the 1980s that is still rare in the United States. All of the patients who have had the surgery by Dr. Bonde at Yale have had very good outcomes.  “This can be a permanent fix for those patients who have been so sick and have lost all hope,” said Dr. Bonde.

Dr. Bonde, one of only a handful of surgeons in New England who perform SVRs, is the director of the Bonde Artificial Heart Lab at Yale and surgical director of mechanical circulatory support. He has saved the lives of very sick patients by thinking outside the box: “We believe a creative and imaginative environment is essential to innovation,” says a message to visitors on the lab’s website.

Matching procedure and patient

Adapting the procedure to individual patients is critical to its success. Those best suited for SVR are patients who need a bypass or valve operation; have scar tissue from a previous heart attack; and have a resulting low ejection fraction, said Dr. Bonde. He has seen men and women of various ages benefit from the procedure even though their heart attacks had left different kinds of damage.

Capozzo had a ventricular aneurysm—a thinning of the heart wall that makes it vulnerable to rupture—which is exactly the problem the procedure was designed to repair. The aneurysm had forced his left ventricle from its natural elongated shape into a life-threatening spherical form. To fix it, Dr. Bonde would have to cut away damaged muscle and use a mesh patch to reshape the ventricle.

The SVR procedure requires a fair degree of artfulness on the surgeon’s part. Despite extensive imaging, surgeons cannot really see the damage to the heart until they are looking inside the patient’s chest. Knowing where damaged muscle ends and healthy muscle begins is a matter of experience and judgment. “That really is the challenge of the procedure,” explained Dr. Bonde.

Changing unhealthy behaviors

SVR spares patients the many lifestyle adjustments that an LVAD dictates, like bathing restrictions and the need to cart the device and a backup power source everywhere. SVR can also postpone—or make unnecessary—a heart transplant or implantation of an LVAD. Capozzo never had to wait for a donor heart, worry about immune system rejection, or take immunosuppressive drugs.

Since his surgery, Capozzo has had a chance to reflect on the behaviors that contributed to his heart disease. “I smoked, ate bad, never exercised,” he said.  Now he hits the elliptical trainer three or four times a week. He misses his favorite guilty pleasure, pickle juice. But for the most part, he’s passing up potato chips and heading instead to the big bowl of fruit he keeps in his kitchen.


For more information on innovative cardiac surgeries at Yale, call 203-785-6122.


This Article was submitted by Mark Santore, on Monday, June 02, 2014.
Source: Yale Medical Group