LVAD surgery traditionally has been a temporary solution while a patient awaits a heart transplant. But it also can be a solution for patients whose other options have run out.
Whittel now has an implanted pump that takes over the work his heart can no longer do.
(January 2012) The Rev. Joseph Whittel was tired after saying morning Mass. So he sat in his favorite chair to catch his breath. He woke up 45 minutes later surprised. At 73, he thought of himself as an energetic person, used to working long days as the pastor of three Connecticut parishes.
But while the spirit was willing, advanced congestive heart failure was making the flesh weak. Even walking to the car was starting to feel like a marathon. He needed a heart transplant, but his age and poor condition made a donor organ unlikely.
So he followed the recommendation of Yale Medical Group cardiac surgeon Pramod Bonde, MD. In September, he underwent a six-hour surgery to implant a left ventricular assist device (LVAD), a battery-operated, mechanical device that pumps blood from the lower, left chamber of the heart to the rest of the body. He had additional surgery to repair his valve and reconstruct his ballooned heart chamber.
Dr. Bonde (left) talks to Whittel about his recovery.
LVAD surgery has traditionally been used as a temporary “bridge” solution while a patient awaits a heart transplant. However, Dr. Bonde, who joined Yale Medical Group in September as surgical director of Mechanical Circulatory Support, also specializes in LVAD surgery as a “destination therapy,” or permanent solution. It is the same treatment that former Vice President Dick Cheney had two years ago, and a boon for thousands of people with end-stage heart failure, but are not transplant candidates because of the shortage of donor organs and the strict criteria a patient must meet to receive a donor heart.
Before coming to Yale, Dr. Bonde practiced at Johns Hopkins Hospital and UPMC, where he accrued an extensive record of outstanding clinical outcomes in LVAD implantation and such cardiac surgeries as bypass surgery, valve repairs and aortic surgeries. His skills were lifesaving for Whittel, whose 2003 ordination was postponed for triple bypass surgery, and whose poor condition made a donor heart unlikely.
“Most people turn down this type of patient. Father Whittel is a patient who, from a medical point of view, had a very sick heart,” says Dr. Bonde. But he also examined his patient from another perspective. “The way he shook my hand told me he had a lot to live for,” he says.
Dr. Bonde discussed the case extensively with fellow heart failure cardiologists. Lavanya Bellumkonda, MD, and Father Whittel’s referring cardiologist, Sabeena Arora, MD, and the three agreed that, with the right treatment, Whittel could be treated and have a good quality of life.
Whittel offers a reading at the Yale-New Haven Hospital Celebration of Life event.
Joseph Whittel is a widower with four children. While working as an executive at The Hartford insurance company, he served in many volunteer positions. When his wife, Eileen, became ill, he served as her constant caretaker for years. After her death, he was ordained a Roman Catholic priest.
After his LVAD surgery, Whittel had to adjust to wearing an external battery back with a cord that runs from the implanted pump through the abdomen to the heart. The device, which Dr. Bonde says will function for several years, essentially takes over the work Whittel’s ailing heart can no longer do.
He still has months of physical and cardiac therapy ahead of him, as well as follow-up visits to monitor his stability and endurance. But soon after the procedure he embraced his physical therapy with such gusto that he earned himself an early release from the hospital. He’s happy to talk about the mile-long walk he recently took on an even grade and his shorter strolls in his family’s hilly neighborhood.
“I’m learning that I have to change some of my daily activities because of the equipment,” he says. “It takes longer to dress, longer to get ready for bed and all of that. I have to be careful that my batteries are always in good shape. It puts some new burdens on me, but if I didn’t have this I wouldn’t be alive.”
On Thanksgiving day, he concelebrated Mass for the second time since his surgery. A couple of weeks later, he gave a reading at a “Celebration of Life” event for patients and families who had come to Yale-New Haven Hospital for LVADs, heart transplants and other procedures. While he can’t say whether he will be able to keep up his old pace, he plans to return to the ministry either as a pastor, a teacher or an administrator.
“I’m thankful for the gift of life, the gift of family, and that there were doctors and nurses willing to put their reputations on the line. They didn’t necessarily take the easy way out,” he says.
Story by Colleen Shaddox
Photos by Rob Lisak
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Pramod Bonde, MD, is hoping to provide patients with better LVADs in the future. He has developed a wireless micro-LVAD that switches on only when the patient needs it, much like a pacemaker does. For patients whose hearts have the potential to recover, this would allow the actual heart muscle to do the work when it is able, strengthening it. But the LVAD would serve as a failsafe, switching on should the heart fail to pump.
This lower impact device would be appropriate to implant in patients in the early stages of heart failure—long before they get to the dangerous and debilitating stage that the Rev. Joseph Whittel reached.
Dr. Bonde has been watching LVADs and their batteries shrink and improve over the years. In 2008, he teamed up with Joshua Smith, a professor of computer science and electrical engineering at the University of Washington. Together they developed a prototype of the wireless device that has worked in the lab, but he will not be able to provide it for patients until it is commercially available. Dr. Bonde says the wireless pump could be implanted with minimally invasive “keyhole-type” surgery.
Meanwhile, Whittel and other patients wear a special vest with a battery pack to keep their LVADs working. The apparatus comes with obvious inconvenience and some added risk of infection. Dr. Bonde is looking forward to the day when the Bonde-Smith model would eliminate those problems.