The surgery, an alternative to a transplant, isolates dead tissue and reshapes the heart into a more efficient pump.
By ADRIENNE LU
Published September 1, 2003
ST. PETERSBURG - Will Witt was just 47 years old when he suffered his third heart attack.
So even though doctors said he might need a heart transplant, the reality didn't sink in until Witt went to see a cardiovascular surgeon a few weeks later.
Dr. Vinay Badhwar didn't mince words: Have surgery soon, he told Witt in June, or you'll most likely be dead by Christmas.
The good news was that Badhwar and his surgical team at Northside Hospital and Heart Institute in St. Petersburg could offer an alternative to a heart transplant.
The procedure, known as a left ventricular reconstruction, is an option for some patients with severe congestive heart failure - typically those who have had one or more heart attacks causing significant damage to the left ventricle, the heart's main pump.
While not without serious risks, the operation, which isolates dead tissue and reshapes the heart into a more efficient pump, sounded less dangerous to Witt than a heart transplant.
Besides, a heart transplant likely would have meant a long wait for a donor organ. Witt, who was working as a driver for patients at the James A. Haley VA Medical Center in Tampa after 20 years in the Army, didn't know if he would last that long.
So he and his wife, Gale, decided immediately to go ahead with the surgery. Badhwar cleared his schedule and in July, Witt became one of the latest to undergo a procedure that is rapidly becoming popular in Tampa Bay and around the country.
Tampa General Hospital, St. Joseph's Hospital in Tampa and St. Petersburg's Bayfront Medical Center and All Children's Hospital's joint heart program are among those offering the surgery, but it is hardly routine.
Witt hates hospitals and dislikes most doctors. But today, as he continues to recuperate, he feels fortunate to have had the operation, which will probably give him more time with his wife, his 30-year-old son and granddaughter.
"I feel like God has really touched me," Witt said.
Even though medical science has made great strides toward improving the survival rate of heart attack victims, heart disease remains the No. 1 killer in the United States. Today, more doctors are focusing their efforts on improving and extending the lives of those who survive heart attacks but have compromised hearts.
"As the medical doctors and as physicians in general get better at treating patients with heart disease, you naturally have people who ordinarily would have died who are now surviving," said Cristobal Alvarado, a cardiothoracic surgeon with the LifeLink Transplant Institute. He has been performing left ventricular reconstruction at Tampa General for several years, along with two colleagues there.
"Cardiologists tend to try to treat people as best they can with medicine because that is their specialty," Alvarado said. "But as the patients grow in number, they are more willing to consider this type of surgical procedure for their patients because they see that it works. It's just a process of educating everybody - patients, cardiologists and surgeons."
Heart failure happens when a heart has been weakened so much by clogged arteries, high blood pressure or other underlying medical conditions that it can't pump efficiently. The victim suffers from shortness of breath, fatigue and leg swelling. It is a rising epidemic, Badhwar says.
An estimated 5-million Americans suffer from heart failure, and 250,000 to 500,000 more are diagnosed each year. Only about 3,000 heart transplants are performed each year, in part because of the limited supply of donor organs and in part because of the inherent risk that a person's immune system could reject an organ.
"People are left with a chronic disease," says Badhwar, who practices with Cardiac Surgical Associates and is chairman and medical director of the Heart Institute at Northside Hospital.
The disease limits patients' quality of life. Some are forced to slow down their physical activity. Others have so much trouble breathing when they lie down, they must sleep sitting up.
Because heart transplants are an option for so few, "operations like left ventricular reconstruction may provide patients with new alternatives to the treatment of heart failure," Badhwar said.
After suffering his first heart attack in 1988 at age 32, the Army placed Witt on restricted duties.
In 1992, Witt suffered his second heart attack. His heart sustained irreparable damage, and the Army decided not to assign Witt to do any work more than 25 miles from a military hospital.
The third time, on June 1, Witt was reading the newspaper in his living room. He had complained to his wife that he wasn't feeling very well. He leaned over to hug his wife, who noticed his heart was pounding hard and fast.
Witt's wife drove him to the hospital, where he was treated for a heart attack and aneurysm.
Witt would eventually need a triple bypass to restore blood to parts of his heart. But Badhwar wanted to do more. After the heart attacks, Witt's heart had stretched to double its normal size. The heart struggled to pump blood, which meant Witt had to severely restrict his physical activity.
What's more, the walls of Witt's heart were so weakened that his next aneurysm or heart attack - which could happen at any time - could prove fatal.
In the meantime, Witt's heart was functioning at about 18 percent capacity; a normal heart functions at 70 percent capacity.
After the left ventricular reconstruction, Witt's heart functioned at about 48 percent capacity. If the recuperation goes well, Badhwar expects Witt will some day be able to do all the things he used to do.
The long-term prognosis for heart failure due to the lack of proper blood supply to the heart, which is what Witt suffered from, is not good. Of those who opt to treat the condition with only medications, only about half live more than two years, Badhwar said.
Badhwar said heart transplants remain "the gold standard" for treating congestive heart failure. "But it supplants one disease of heart failure for the disease of immunosuppression," Badhwar said.
Transplants are typically reserved for the sickest patients, Alvarado said. Left ventricular reconstruction is a good alternative for those who are in the earlier stages of congestive heart failure.
"It's less risky and more beneficial," he said. "As with anything else, if you let it go too long, you lose your window of opportunity."
- Times researcher Cathy Wos contributed to this report.