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They replace broken hearts

Vatalya Bynum needed a new heart. It's a condition Tampa General has dealt with 690 times.

By LISA GREENE
Published June 13, 2005

How a heart transplant is performed A look at the surgery to mark the 20th anniversary of the heart transplant procedure. Graphic and photo gallery

TAMPA - Vatalya Bynum came to Tampa General Hospital with a photo of her baby girl, a stuffed blue unicorn and a failing heart.

Two nights later, it gave out.

By then, Bynum was in surgery. Tampa General surgeons were trying to give her a new heart - a procedure they had performed 690 times before.

But this time, things weren't going well. Just 28, Bynum had been healthy and athletic before her heart began to fail last year, after she delivered her daughter Jaidyn.

By the afternoon of June 3, Bynum was still smiling, still thanking God for "putting me on the midnight express," but she was desperately ill.

In the operating room a few hours later, after Dr. Dimitri Novitzky sawed open her chest, Bynum's blood pressure began to fall.

* * *

Twenty years ago this month, surgeons at Tampa General performed Florida's first heart transplant. Tom Thrasher lived for 10 years and started an advocacy group for uninsured transplant patients.

Fifteen days after Thrasher's operation a transplant was performed on 43-year-old Lakeland resident Glen Frank Spurlin.

Spurlin had survived the cancer that cost him a leg. But chemo drugs damaged his heart. In January 1985, his doctor said he had three months to live.

He made it to June, when doctors told him that a transplant might give him five more years.

Once again, doctors were wrong.

Spurlin still lives in Lakeland. He spends summers in the North Carolina mountains. He has three grandchildren. The oldest is 4.

"They look after Grandpa," he said. "Without the transplant, I wouldn't be able to see them."

Soon after Spurlin's transplant, a young cardiologist, Dr. Mark Weston, began caring for him. Weston began his residency at Tampa General in 1981 and hoped to work with transplant patients. The idea of transforming the lives of people about to die fascinated him.

"They're at the end of the line," Weston said last week. "It's kind of the ultimate to put a new heart in, and watch them walk out of the hospital and try to lead a normal life."

Weston, now medical director of the heart transplant program, wasn't the only one with such ambitions. New advances had made heart transplant patients more likely to survive.

In 1983, a new drug, cyclosporine, made it easier to keep the body's immune system from rejecting the heart. The next year, a new federal law established a national network for sharing organs.

Transplant centers were springing up everywhere. In 1982, 196 heart transplants were performed around the world. By 1990, the number soared to 4,147.

Surgeons at Tampa General, which had started a kidney transplant program in the early 1970s, wanted a heart program too.

An experienced transplant surgeon moved to Tampa. Other doctors visited Stanford University for training. The transplant team practiced several mock operations before Thrasher's surgery.

In 1985, surgeons performed three transplants at Tampa General - including Thrasher and Spurlin.

Last year, the hospital's surgeons - who work for the University of South Florida, LifeLink HealthCare Institute, or in private practice - did 54.

It made Tampa General the fifth-busiest heart transplant center in the nation.

* * *

In Bynum's operating room, a man wearing green scrubs and sneakers carried a battered red Coleman cooler to the back of the room and set it on the floor.

Nobody paid much attention, even though the cooler carried Bynum's chance to live, triple-bagged and packed in ice.

"Put the pump suction on, please," asked Novitzky. Blood already splattered his blue scrubs, a messy contrast to his precise movements.

Bynum's heart kept slowing. Novitzky and fellow surgeon Dr. Jack Brock could see that it was no longer doing its job. Barely beating, Bynum's heart could no longer push blood and its life-giving oxygen to her brain and other organs.

The monitors showed what the surgeons could see: falling blood pressure, slowing heart rate. Rising pressure in her pulmonary artery was a sign that blood was backing up in Bynum's lungs.

Bynum was about to die.

Novitzky reached deep into Bynum's body and pulled her heart halfway out. He started pumping, squeezing the rhythm it could no longer perform.

* * *

The surgery itself hasn't changed much since the beginning. The first successful human heart transplant was performed in South Africa in 1967 by Dr. Christiaan Barnard.

Novitzky trained under Barnard, then came to the United States, working in Oklahoma before moving to Tampa General 15 years ago. He keeps video clips of his operations on his computer.

"It's not a difficult operation," he said as he watched a video of himself at work. "But you need to be very precise."

You also need speed. A heart can survive only eight hours outside the body, and less is better. Tampa General surgeons often fly more than two hours to harvest a heart, then fly back.

Other surgeons fly from around the country to collect other organs from the same donor. A single transplant requires several consultations between various surgeons and transplant coordinators.

The bigger changes for transplants have happened outside the operating room. Sophisticated pumps keep patients alive longer while they wait for a transplant. Better drugs make rejection easier to control. Doctors can probe inside a newly transplanted heart, scraping out cells to check white blood cell counts, checking for rejection before much damage is done.

Today's average heart patient survives nine years.

* * *

Novitzky and Brock, Tampa General's chief of cardiothoracic surgery, quickly clamped off the blood supply to Bynum's heart and secured tubes from her blood vessels to a heart-lung machine.

Despite the crisis, the team worked with speed, not panic. Soon Bynum's blood was running into the machine, and the tension level eased. The machine took over for Bynum's failing heart and lungs, filtering out carbon dioxide and adding oxygen before more tubes returned the blood to her body.

"Her heart's just on vacation now," said perfusionist Don Olson, who was in charge of the heart-lung machine.

Except this vacation was permanent. Novitzky began cutting out Bynum's heart - but not all of it. The back of the heart remained, where the veins from the lungs enter. That way, he wouldn't have to stitch those veins back together.

The old heart, large and listless, was dumped in a blue plastic bucket. Often, when diseased hearts are removed, they continue to beat for a while. Bynum's only managed a feeble quiver.

The new heart came out of the cooler, bathed in ice and a paralyzing chemical and stored in plastic bags. It was smooth and pinkish-blue, with a yellow ribbon of fat running down the side.

It looked healthy, but even the surgeons couldn't know for sure. Sometimes, a heart can be damaged by cold, or chemical changes from the donor's dying brain. It might look fine, but not start to beat. When that happens, surgeons attach a temporary pump to the heart to keep blood circulating. Sometimes, the heart starts in a few days. Sometimes it never starts, and they have to find a new one.

There would be no way to tell until the heart was placed in Bynum's chest.

One day, heart doctors say, there might be better choices. Artificial hearts, still risky, might be perfected. Or researchers might figure out how to use patients' own stem cells - bone marrow cells that have the potential to change their function - to heal heart disease.

But for now, a transplant is often the only option. There aren't enough hearts to go around. Up to 30 percent of heart patients die waiting.

Bynum was lucky. She arrived at Tampa General on a Wednesday night. Her heart was found early Friday.

* * *

Novitzky began suturing the new heart into Bynum's body: the left atrium to what remained of the left atrium of her old heart. Right atrium to right atrium. He joined the pulmonary arteries. Next the aorta.

"Start warming," Novitzky said. The heart, still chilled, can't beat until it's warm.

"I'm warming," Olson said.

The stitches almost encircled the two pieces of the new and old aorta. Soon, it would all be Bynum's heart.

One stitch, then another.

The anesthesiologist, Dr. John Basile, began squeezing a bag behind Bynum's head. Through the surgical opening, Bynum's lungs could be seen expanding, then disappearing.

"Yeah," Novitzky said. "Keep ventilating."

"I got it," Basile replied.

A moment later, Novitzky undid the clamps keeping blood out of the heart. And then, quietly, it happened.

"Ka-boom," Novitzky said softly.

Bynum's new heart started to beat.

* * *

Vatalya Bynum is recovering well from the four-hour operation. She says the air she breathes seems fresher and she can feel her new heart beating faster and stronger. She is up and walking and enjoying her family - especially her baby, Jaidyn, who turns 1 year old today. Bynum plans to write the family of her donor.

"I want to let them know they saved an entire family," she said last week.

[Last modified June 13, 2005, 06:14:11]