Heart transplant success: collaboration saves a life

Rick-Bales-Barnes-Jewish-Hospital-TransplantIf you ask anyone who was part of Rick Bales’ care team, they’ll all agree his story is rather remarkable. In January, Bales underwent a heart transplant procedure. The surgery only lasted a few hours, but his journey to a new heart began more than two years ago, after he survived a massive heart attack.

In October 2012, Rick Bales was a healthy 61-year-old; he exercised regularly and had normal cholesterol levels. On the Friday before Halloween that year, Bales was at the St. Peters Rec Plex for his daily 6 a.m. workout, something he’d been doing since he was in his 30s. After warming up on a stationary bike, he began his usual weight routine; afterward, he felt unusually nauseous. Once in the locker room, he sat down, head-in-hand, waiting for the sensation to pass. A fellow gym-goer asked if he was all right.

“I told him, ‘I think I’ll be fine,’ and then I passed out,” Bales says. The passerby ran for help. “I hit my head on a bench, and on the way down, I busted up my head and teeth. When I woke up, I was on the cold tile floor.” For Bales, the rest of the day went by in flashes of consciousness.

When the EMTs arrived, they determined Bales was having a massive heart attack. They intubated him, loaded him into the ambulance and headed for Barnes-Jewish St. Peters Hospital.

K. Bryan Trimmer, DO, interventional cardiologist at Barnes-Jewish St. Peters Hospital, discovered a clot was blocking blood flow through Bales’ left main coronary artery. The result was cardiogenic shock—a condition that happens when a weakened heart can no longer supply adequate blood flow to the body’s organs. To stabilize Bales’ heartbeat and blood pressure, the team implanted a temporary balloon pump and pacemaker. Bales was then transferred by helicopter to Barnes-Jewish Hospital.

The Barnes-Jewish Hospital cardiac intensive care unit (ICU) and staff are on 24-hour standby to treat cardiogenic shock. “Basically, patients with this condition are dying right in front of you,” says Kathleen Kopf, RN, ICU clinical nurse manager. “Hospitals in the region send patients in cardiogenic shock to us because they know we’re always ready to treat them.”

Even with the balloon pump and pacemaker, Bales’ heart wasn’t beating. The team chose to employ a procedure called extracorporeal membrane oxygenation, or ECMO, which would do the job Bales’ heart couldn’t do—circulate blood through the lungs so vital organs could receive the oxygen they need to survive.

Like the bypass machine used during heart surgery, ECMO moves blood out of the body into an oxygenator, then returns the oxygenated blood to the body and its organs. After three days of ECMO intervention, Bales underwent heart bypass surgery on two partially blocked coronary arteries.

Though the surgery was successful, Bales experienced tachycardia, or rapid heartbeat, in the days afterward. This was an indication that his heart needed more help to function effectively. The cardiac team determined Bales was a candidate for a left ventricular assist device, or LVAD—a small implantable pump designed to help the heart circulate blood. After the LVAD was implanted, Bales began to improve. But his heart was significantly damaged; he would need a new one.

A little more than two years after the heart attack, ECMO and implantation of the LVAD, Bales and his wife, Karen, got the call they’d been waiting for. “Just an hour and a half later, I was at the hospital getting prepped for heart-transplant surgery.”

Gregory Ewald, MD, Washington University cardiologist at Barnes-Jewish Hospital and medical director of the heart transplant program, worked closely with Akinobu Itoh, MD, PhD, Washington University transplant surgeon at Barnes-Jewish Hospital, who performed the procedure. “Mr. Bales is our hero; he’s a wonderful person. I’m so glad we were able to put our expertise and teamwork to good use for him. Everything went smoothly,” Itoh says. Itoh also is the surgical director of the heart transplant program.

Five weeks after receiving his new heart, Bales is feeling better than he has since his heart attack. He’s walking with Karen up to two miles a day, gradually working toward a return to his exercise routine. And a vacation is planned for April: an annual road trip to Austin for a car show, which the couple thought they would have to postpone this year.

“I feel excellent, and I’m gaining strength every day,” says Bales. “Every single doctor, nurse and staff member I’ve encountered in the BJC HealthCare system has just been super good to me, and I’m so appreciative of that. It’s the end of a long journey. I can finally start moving forward.”

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Category: Heart & Vascular, Transplant

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Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in addition to nurses, technicians and other health-care professionals.

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