June 25, 2011

Paul Gagne was running out of options.

By August 2010, the once-active construction contractor had become so weak, he couldn’t shuffle the 20-or-so paces from his recliner to the kitchen of his Grandview, Mo., home without stopping. He napped constantly. And he couldn’t lie flat without feeling like he was suffocating. His heart was so weak, it had drained Gagne’s energy, stolen his breath, and forced him into retirement at age 55.

“I knew I was going downhill fast,” said Gagne, now 77. But it wasn’t until an appointment in September, when he sat gasping for air and heard the words “we have to do something now,” that Gagne realized he’d reached a fork in the road. His cardiologist, Tracy Stevens, M.D., had floated the idea of a heart transplant years earlier.

“I didn’t want my grandchildren remembering me as Grouchy Grandpa,” said Gagne, who’d read that transplant medication often affects recipients’ personalities.

“I didn’t want a heart transplant.” Luckily, Dr. Stevens had one more hope for keeping him alive: a new mechanical heart pump used for permanent or “destination” therapy.

From stem to stern

Gagne’s journey began in 1989, when he was first diagnosed with cardiomyopathy, a heart muscle disease. Since then, his health—and quality of life—had steadily sunk.

When medications no longer helped, Saint Luke’s cardiologists gave Gagne one of the area’s first biventricular pacemakers in 1999. It helped synchronize his heart’s beating and pumping. When that no longer did the job, Saint Luke’s cardiologists implanted a defibrillator in 2005 to regulate his erratic heartbeats and shock his heart out of potentially fatal rhythms.

And in September, he turned to Saint Luke’s Mid America Heart Institute again. It’s one of 120 hospitals in the nation—and the only one in the region—with a certified team of surgeons and support specialists who can implant the mechanical heart pump, aka a ventricular assist device (VAD).

About the size of a pine cone, the device features an inch-long tube that shunts blood from the ventricle. It then pumps blood into the aorta, the body’s main artery. The device’s 18-inch power line snakes down and exits through the patient’s abdomen, where it connects to the controller and a power supply.

Ventricular assist devices can be used not only as a bridge to transplant or decision, they can now function as a permanent “destination”—a solution that can potentially support the hearts of patients with end-stage heart failure for years. Gagne received the device on Sept. 24. Nineteen days later, he returned home.

“The use of VADs as destination therapy has become an important treatment option for patients suffering from end-stage heart failure who are not candidates for heart transplantation,” said Sanjeev Aggarwal, M.D.

“With limitations in the number of donors available for transplants, the use of VADs as destination therapy has the potential to benefit a large number of patients suffering from heart failure.”

All hands on deck

As a young boy, Gagne often visited his aunt, who ran a hotel for sailors in New Bedford, Mass. He’d watch the great sailing ships approach and depart port, mesmerized by their grand hulls, rigging, and masts.

Today, Gagne is an avid model shipbuilder. His award-winning replica of the HMS Victory—a 2,500- hour project—has been exhibited at maritime museums and events nationwide. He credits Saint Luke’s for giving him the stamina to enjoy such a time-consuming hobby. In nautical parlance, the heavy timbers that shore up the ship’s deck and support the mast are called partners. Partners essentially help ships function.

In Gagne’s case, the therapies he’s received under Dr. Stevens’ care are the partners that have sustained him for 14 years. Now, destination therapy has restored normal blood flow to his failing heart. You could say they’ve put the wind back in Gagne’s sails: He’s filled in the backyard swimming pool, built a gardening shed, and laid stones for a patio and retaining wall.

“Paul is the perfect example of someone who’s benefited from heart care advances,” said Dr. Stevens. “He’s clearly beaten the statistics.”

Maiden voyage

With his “destination” known, Gagne has adjusted to life with a mechanical heart pump. His bedroom resembles a command center: The large printer-sized power unit connects to a dedicated electrical outlet beside his bed. It records the pump’s activity and sounds alarms when power’s interrupted. (The pump requires constant power: When not connected to the main unit, Gagne uses one of his eight 12-hour batteries.)

Gagne always sports a specially made vest with pockets for the pump’s controller and battery pack. And he wears a nylon and plastic messenger bag while showering to prevent the components from getting wet and short-circuiting. Venturing out takes extra effort.

“I always have my best girlfriend with me to carry an extra bag with a set of batteries and an extra controller,” said Gagne, referring to Juanita, his wife of 54 years. “I don’t feel limited at all, because I wouldn’t be here without the pump.”

Gagne also made close acquaintance with Grandview emergency personnel. In February, he spoke to three shifts of EMTs and showed a chest X-ray of his pacemaker, defibrillator, and heart pump. Gagne explained how he no longer has a pulse.

“It’s there, but very faint, so you need special Doppler equipment that magnifies the sound,” explained Nancy Richards, R.N., M.S.N., A.P.N., one of two VAD coordinators at Saint Luke’s. “We have to educate medical personnel where patients live or travel about their conditions because treating them can be a challenge.”

Ship shape

Now with his heart in working order, Gagne is enjoying life and resuming activities he once had to give up—like gardening.

When he’s out in public, curiosity often prompts folks to question him about the components he constantly packs. He’s happy to oblige and explain how the heart pump keeps him afloat.

“Everyone wonders about my activity, but I don’t feel like this holds me back,” said Gagne. “It’s hard for many people to relate, but I’ve learned to just go with the flow.”


A Bridge to Life

As the region’s only provider of destination therapy, Saint Luke’s offers hope to patients with failing hearts

Dick Cheney has one.

And so soon could many more Americans who suffer from congestive heart failure today. The former vice president made headlines last year when his doctors announced they’d implanted a mechanical heart pump, aka a ventricular assist device (VAD).

Available since the mid 1990s, VADs have mainly been used as a bridge to transplant—a temporary device to sustain patients awaiting heart transplants.

However, in January of 2010, the FDA approved VADs for use as permanent or destination therapy for patients who are not eligible for a heart transplant.

To and flow

With normal blood flow restored, patients experience less shortness of breath and fatigue. And, in a few cases, destination therapy has allowed some hearts to rest and recover normal function. Patients in the destination therapy clinical trial experienced excellent one and two year survival rates, approaching the results of heart transplant patients.

In recent years, technological advances as well as improvements in patient selection and management have led to dramatic improvements in clinical outcomes and overall quality of life.