Christopher Marshall the first total-artificial-heart patient in the Northwest who was able to leave the hospital while waiting for a donor heart, received that new heart Wednesday in a seven-hour surgery at the University of Washington Medical Center.
Earlier this week, Christopher Marshall took a long walk.
He had to take extra batteries to make sure his heart, an artificial one powered by a machine in his backpack, didn’t run out of juice.
On Wednesday, in a seven-hour surgery at the University of Washington Medical Center, Marshall got a heart that doesn’t need batteries. Late Wednesday night, as expected, he remained in the hospital’s Intensive Care Unit.
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Marshall, 51, is the first total-artificial-heart patient in the Northwest who has been able to leave the hospital while waiting for a donor heart, thanks to an experimental backpack-sized, battery-powered driver. And for the past several months, he’s been taking advantage of the mobility, hiking and exploring everywhere, even if it meant toting spare batteries.
In February, UW surgeons removed Marshall’s deeply damaged heart, replacing it with a bulbous polyurethane heart tethered to a portable pneumatic machine.
Previous artificial-heart patients haven’t been able to leave the hospital while they waited for a transplant — a wait that could be a year or longer — because the artificial heart’s driver weighed 418 pounds.
The backpack-sized battery driver that let Marshall escape the hospital is now being tested in about 50 U.S. patients by its manufacturer, SynCardia.
Marshall and his wife, Kathy, live in Wasilla, Alaska, where he has been an avid hiker and outdoorsman, working for an oil company on the North Slope of Alaska until last year, when his heart, weakened by idiopathic cardiomyopathy and ventricular tachycardia, deteriorated.
The first condition steadily destroys heart muscle, and the second meant a heartbeat often so fast and irregular it required shocks from an implanted defibrillator.
Since Marshall’s heart was replaced with the artificial heart as a bridge to transplant, he and his wife have had to stay in the area to be close to the UW in case they got “the call.”
Tuesday night, it came.
Wednesday morning, Marshall was wheeled into surgery. At about 10:30 a.m., Dr. Nahush Mokadam, the lead surgeon, Dr. Jason Smith, the assisting surgeon, and a host of other team members began the work.
A large rectangular monitor on the wall, tracking such vital signs as heart rate, blood pressure and others, showed a parade of numbers as surgeons painstakingly removed pieces of the artificial heart and the grafts connecting it to Marshall’s blood vessels, chucking them into a blue plastic tub as they went.
Suddenly, Marshall’s heart rate plummeted to zero.
Zero meant his synthetic heart was gone, explained Mike Crandall, the assistant nurse manager of the operating rooms. Now, Marshall’s life was being sustained by a bypass machine, which was pumping blood.
Soon, without ceremony, Crandall opened up the portable cooler storing Marshall’s new heart, packed in ice and a solution to keep it healthy. John Palmer, a physician assistant, took it in his gloved hands, checked it over and carefully placed it into a stainless steel bowl.
Sewing in the new heart went smoothly, Mokadam said, and took less time than removing the artificial heart, which had to be separated from scar tissue.
Overall, Mokadam said, the operation — which often can take 10 to 12 hours — went very smoothly, with no unexpected problems. “I’m delighted,” he said.
Marshall will be in the ICU for several days, and with luck be able to leave the hospital within a few weeks, his surgeon said. He’ll have to stick close to the UW for another three months or so, while doctors monitor his progress
One problem expected to crop up soon is a quirk of donor hearts, something Mokadam calls “the dwindles.” Typically, Mokadam said, the new heart feels very perky after getting out of the ice box and being filled with blood. Then, in six to eight hours, “it takes a break.”
A cocktail of drugs typically convinces it to keep going, Mokadam said.
Then, the transplant team will move to the next step, watching for signs of rejection, guarding against infection, and seeing that Marshall heals well and that his strength returns.
Mokadam, UW’s co-director of heart transplantation, was optimistic. “He’s a very healthy guy,” he said.
Outside the operating room, Kathy Marshall waited anxiously. The two of them spent the night at the hospital after getting the call, and she hadn’t slept at all, she said.
Her husband has always had an upbeat attitude, she has said, which doctors say is key for a successful transplant.
Although she hadn’t wanted to be in the operating room, she was curious about how it looked inside. A photographer showed her a digital picture of the new heart as it waited in a basin to be implanted in her husband’s chest.
She opened her eyes wide. “Wow! That is totally a miracle!”
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org. On Twitter @costrom.