Gordon White, of Racine, struggled with heart disease for years, but last spring he felt worse than ever. Even after a stent procedure in June, he remained listless and fatigued.
“I had no energy at all,” Gordon said. “My wife, Jeannette, kept asking me to call and schedule my cardiac rehab, but it was like she was talking to a lump.”
His problems came to a head on the Fourth of July when Gordon was unable to sleep and extremely short of breath. The next day, no improvement. “I was so weak, I could barely stand,” he said.
On the recommendation of a cardiologist, Jeannette drove her husband straight to Froedtert Hospital, the academic medical center of the Froedtert & the Medical College of Wisconsin health network. There, physicians quickly realized Gordon was in cardiogenic shock.
“Cardiogenic shock is when the heart is not pumping well enough to provide the necessary blood flow to the body,” said Michael Salinger, MD, interventional cardiologist and MCW faculty member. “It can be caused by coronary artery disease or, as in Gordon’s case, by a severe narrowing of the aortic valve.”
At Froedtert Hospital, Gordon was evaluated by the Comprehensive Heart Failure and Transplant team. Their initial strategy was to adjust his medications and start him on IV drug therapy. In the following days, however, Gordon’s heart continued to weaken.
On July 11, Gordon was taken urgently to an operating room, where surgeons inserted a tiny device called Impella® into the main pumping chamber of his heart.
“The Impella is a microaxial pump that temporarily supports the function of the left ventricle,” said Lucian Durham, III, MD, PhD, cardiothoracic surgeon and MCW faculty member. “It can be placed through a small incision under the right shoulder, without the need for an open heart procedure.”
With the Impella supporting Gordon’s heart, his care team began to plan next steps. Transplant was an option, but the team believed they had a chance to save his heart using minimally invasive tools.
Step one was to use a balloon catheter to gently stretch open Gordon’s diseased valve. This procedure, performed on July 17 by Peter Mason, MD, MPH, interventional cardiologist and MCW faculty member, literally gave Gordon’s heart some breathing space.
Step two was a transcatheter aortic valve replacement (TAVR), which Dr. Salinger did on July 22. Gordon’s heart responded so well to his new valve that the team was able to remove the Impella.
Step three was a biventricular pacemaker, which Gordon received on Aug. 1 from Graham Adsit, MD, electrophysiologist and MCW faculty member. This device resolved some remaining electrical signaling issues to ensure consistent heart function.
“When Gordon came to us, his heart function was severely impaired,” Dr. Salinger said. “By the time he left, his impairment was only mild and his function was improving.”
Experts in Advanced Heart Failure
Gordon’s story is not unique. The Comprehensive Heart Failure and Transplant Program has been successful in using mechanical support to avoid transplant and bridge patients to recovery. The critical factor is specialty expertise.
“While all cardiologists treat heart failure as part of their day-to-day practice, when the disease reaches an advanced stage, it makes sense to seek out a specialist,” Dr. Salinger said.
The Froedtert & MCW health network has one of the largest teams of board-certified advanced heart failure and transplant cardiologists in Wisconsin. “Our team is uniquely positioned to examine all possible options,” Dr. Salinger said. “We provide patients with the most advanced treatment appropriate for their situation.”
Froedtert Hospital also has a specialized cardiogenic shock team available 24/7 to consult on patients.
“Physicians anywhere can call the shock consult number,” Dr. Salinger said. “Our team will be assembled within 15 minutes to discuss the patient, offer advice and coordinate a rapid response if needed.”
Up and at It
Gordon now receives ongoing care from Eugenia Raichlin, MD, advanced heart failure and transplant cardiologist and MCW faculty member.
“Our team discusses Gordon’s case regularly during our weekly meeting, and we follow him closely,” Dr. Raichlin said. “His exercise capacity is improving, and a cardiac MRI recently showed that his heart doesn’t have a lot of scar tissue. That gives us hope that he may continue to improve with medical treatment alone.”
Today, Gordon is back on his feet and feeling good. “Compared to where I was last summer, I’m way better off and much stronger,” he said. “I really feel fortunate that all my issues were taken care of.”