September 13, 2012

After months on portable artificial heart, Alaska man receives transplant

UW Health Sciences/UW Medicine

Clare McLean

Christopher Marshall at a March 2012 press conference just before he was discharged with a portable artificial heart.

Yesterday, Sept. 12, Christopher Marshall of Wasilla, Alaska, could no longer joke, with his winning smile, that he was heartless.  After 220 days on an artificial heart, Marshall received a donor heart transplanted in a seven-hour surgery at UW Medical Center. He is now the Intensive Care Unit, as expected after surgery of this nature. This afternoon, Sept. 13,  he is alert, his condition remains stable, and he can spend some time sitting in his chair.

In March of this year, Marshall, 51, became the first Total Artificial Heart patient in the Pacific Northwest to be discharged from a hospital while awaiting a heart transplant. His heart was removed, and an artificial heart implanted, on Feb. 6. As he recovered from the procedure, he was placed on a small portable machine that powered the polyurethane heart. Eventually, when the surgical wound to his chest healed sufficiently, he was able to wear the pneumatic device in a backback.

The portability of the device let him to return to a house in Bothell, Wash., where he was staying with his wife Kathy and their dog, who was flown down to join them. Equally important for the hiker and outdoorsman, he could take walks with his family and friends and explore many trails in this area … as long as he took extra batteries.  He logged hundreds of miles walking outside, looking like any other Northwest backpacker.

Patients have been placed on artificial hearts before while awaiting transplants, but until the advent of the portable driver, they had to remain hospitalized, tethered to a driver that weighed 418 pounds.  Marshall had to establish a temporary home in the greater Seattle area to receive his outpatient and home nursing care, and to be nearby when the call came that a suitable donor  heart had become available.  Otherwise, he enjoyed a freedom of movement that would been impossible without the portability of his device.   The manufacturer, SynCardia, is now testing the portable driver with about 50 U.S. patients.

Clare McLean

A surgical team led by Dr. Nahush Mokadam performs heart transplant surgery for patient Christopher Marshall Sept. 12 at UW Medical Center.

Marshall worked for an oil company on the North Slope of Alaska until last year, when his heart weakened from idiopathic cardiomyopathy, a condition that destroys heart muscle.  At times he had a fast, irregular heartbeat that required shocks from his implanted defibrillator.  When his heart condition deteriorated, he became a candidate for a heart transplant.  As he grew more seriously ill, the artificial  heart was presented to him as an option to bridge the time before transplant surgery.  Reluctant at first to have his heart removed and temporarily replaced with a machine, the realization of how critical situation was made him decide to go ahead with the procedure.

After seven months on the artificial heart, his chance came to come off it.  Wednesday morning he was wheeled into the pre-operative area where preparations began for his surgery.  His surgeon had been notified  that the aircraft transporting the donor’s heart was landing at Boeing Field.  The heart was gently packed in a solution to keep it viable and stored on ice in a cooler. An ambulance was on its way to take the cargo to UW Medical Center.

Clare McLean

Christopher Marshall’s artificial heart before his Feb. 6 implant (left), and after it was removed Sept. 12.

At about 10:30 a.m., Dr. Nahush Mokadam, the lead surgeon, and Dr. Jason Smith, the assisting surgeon, and the other team members began the procedure. They removed the pieces of the artificial heart and the grafts connecting it to Marshall’s  blood vessels. Without it, he had no heartbeat. The whoosh of the pneumatic  that had followed him this past several months was silent.  His life was supported now by a bypass machine that pumped his blood.

Clare McLean

The artificial heart has been removed and surgeons prepare to place the donor heart into Christopher Marshall’s chest.

Sewing in the new heart went smoothly and took less time than removing the artificial heart,  Mokadam said. The surgeons faced no unexpected problem.  Before early evening, Marshall was out of the operative room and heading toward his post-operative and post-anesthesia recovery.

Now his UW Medicine team will keep watch for signs of rejection and infection, and will help him regain his strength as he heals from transplant surgery.

Kathy Marshall said her husband’s upbeat attitude helped him successfully deal with being an artificial heart patient and with the prospect of  transplant surgery.  While she was in the UW Medical Center surgery waiting room eager for more word of his progress, a news photographer brought out images for her of the donor heart being transplanted into her husband’s chest. She looked at the photos with wide eyes and said, “Wow! That is totally a miracle.”