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Making Heart History
Mississippi’s First Implantable LVAD Successfully Placed in Verona Heart Failure PatientHeart failure patient Jackie Kirkman had run out of lifesaving options when she received the state’s first implantable left ventricular assist device (LVAD) from a University of Mississippi Health Care surgical team. Six months later, she’s doing just fine. (See related stories below.) The LVAD bridge-to-transplantation mechanical blood pump that assumes some of the work for the heart is an eleventh-hour opportunity to bridge the gap between need and the shortage of organ donors, making it possible to maintain and stabilize transplant patients with this device for a longer period of time. Curt Tribble, MD, professor of surgery at the University of Mississippi Medical Center (UMMC) and the surgical team leader, said the device will “allow our patients to become stronger while they’re waiting for a heart transplant and keep them alive longer so they can have a transplant eventually.” The 43-year-old Verona resident was seriously ill when she arrived at UMMC on Aug. 3, with her body bloated from more than 40 pounds of excess fluid, her kidneys shutting down, and her skin discolored from poor blood circulation. Kirkman’s idiopathic cardiomyopathy had weakened her heart muscle to the point that she couldn’t complete a sentence without shortness of breath. She needed help to walk and even though she thought she was talking loudly, her voice was a barely audible whisper. “She was so sick,” said Kirkman’s fiancé, Andy Elzie Jr. Kirkman was first diagnosed with congestive heart failure nearly 11 years ago, when she was working as an assistant teacher. “I was constantly coughing and short of breath,” she said. “I had a hard time functioning at work.”
Close Calls Initially, medicine kept congestive heart failure at bay for Kirkman, but over time, her condition steadily declined. Her prognosis was so grim in 2005 that she was placed on hospice care. She refused to give up hope. After being in and out of the North Mississippi Medical Center (NMMC) several times, her family was called in to say goodbye in September 2009. Kirkman continued fighting for her life. Several years ago, NMMC electrophysiologist Karl Crossen, MD, implanted an internal cardioverter defibrillator, a device that monitors the heart and shocks it back into rhythm when necessary. Last summer, when Kirkman’s condition continued to deteriorate, Crossen placed her on continuous intravenous medication for several weeks. “Jackie couldn't get out of bed without being short of breath,” said Crossen. “She was alive but couldn't function. She really had no quality of life.” Kirkman had been placed on the UMMC heart transplant waiting list, but her condition made her too weak to survive transplantation and the immunosuppression required to prevent rejection of the organ. “That’s the type of patient for which the left ventricular assist device seems appropriate,” explained Charles Moore, MD, associate professor of medicine at UMMC. During the Aug. 11 surgery at UMMC, the LVAD was attached to her heart, and an external tube connected to a battery was stored in a “fanny pack” she wears around her waist. After several weeks of recuperation in the hospital, Kirkman felt so much better physically that she joked she was “almost ready to run a marathon.” After Kirkman was discharged from the hospital, she remained in Jackson for another month until doctors were satisfied that her recovery had progressed to the point where she could return home.
Village of Teamwork The transfer of care was no easy feat, with more than 100 medical personnel contributing to Kirkman’s case. Detailed planning with a multidisciplinary team was vital to the success of the LVAD program, which includes surgery, follow-up care, patient education and community medical training. For example, the program requires two teams—one at UMMC and another in the patient’s community. Through a partnership between UMMC and Cardiology Associates of North Mississippi (CANM), Moore travels to Tupelo monthly to evaluate potential transplant patients and follow up with current ones like Kirkman. Crossen and CANM nurse practitioner Chris Bell work closely with Moore’s team and NMMC’s Home Health Agency to monitor Kirkman’s condition. UMMC staff trained Tupelo emergency medical personnel how to care for the patient if called to respond. Because LVAD patients don’t respond to traditional lifesaving measures such as chest compressions—because of the continuous heart pump—the emergency room staff learned the proper steps to take once the patient arrives at the hospital. Also, a letter was sent to Kirkman’s utility company to make sure she’s at the top of the list for restoration of electricity in case of outages because the LVAD is battery-operated and the batteries must be charged regularly.
Home Health Lifeline Tonya Mathis, RN, was assigned to Kirkman in October 2009, when Kirkman was referred to NMMC's Home Health Agency. Kirkman had been placed on the transplant list and prescribed Milrinone, an intravenous (IV) medication that helps the heart work more effectively and improves blood circulation. Because of its potentially fatal side effects, Milrinone is usually given in a hospital's Intensive Care Unit. Thanks to teamwork between UMMC and NMMC Home Health, and special training for Mathis and fellow nurses Jan Starling and Angela Coggins, Kirkman became the first patient to receive this life-sustaining drug at home in March, five months before the surgery at UMMC. (A few days later, another Verona resident, Aussie Hubbard Jr., became NMMC Home Health’s second such patient. He received a heart transplant at UMMC last June.) “When I met her, Jackie’s goal was to see her daughter Jacques graduate from high school,” recalled Mathis, who affectionately called Kirkman “hard headed.” Kirkman, who watched her daughter graduate in May, responded: “I was just strong-willed and determined.”
LVAD Evolution Early models of LVAD were large, cumbersome and placed outside the body. UMMC has previously offered LVAD with an older model of the device that required patients to remain in the hospital. The technology has improved over time, becoming smaller, more easily implantable and easier to remove, said Moore. “The potential improvement in lifestyle is substantial,” he said. “Patients have limitations, however. They have to be near a power source. There’s a risk of infection through the drive line, and they also have to take blood thinners to prevent blood clots and strokes.” The LVAD is attached to the heart, and an external tube connects to a battery that can be stored in a pouch similar to a “fanny pack” or a shoulder bag. Additionally, the FDA has approved the device for use as destination therapy, which is prescribed for patients who may not be a candidate for transplant, perhaps because of underlying medical conditions or age, but may qualify for LVAD to improve their quality of life. “Realistically, it might buy someone several more years, even without a transplant,” said Cossen. Tribble said the program’s goal is to offer the LVAD as destination therapy at some point in the future. “It makes sense that this be a part of a tertiary care center where there’s a multidisciplinary team in place to care for the patients,” he said.
UMMC Celebrates New Status as Accredited Chest Pain Center
The Society of Chest Pain Centers (SCPC), an international organization dedicated to eliminating heart disease as the leading cause of death worldwide, recently bestowed chest pain center accreditation to the University of Mississippi Medical Center (UMMC). The SCPC accreditation required UMMC to successfully pass a rigorous evaluation for its ability to assess, diagnose and treat patients who may be experiencing a heart attack. This includes having processes in place that meet strict criteria aimed at reducing the time from onset of symptoms to diagnosis and treatment, treating patients more quickly during the critical window of time when the heart muscle can be preserved, and monitoring patients when it’s not certain whether they are having a heart attack to ensure they’re not sent home prematurely or needlessly admitted to the hospital. “This accreditation recognizes that our processes for treating heart attacks are in keeping with national standards,” said Richard Summers, MD, interim chair of the Department of Emergency Medicine. “This review of our facilities, capabilities and staff as it relates to acute coronary syndromes was a more rigorous process than evaluations done by the SCPC in previous years, and it was difficult to achieve.” By becoming an accredited chest pain center, UMMC has enhanced the quality of care for the cardiac patient and has demonstrated its commitment to higher standards, said Summers.
NMMC Heart Institute Echocardiography, Cardiopulmonary Rehab Earn Re-Accreditation
TUPELO— The Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and the American Association of Cardiopulmonary Rehabilitation (AACVPR)—recognized for their commitment to high quality patient care—have granted North Mississippi Medical Center (NMMC) re-accreditation. Cardiology Associates of North Mississippi physicians, along with Gloria Cook, RN, BSN, noninvasive cardiology manager; Scott Taylor, cardiopulmonary rehabilitation manager; and Suzanne Tackett, RDCS, echocardiography coordinator, led the effort. The Heart Institute is located in NMMC’s East Tower. The intricate imaging technique—echocardiography—relies on the expertise and training of both the physician and sonographer. The ICAEL, which accredits only the top performing hospitals throughout the United States, accredited NMMC in extracranial cerebrovascular testing and peripheral arterial testing. Cardiovascular and pulmonary rehabilitation programs that are accredited by AACVPR have the highest standard of practice. Accredited programs are multidisciplinary and meet the nutritional, psychosocial, physical and educational needs of their patients. AACVPR re-accredited NMMC in cardiology and pulmonology, one of only seven hospitals statewide with accreditations in both programs, with the cardiology program at NMMC in West Point also accredited.
ICAEL-accredited labs in Mississippi are also located at:
AACVPR-certified cardiology programs in Mississippi include:
Tags:chest pain center accreditation, Dr. Charles Moore, Dr. Curt Tribble, Dr. Karl Cossen, Dr. Richard Summers., Jackie Kirkman, Left Ventricular Assist Device, LVAD, SCPC, Society of Chest Pain Centers, Tonya Mathis, UMMC, University of Mississippi Health Care, University of Mississippi Medical CenterBookmark:
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