LVAD Surgery Restores the Life of a Heart Failure Patient
There’s a joke that Howard Dybedock likes to play on inexperienced nurses at the Kankakee clinic where he receives dialysis. It works like this: when they are unable to find his pulse with a cuff and stethoscope, Dybedock suggests that they listen to his heart.
"To make sure I’m still alive," laughs the 69-year-old grandfather.
Now comes the joke – when they place the stethoscope on his chest, what they hear is not the traditional propulsive beat of a heart. Instead, there is only a whirring sound, followed by a strange look and the inevitable question, "What is that?"
"That" is the sound of the left ventricular assist device (VAD or LVAD) that was implanted into Dybedock’s chest in February 2010 by Valluvan Jeevanandam MD, chief of cardiac and thoracic surgery at the University of Chicago.
A mechanical pump that helps the heart move blood from its lower chamber to the rest of the body and vital organs, the LVAD doesn’t replace the heart, but it can provide enough assistance for a badly damaged one to function and – in some cases – heal.
Because it makes blood flow like water from a garden hose, the LVAD renders a patient’s pulse nearly undetectable without a special Doppler blood pressure monitor, like the one that more seasoned nurses know to use on Dybedock. However, even though he sometimes likes to have fun with the device, Dybedock’s need for heart surgery was no laughing matter. The LVAD not only saved his life. It also restored it.
A veteran of microvalve surgery and successful treatment for prostate cancer, Dybedock worked out at the YMCA and lived an active lifestyle until he began to suffer from congestive heart failure, which left him completely drained.
"I felt wiped out and was very low energy," said the Kankakee business executive. "I was facing more and more limitations on what I could do. I would go up three steps and need to catch my breath before I continued."
This was compounded by renal failure. Unable to process toxins, in May 2009, Dybedock became so ill that he gathered his seven grown children and began talking about what should happen after he was gone.
"I really felt that my days were limited," he said.
Dialysis began to turn things around, but last winter, Dybedock’s cardiologist told him there was very little that could be done medically to repair his heart and referred him to the heart failure program at the University of Chicago. Though Dybedock initially was considered a transplant candidate, physicians feared that the immunosuppressant drugs required to prevent rejection of a new heart might reactivate dormant prostate cancer cells. With that avenue closed, Dybedock met with Jeevanandam, who knew that his patient’s weakened kidneys would pose a challenge.
"Howard was a bit of a pioneer," Jeevanandam said. "There hasn’t been much literature about how to perform this surgery on renal failure patients."
Jeevanandam, however, had 20 years of experience performing LVAD surgery, dating back to the original implants that were connected through an external wire that ran from the patient’s chest to a large console the size of a desktop computer. Those devices then would need to be wheeled around until they wore out in 15 months and more surgery was required.
The second-generation device Jeevanandam implanted in Dybedock, however, is expected to last at least 10 years. It’s also smaller, has only one moving part and is powered by a computer and battery that are small enough to fit conveniently in the pocket of the cargo pants that Dybedock now wears during the day. At night, he says, while the batteries recharge, he plugs the cord that runs from his chest into an electrical outlet nearly 20 feet away.
"It’s very easy to live with," Dybedock said. "I don’t even notice the thing. It’s just a part of you."
Because he adapted so easily to life with an LVAD, Dybedock has been counseling other patients who are considering, or have had, the same procedure.
"Some patients are reluctant in the beginning, when they are presented with all of the equipment and accessories. They get discouraged," said Tracy Valeroso, RN, ventricular assist device coordinator at the University of Chicago. "But Howard is a very dynamic guy. He’s so positive. After speaking with him and seeing the way he is, they are ready to have the surgery."
After the device was implanted, Dybedock was a willing resource and sounding board. He has helped patients cope with everything from post-operative recovery and taking a shower to finding the most comfortable clothing to accommodate the lifesaving implant.
To Jeevanandam, Dybedock’s attitude toward his LVAD had an enormous impact on others, as well as his own post-operative life with no discernible pulse and a heart that whirs.
"A surgeon and a device can only do so much," Jeevanandam said. "He’s not running his life to take care of his device. His device is helping him run a good quality of life."