Music Teacher Is Back On Beat After Heart Surgery

A left ventricular assist device (LVAD) helped Ron Lekavich return to teaching music after suffering from weakness and shortness of breath due to heart failure. Lekavich's cardiac surgeon, Valluvan Jeevanandam, MD, is also featured in this brief video.

Ron Lekavich was driving home while talking to his wife on the cell phone one night 10 years ago when suddenly he passed out and crashed.

"The next thing I hear is the horn," said his wife, Barbara Lekavich. "I'm envisioning a head-on collision. I'm yelling ‘Ron, Ron!'"

Though he escaped serious injury, something clearly was wrong. Lekavich had been feeling fatigued before the crash but didn't give it too much thought. After the crash, he learned his heart was in a serious state of decline.

A music teacher and owner of two music stores named Midlothian Music in Midlothian and Orland Park, where he also lives, Lekavich was diagnosed with nonischemic cardiomyopathy, a condition in which his weakened heart had severely restricted blood flow. It's usually caused by structural damage to the heart rather than by coronary artery disease. Lekavich also was diagnosed with congestive heart failure. Over the next several years he managed his condition with medications, had a pacemaker implanted and underwent a heart ablation procedure to control arrhythmia.

"It seemed to be getting better, but then all of the sudden it got worse," said Lekavich, now 72. "I couldn't go up the stairs. I got winded right away. I wasn't eating anything. Nothing tasted right to me, and I lost about 30 pounds."

His wife was alarmed at the sudden changes, which began last May. "He could hardly walk and he could barely lift his feet. He just hurt all over," she said. "I remember I would go into the kitchen and see him with his head resting on the table. It was as if someone flipped a switch. One minute he was fine, the next he was very sick."

In the summer of 2009, his doctor recommended he go to the University of Chicago Medicine, where he might be a candidate for a heart transplant.

Valluvan Jeevanandam, MD Valluvan Jeevanandam, MD

In the summer of 2009, his doctor recommended he go to the University of Chicago Medicine, where he might be a candidate for a heart transplant.

Lekavich remembered arriving at the medical campus in a wheelchair because he didn't have the endurance to walk more than a few hundred feet. He met with Valluvan Jeevanandam, MD, chief of cardiac and thoracic surgery. An internationally renowned surgeon known to take on the toughest cases, Jeevanandam had seen many patients at this stage before.

A Hopeful Treatment

For most patients their options are hospice, a heart transplant or a mechanical heart pump. Lekavich was too weak for a transplant. "If I didn't receive a heart pump, they would have given me six months to a year to live," Lekavich said.

"You could see he had a glint in his eye that he wanted to continue to live -- he had his wife and his interests and hobbies and family," Jeevanandam recalled. "He just didn't think he had any hope of living."

"If I didn't receive a heart pump, they would have given me six months to a year to live," Lekavich said.

As an interim before considering a heart transplant, Jeevanandam implanted a device known as the Thoratec HeartMate® II LVAS, a left ventricular assist device (LVAD). "It's a partial assist device," Jeevanandam explained. "It has a very small turbine like a fuel injector and injects blood into the aorta."

Lekavich felt this was the right choice. "I had a lot of confidence in him," he said. "Before this visit, I didn't think I was coming back home."

In July 2009, Jeevanandam and a team of surgeons implanted a HeartMate II® into Lekavich. The three-hour surgery involved grafting the pump to his aorta, and threading a "drive line" through his body so that it could connect with a 10-pound, outside battery pack, which he must wear around his waist.

Because of his weakened condition before the surgery, Lekavich recruited his son, John, to run the two music stores, but a few months later Lekavich returned, working part-time.

His rebounding energy has allowed Lekavich to resume his passion – teaching music, including piano and woodwind instruments.

Whether Lekavich will receive a heart transplant is uncertain. "We did it for a bridge to transplant," Jeevanandam said. "If he puts on more weight and gets healthier, we may want to transplant. On the other hand, if he doesn't want to, he can go on with the LVAD for a long time, possibly five or more years."

"I feel better than I have in a long time," Lekavich said. "It's like I'm a new man."

In fact, Jeevanandam said that the LVAD may very well serve as the first and only necessary treatment for severe heart failure for patients of advanced age. Only about 2,000 patients a year are able to receive heart transplants. Transplants bring different kinds of complications and drug regimens that include some 40 pills a day.

Jeevanandam anticipates that by 2015, after long-term studies confirm effectiveness, patients will receive LVADs before transplants. If that happens, a transplant may not be necessary at all unless the pump fails or leads to infection. "So, I'm calling transplant surgery a rescue therapy for LVAD in another five years."

The University of Chicago Medicine performed 37 such LVAD implants in 2009 and by March 15, 2010 had done 10 so far. The center is also involved in clinical trials to test smaller pumps.

"The devices we will be testing here next are no bigger than your thumb," Jeevanandam said. "I think the general trend with these pumps is that they will be smaller. With that comes fewer complications, less bleeding and a smaller drive line. We're doing a lot of work for the next generation of devices and also to better understand the complications with this device and ways to lessen those complications."

Survival rates for the first year are 85 percent. "It's like a liberation. It's like a rebirth after this long, slow spiral of downward steps," he said.

One thing Lekavich will never forget is to always carry fresh replacement batteries for his new heart pump. During a recent lunch outing with his wife, the pack sounded a low battery warning, and Lekavich told his wife he did not have a replacement. She raced home.

"I broke every speed limit," Barbara Lekavich said. "I said if I a cop tries to stop me, I can't stop. I still get goose bumps thinking about that. What if it had stopped?"

Fortunately, they made it, and Lekavich is doing better than ever. "I feel better than I have in a long time," he said. "It's like I'm a new man."

April 2010