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A Promise that Saved a Life

Torrence Tate's congestive heart failure required physicians to think outside the box to find a mechanical circulatory support solution to maintain Tate's heart function until he could be successfully transplanted.

Torrence Tate's congestive heart failure required physicians to think outside the box to find a mechanical circulatory support solution to maintain Tate's heart function until he could be successfully transplanted.

Torrence Tate is the kind of patient who inspires doctors to think outside the box. When he arrived at the University of Chicago Medicine in January 2015 with worsening congestive heart failure, 43-year-old Tate insisted he didn't want a left ventricular assist device, or LVAD, to help his weakened heart pump blood and keep him alive.

"When my doctors explained everything to me, I started thinking about my dad," said Tate, of Lansing, Illinois.

Heart disease runs in his family. Tate's father, two sisters and a niece were diagnosed with cardiomyopathy, a disease that damages heart muscle, and they all had cardiac pacemakers. So did Tate, whose cardiomyopathy progressed to heart failure.

"We're professional patients," he said of his family.

At a different hospital, Tate's father had an LVAD implanted. What Tate remembers is that "it wasn't too successful." For two years, his father was in and out of the hospital with problems from blood clots and bleeding. In October 2014, his father passed away from congestive heart failure. One of his sisters also died of heart failure, in December 2013.

Only three months after his father's death, while still coping with the loss of his loved ones, Tate began struggling to breathe and was taken by ambulance to a community hospital. After a few days of tests, doctors there said he needed more sophisticated treatment than they could provide and referred him to Nir Uriel, MD, director of the heart failure program at the University of Chicago Medicine.

Finding the Right Solution

Because he was young and in otherwise good health -- he coached community sports league teams and played pickup basketball -- Tate was a candidate for a heart transplant. But after a balloon pump inserted into his aorta couldn't stabilize him, Uriel told him he needed an LVAD to keep his heart pumping until a donor heart became available.

Tate dreaded the possibility of having complications similar to his father's. Deciding how to move forward with treatment required a "tough discussion," Uriel said.

Tate dreaded the possibility of having complications similar to his father's. Deciding how to move forward with treatment required a "tough discussion," Uriel said.

Uriel explained to Tate that his condition was deteriorating and, without the LVAD, doctors weren't certain he would survive until a new heart could be found. "I told Dr. Uriel that I'll try anything, but I just don't want the LVAD," Tate said.

"We had to think about how we could be compassionate toward our patient's issues, but give him a safe way to reach the next level of [treatment]," Uriel said.

Uriel and his team turned to the relatively new Impella 5.0, a tiny heart pump that's far less cumbersome than a traditional LVAD. Although it is considered less durable than the traditional device, clinical research is showing the Impella 5.0 to be an effective "bridge to transplant" technology.

Because of its small size -- about the width of a fork tine -- the Impella 5.0 is implanted with minimally invasive catheterization. The device is inserted into the heart's left ventricle using a catheter threaded through an artery, in Tate's case the subclavian artery under his left arm.

The pump sucks blood from the left ventricle at a rate of five liters per minute, about the same as a healthy heart. From the left ventricle, blood is pushed to the aorta and on to the rest of the body.

A tube from the small incision where the pump is implanted connects with an external controller that monitors the pump's performance. The controller weighs about 26 pounds and can be moved in a wheeled cart, allowing patients to get up and move around freely.

"If you have a chance to see someone who's been through it, who's looking healthy, then you can say, 'I can do it, too.' "

Not only was he pleased with receiving the Impella 5.0, Tate also gained the distinction of being the first University of Chicago Medicine patient to have the device implanted. "We told him we had never done it here before, and he was okay with it," said Uriel. "He was so happy that we didn't break our promise" to avoid using the same type of device his father received.

Two and a half weeks later, in mid-March 2015, a donor heart became available. "It was very emotional," Tate said. Uriel and the nurses caring for him were reassuring. "They kept me grounded," he added.

A New Motivation After Setbacks

The transplant was successful, but not without a few setbacks. Tate's cardiomyopathy had left him with an enlarged heart. The excess space surrounding his new, healthy heart filled with blood that had to be drained, requiring an additional surgery just two weeks into his cardiac rehabilitation program.

"I was close to going home, so that was a blow," he said.

Not long after he resumed rehab, his doctors discovered blood clots in his legs that were traveling toward his heart. "I lost it, I broke down," Tate said. He underwent another procedure to have a filter implanted to catch the clots. Then it was back to rehab again.

"The third time's the charm, right?" he said. And so it was. Tate went home about a month after his transplant. Before he left the University of Chicago Medicine, one of the heart failure physicians introduced him to a fellow patient, who had undergone a heart-kidney transplant two years earlier.

"He talked with me when I was really down," Tate said. "He's been my motivation." The two became friends, and as luck would have it, realized they live only 10 minutes apart. "Now he's my workout partner," Tate adds.

It wasn't long before Tate was back as a volunteer coach for the boys' football, basketball and baseball league teams. He's looking forward to returning to work as a project manager for an electrical company.

"I'm feeling great," he said.

Now he wants to give back to the heart transplant community, too. Tate has talked with Uriel about playing a similar role for other patients, after the impact meeting another transplant patient had on him. "You're scared, you don't know how it's going to play out," Tate said. "But if you have a chance to see someone who's been through it, who's looking healthy, then you can say, 'I can do it, too.' "

March 2016


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