First artificial heart patient gets permanent replacementMar. 28, 2019, 8:57 AM
by Matt Batcheldor
Tim Lowell of Hernando, Mississippi, received the first total artificial heart in the state of Tennessee when the cardiac surgery team at Vanderbilt Health placed the device in his chest on Sept. 26, 2018. The mechanical heart kept him alive for nearly three months until a matching human donor heart became available and he was transplanted on Dec. 16, 2018, at Vanderbilt University Medical Center.
Lowell, 57, who was at the end stage of congestive heart failure before receiving the artificial heart, was recently released from Vanderbilt Stallworth Rehabilitation Hospital and is continuing to recover at a private apartment in Nashville. In addition to a new human heart, he also has a new kidney, transplanted the day after his heart.
“The staff over at Vanderbilt did everything in the world to get me better,” Tim said. “The nurses did everything to get me comfortable. There are a lot of good people over there.”
The cardiac surgery team used a SynCardia Total Artificial Heart, a mechanical solution for a patient’s failing heart, whereby surgeons remove the patient’s heart and replace it with an artificial device, eliminating risks associated with leaving a diseased heart in place.
Artificial heart technology has been around for several decades, but now advanced teams have the expertise to understand which patients benefit most from implantation, said Ashish Shah, MD, professor and chair of Cardiac Surgery. The device is not currently intended for use as a permanent replacement for a heart; rather it is a temporary implantation that can save a patient’s life before a permanent donor heart becomes available for transplant.
“Mr. Lowell was a first for the state of Tennessee and Vanderbilt,” Shah said. “He really is a great example of how complex care is delivered. He was supported with artificial systems and ultimately received a heart and kidney transplant. Moreover, he was expertly managed through a challenging postoperative time. There are few places where that is possible. Our goal of saving his life certainly brought out the best in what is already a world-class group.”
“Patients with advanced heart failure are one of the sickest groups of patients that we take care of,” said Sandip Zalawadiya, MBBS, assistant professor of Medicine and medical director of Vanderbilt’s Ventricular Assist Device program. “Understanding their complex pathophysiology and making life-saving clinical decisions at critical times are of vital importance. Equally important is that we have a great team that works cohesively and offers expertise at comprehensive cardiac support systems such as left ventricular assist devices (LVAD), heart transplantation and total artificial heart.”
The medical team for Lowell’s perioperative management included Zalawadiya, Kelly Schlendorf, MD, MHS, assistant professor of Medicine, medical director of the Adult Heart Transplant Program; JoAnn Lindenfeld, MD, professor and chief of the Division of Heart Failure and Transplantation; and advanced heart failure physicians Marshall Brinkley, MD; Suzanne Brown Sacks, MD; Jonathan Menachem, MD; Mark Wigger, MD, and Lynn Punnoose, MD, in addition to VAD coordinators and nurse practitioners.
Vanderbilt’s surgical teams for the state’s first total artificial heart included the Cardiovascular Intensive Care Unit team led by Tony Hernandez, MD, co-director of the CVICU. His kidney transplant was led by Rachel Forbes, MD, MBA, assistant professor of Surgery and associate chief of the Division of Kidney and Pancreas Transplantation.
Lowell’s journey to become the state’s first artificial heart recipient goes back to 2003, when he had his first open heart surgery. The resident of a suburb just south of Memphis was first diagnosed with atrial fibrillation, also known as AF or AFib. It is a heart condition in which the upper chambers of the heart beat too fast and with irregular rhythm, putting him at a higher risk for blood clots that cause strokes. AFib, the most common cardiac arrhythmia, affects more than 5 million Americans.
Since 2003, he has had a number of procedures in Memphis and Cleveland, Ohio, to treat his AFib, including a left heart ablation and receiving a pacemaker/defibrillator. But it was on Mother’s Day 2016 when his defibrillator alarm went off at home, that his doctor referred him to Vanderbilt, where he was diagnosed with congestive heart failure. He began seeing Zalawadiya and the team of cardiologists. He also was evaluated at the Vanderbilt Transplant Center that fall.
On Sept. 24, 2018, Lowell was scheduled to return to Vanderbilt to receive an LVAD, but on Sept. 19, his defibrillator alarm went off and he had to rush back to Nashville. On Sept. 20, he was told he needed to stay at the hospital due to his deteriorating condition. The next day, there were two more defibrillator alarms. Three days later, he was placed on the transplant list at Vanderbilt, rather than receiving the LVAD.
By Sept. 24, Lowell, who suffers from a form of PTSD due to the continuing defibrillator alarms, elected to be sedated. His wife, Ginger Lowell, a constant presence at his side during his medical episodes, recalls what happened next.
“That afternoon, the team began discussing that the right side of his heart was just getting worse and worse,” she said. “They approached me and we talked about it. His brother and his best friend were here. We needed to do something right then. So we did ECMO on the 24th.”
Extracorporeal membrane oxygenation is a machine that temporarily took over the functions of Tim Lowell’s heart and lungs, artificially oxygenating his blood, then pumping it back into his body.
“Dr. Zalawadiya approached me about the total artificial heart,” Ginger Lowell said. “We had never heard of a total artificial heart. He (Tim) was out (unconscious). Neither one of us knew anything about that technology at all. But with everything that he had going on, the concern that the team had was ECMO was not a viable solution for a long-term period.
“So, I said yes.”
The mechanical device kept Tim Lowell alive until he received a donor heart on Dec. 16, 2018. He describes his heart transplant as “like putting a brand-new engine in a rusty 1967 Chevelle. Everything is worn out. The rest has to get tuned up.”
On Dec. 17 he received a kidney transplant. A circulation issue with his leg resulted in another two weeks in the intensive care unit. Throughout January, he steadily improved, checked into Stallworth for rehab on Feb. 7 and checked out a month later. His therapy continues at Dayani Center.
A retired facilities manager, Tim Lowell said he is looking forward to returning home to his 10 acres, swimming pool and garden.
“I like gardening,” he said. “I grow a big garden every year. Give it all away. Hunt ducks and deer and doves. I like to fish. I do all the shopping, all the cooking, all the running around town.”
Ginger Lowell, a director of finance, keeps a log in her phone of every twist and turn of her husband’s case. It has been quite the journey, she said.
“For us, it has been a great experience, even with all its trials and tribulations,” Ginger said. “I’ll be honest — if I had to do it again, I’d absolutely do it all over again.”