January 26, 2023

LVAD, medication therapy help patient’s heart recover full function

Six months receiving an LVAD at Vanderbilt, Autumn Bowling’s heart fully recovered its function and doctors were able to turn the device off, a rare feat.

LVAD patient Autumn Bowling with her cardiologist, Sandip Zalawadiya, MBBS, during a follow-up visit.
LVAD patient Autumn Bowling with her cardiologist, Sandip Zalawadiya, MBBS, during a follow-up visit.

One of the most exciting times in Autumn Bowling’s life turned terrifying, and doctors at first struggled to understand what was happening. She had arrived at a Knoxville hospital in labor in November 2021 to deliver her baby, but her heart was failing. Bowling, 19 years old at the time, with no previously diagnosed heart condition, presented with extreme shortness of breath and a very elevated heartbeat.

Bowling’s daughter, Hadley, was immediately delivered by C-section, and Bowling eventually went home, but her health kept worsening.

After multiple return visits to the hospital to treat her heart failure, her cardiologist told her she needed to go to Vanderbilt immediately, and she boarded an aircraft to Nashville, arriving on Christmas Eve 2021.

That began what Bowling calls her Christmas miracle. At Vanderbilt, she was diagnosed with peripartum cardiomyopathy, a rare condition in which the heart fails because of the stress of labor and delivery. Bowling received a left ventricular assist device (LVAD), an implantable, mechanical support system that pumps blood through the body when the heart is too sick to do it. And just six months after receiving the LVAD, with medication therapy, her heart fully recovered its function and doctors were able to turn her LVAD off, a rare feat.

“It all worked out so perfect,” she said. “I’m so thankful for Vanderbilt.”

“She came to us quite sick, and the only alternatives were a lifesaving surgery such as LVAD or transplant or she would not survive,” said Bowling’s cardiologist, Sandip Zalawadiya, MBBS, medical director of the Ventricular Assist Device (VAD) program.

“After treatment, she was able to go home. She’s playing with her child. She’s looking forward to a happy, healthy life.”

Zalawadiya said doctors opted to give Bowling an LVAD to offer her longevity and get her out of the hospital so she could be back home with her baby. But they also kept another possibility in mind — that the LVAD and medications would give the heart a chance to rest and recover.

“As an LVAD team, we aim to optimize every patient’s care to the best of our ability,” Zalawadiya said. “The right combination of medications along with the right amount of LVAD support is a huge part of a patient’s success. It helps them achieve not only a wonderful quality life, but also the longevity.

“For many patients, LVAD serves a bridge to transplantation, but for a select few, it can be a bridge to recovery. Assessing heart recovery while on LVAD support can be a challenging, as the price to pay for a wrong decision can be high. Last year, through a collaborative approach between the VAD team and structural heart team, we implemented a novel way of assessing heart recovery with the LVAD — an invasive CardioPulmonary Exercise Testing (iCPET) program became a reality,” Zalawadiya said.

After receiving the LVAD, Bowling underwent rigorous efforts at optimization of her medications and LVAD, and those efforts started showing promises of heart recovery. Bowling returned to the catheterization lab for the iCPET procedure — one of the first patients to undergo such a test at Vanderbilt.

“We brought her in the catheterization lab for this procedure,” Zalawadiya said. “We checked her heart numbers in different situations, including with the full LVAD support and without any LVAD support while she was exercising on a bike. It gives us a comprehensive outlook of the heart’s ability to perform at best in different stressful situations. It allowed us to assess the heart of this young woman in a way that we felt more confident in our assessment, in our success, up front.”

Remarkably, Bowling’s heart had gone from 20% function before the LVAD to normal function (55% to 60%).

“Understanding the changes in the heart and lungs of patients that leads to their symptoms, which we can do with an invasive CPET test, is an important step toward personalizing the best treatment strategy for them,” said Vineet Agrawal, MD, PhD, assistant professor of Medicine and director of the Invasive CPET Program. “As such, we are excited to be, to our knowledge, the only institution in Middle Tennessee that offers the invasive cardiopulmonary exercise test for better personalized care of our patients.”

“iCPET has the potential to make a powerful impact in individualizing the care for these incredibly complicated and sick patients,” said Colin Barker, MD, director of the Section of Interventional Cardiology and associate professor of Medicine. “It allows for rigorous and dynamic assessment of the physiologic response to the state-of-the-art therapies that can be offered at VHVI. We anticipate the growth and utilization of iCPET to expand rapidly, and further enhance and optimize the excellent outcomes of our patients.”

Following the iCPET procedure, clinicians used a minimally invasive procedure to cap the LVAD and turn it off, leaving it in place in Bowling’s heart.  She said she now feels better than she did before her heart failure. And she can function with her original heart.

“I just feel amazing,” she said.

Bowling was able to celebrate Christmas at home this past year, as well as Hadley’s first birthday.

“I always say she helped my heart,” she said. “She gave me a reason to want to get better.”

Several members of both the LVAD and structural heart teams played a crucial role in Bowling’s success, including but not limited to Casey West, ANP (VAD nurse practitioner); Robert Tunney, PharmD (VAD pharmacist), Jessica Hassler, RN (VAD coordinator); Kerry Dettorre, MSN, RN (VAD coordinator); Amanda Judge, BSN, RN (VAD coordinator); Jonathan Hunter Tramel, RN; Mica J. Sanders, RT; and Anika C. Phy, RCIS.