- The Washington Times - Tuesday, September 25, 2007

The strap and battery pack worn over Roger-Guy M. Folly’s shoulder gives new meaning to wearing your heart on your sleeve.

The pack is an essential part of the machinery that keeps his heart alive. The battery provides power to a tiny pump implanted surgically inside his body to force blood through key arteries in his weakened heart. It thus enables him to maintain a more or less normal existence — within limits.

The implant is known technically as a left ventricle assist device (LVAD) and commercially as Heartmate II, a lighter, more advanced version of Heartmate I. As outlined in a recent study by Dr. Leslie W. Miller, the Washington Hospital Center’s director of cardiology, and published in the New England Journal of Medicine, the device is intended to give long-term cardiac support to patients with advanced-stage heart failure.

People such as Mr. Folly are medical pioneers, but for him, the experimental aspect is moot. Agreeing to the implant was a matter of life or death.

“I had no choice,” says the retired Voice of America broadcaster, a District resident. “It was either [get the implant] or stay in the hospital and die.”

The operation was done June 12, a week after his 73rd birthday.

“The doctors’ communication with me was very realistic about relative success and failure,” he notes.

Like artificial hearts, LVADs don’t come without the possibility of complications. Weeks of training are necessary, with a patient’s closest relatives or friends involved in the process. There are inconveniences, such as having to carefully clean and dress daily an incision the diameter of a small finger in the side where bandages protect tubing connecting the battery to the pump.

Sleeping on one’s stomach is out of the question. Taking a shower requires wrapping oneself in plastic to cover the bandages.

The battery pack by his side weighs close to 11 pounds and “feels like a small suitcase,” Mr. Folly jokes. A person must be attuned constantly to electronic signals warning of the need to change a battery when power gets low. Mr. Folly has not yet been given permission to drive, but he expects that will happen soon.

For many patients, the device acts as a bridge until a new heart becomes available for them. More than 2,600 people in the United States are awaiting heart transplants, according to the United Network for Organ Sharing.

Because of the scarcity of donor hearts, older patients are not always eligible for a transplant and look to the Heartmate as their lifeline for an indefinite future. According to Dr. Miller, the new-generation pump is expected to last five to 10 years.

Mr. Folly, a native of Togo in West Africa, has had a long and troubled history regarding his heart, extending back to 1968, when doctors at the American Hospital in Paris detected that he had “an enlarged heart — an athlete’s heart.”

He wasn’t really an athlete, he told them. Then it was thought that a virus dormant in the heart tissue had emerged as he had grown older and the tissues had weakened.

He had a pacemaker installed more than 20 years ago when it was established that his heart muscles were losing strength. Matters grew worse slightly less than three years ago when he found himself being out of breath and unable to talk with ease. Medications helped, but not entirely. In March, he was going to the hospital emergency room every 10 days. That brought on the decision to try the Heartmate.

Congestive heart failure occurs when the heart fails to properly pump oxygen-rich blood to the body’s organs and tissues. It results from any number of factors, one of which is a disease weakening the heart muscle.

Heart failure can be related to a heart attack, but that is not always the case. Symptoms vary, with one of the most common being severe shortness of breath, fatigue and even nausea.

“Heart failure is increasing and is almost an epidemic, with over 7 million people [affected] in the U.S. and over 25 million worldwide,” Dr. Miller says. “One of the most sobering statistics is there is an average mortality across the board of 60 percent after five years.”

Hence the pressure to get better therapies because not everyone can be a candidate for a heart transplant — the most invasive and costly therapy of all — least of all the elderly or infirm.

Washington Hospital Center has done 16 implants of the latest Heartmate device in the past 12 months, according to Dr. Miller, and a total of 60 implants of all versions of the device.

More than 700 patients nationwide have received the Heartmate II device in a clinical trial, and insurance sometimes covers the minimum $150,000 cost for an average case.

“The difference in this generation of the LVAD is that this one has a single moving part — a hollow chamber with a rotor blade that spins around and propels [blood] to the rest of the body,” Dr. Miller explains. “The other [earlier] ones look like bellows, but this is a whirling vacuum.” (The ventricles are the heart’s two muscular lower chambers that pump blood when the muscles contract. Some patients have been known to require both right and left ventricle assists.)

These days, Mr. Folly says, “I wake up and feel good.” Before the implant, “I slept and woke up tired.” He is able to walk daily in his Northwest neighborhood without problems, and he has learned, with some difficulty, to sleep on his back. “If I find myself on my side, I correct myself. The pump tells you; you feel an uneasiness, and it becomes slightly painful,” he says.

He is philosophical about his condition.

“I don’t feel anything sitting here,” he says, sitting on his home sofa attired in a handsome shirt with French cuffs. Music plays softly in the background. “It now is part of me. I don’t let the idea play on my mind.”

Having previously lived with a pacemaker helped him adjust, but he confesses that “it took a long time to accept that foreign device inside me.” He takes a number of medicines and a restricted number of liquids but has not changed his diet in any dramatic fashion.

“One doctor said ‘Just go out and enjoy yourself,’ ” he relates. “What will happen, will happen.” He still dreams of traveling again, of visiting Moscow and St. Petersburg, and expects that will be possible one day.

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