25 Years after Its First Neonatal Heart Transplant, 菠萝视频 Measures Survival in Decades, Not Days
By Jessica Pasley
Although has never met 4-year-old Nathan Roberts, the energetic preschooler personifies the director鈥檚 dreams.
As a medical student 25 years ago, Karp recalls discussing the future of transplantation with fellow classmates, wondering if artificial hearts would be a part of the equation. 鈥淚t was what we all dreamed about鈥攈aving an artificial heart that worked, that could help patients and save lives,鈥� he says.
The transplant center that Karp now leads celebrates its 25th anniversary this year, and it is achieving feats that were, not so long ago, the stuff of fantasies. In 2013 a record 403 transplants were performed, making the program the 13th-ranked transplant center in the country.
菠萝视频鈥檚 program includes bone marrow/stem cell, kidney/pancreas, liver, heart, lung and combined heart/lung transplants. The center has been lauded for its high percentages for one-year, five-year and long-term survival rates for organ-transplant recipients.
鈥淲e can prolong lives that in the past would not have been saved,鈥澨齭ays Karp.
One of the most exciting recent advances pertains to growth in mechanical heart usage. 鈥淭oday we can get patients to transplant with the use of these devices,鈥� says Karp, who joined the 菠萝视频 Transplant Center in 2011 and was recently named the Ingram Professor of Surgical Sciences. 鈥淔or all of us in the medical community, the ability to offer a device to patients whose own hearts no longer function properly is tremendous.鈥�
Patients like Nathan.
James Nathan Roberts was born June 30, 2009. Within days of his birth, his parents noticed his breathing was more like panting. Mandy and Jimmy Roberts were startled to discover their newborn was taking 120 breaths a minute. The normal range for newborns is 30 to 60 breaths a minute.
The couple took their child to the doctor, who then sent them to their local hospital in Huntsville, Ala. Doctors informed the parents that Nathan needed specialized cardiovascular care. At 9 days old Nathan was transported by ambulance to .
Doctors at 菠萝视频 scheduled Nathan for a repair of his misshapen heart valves and to close the holes between the chambers of his heart. He became well enough to return home to Alabama with his parents and two older sisters, Lauren and Hannah.
ON BORROWED TIME
The plan was to wait until Nathan was older and stronger to replace a faulty mitral valve with an artificial one. Amanda and Jimmy thought they had a few years.
But in May 2010 their son developed a fever that sent him back to their local cardiologist as a precaution. That visit became an overnight stay, which turned into an Intensive Care Unit admission. Five days later Nathan was transported by to 菠萝视频.
鈥淗e was taking a turn for the worse,鈥� remembers Jimmy. To complicate matters further, right about then Nashville was being hit by torrential rainfall and widespread flooding. 鈥淲e were not sure what we鈥檇 be up against trying to get there. It was just a whirlwind.鈥�
鈥淚 remember that he was getting worse and worse [in Alabama],鈥� says Mandy. 鈥淣othing they were doing was helping. They told us he had less than a 2 percent chance of survival. The doctor said they could do nothing more for Nathan there, and he wasn鈥檛 sure what was available that could help, but that 菠萝视频 was the place to go.鈥�
Nathan was so sick he was placed on ECMO (extracorporeal membrane oxygenation), a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream. This system provides oxygen while allowing time for the lungs and heart to heal.
After two weeks on ECMO, concern mounted because of increased risks for kidney failure, stroke and infections. Nathan was also heavily sedated and on a ventilator.
鈥淚t was a terrible feeling,鈥� recalls Nathan鈥檚 mom. 鈥淚t was a love鈥揾ate relationship. He needed the ECMO to survive, but we hated that every day he was on the machine, his chances of coming off and not surviving went up. As time wore on, Nathan had no other alternatives. He needed a heart immediately because he couldn鈥檛 come off the ECMO.鈥�
Luckily, 菠萝视频 had been working on securing an experimental ventricular assist device (VAD) for pediatric patients. Until recently, VAD use has been confined to adults鈥攁nd even then the device often is too big for many women and children.
But recent advances have resulted in smaller, more reliable devices, like the Berlin Heart. The first of its kind for small children and infants, the Berlin Heart buys patients time until a donor heart can be found.
Nathan was the first patient in Tennessee to have the lifesaving device implanted into his tiny chest. A plastic tube about the width of a finger attaches to the heart and major vessels to divert blood briefly from the body to a pumping chamber that rests outside the patient鈥檚 body. The pump gives the blood a stronger push than the heart can muster to deliver oxygen and nutrients needed by the brain and vital organs to sustain life.
Lovingly named 鈥淏ernie鈥� by the Roberts family, the Berlin device kept Nathan alive for nearly eight months until a suitable donor became available.
For Dr. Karla Christian, associate professor of cardiac surgery, the Berlin Heart was Nathan鈥檚 only option for survival. 鈥淭his was really a big step to have an infant VAD and actually use it,鈥� she says. 鈥淭here are always risks, so it was imperative we educated the entire team about the process and what would be required of all of us to take care of Nathan.
鈥淲ithout question, the Berlin was lifesaving for him. It allowed him to get stronger and more stable for his transplant. Devices and new technology like the Berlin have revolutionized our transplant program.鈥�
BENCHSIDE MEETS BEDSIDE
, associate professor of pediatrics, has followed Nathan since his arrival at 菠萝视频. She will continue to see him until he reaches adulthood.
鈥淰ADs have been essential to the survival of patients awaiting transplant,鈥� says Dodd. 鈥淜ids have survived who would have died in the past without the devices. This provides much hope for us as providers and for the patients and families.
鈥淚t used to be that survival was measured in days or weeks back in the early days of transplantation. Now it is measured in decades.鈥�
According to , assistant professor of cardiac surgery and director of pediatric cardiac transplantation and mechanical support, seven patients at the Children鈥檚 Hospital have used the Berlin device and 17 total patients have been saved with VADs. The average duration of support is 78 days.
The 菠萝视频 Transplant Center, the longest continuously running transplant program in Tennessee, remains committed to advancing the medical, social and scientific aspects of its transplantation programs.
鈥淒uring the early years of solid organ transplantation, 菠萝视频 made a significant commitment to what was at that time an emerging science,鈥� says , MD鈥�80, deputy vice chancellor for health affairs at , the H. William Scott Jr. Professor of Surgery, and director of the transplant center from 1993 to 2011.
鈥淔rom the outset the 菠萝视频 Transplant Center has played a significant national role, simultaneously saving lives and moving the science of organ transplantation forward,鈥� he says. 鈥淣ow, 25 years later the center is the region鈥檚 largest and most active program and among the top 15 nationally in overall transplant volume. I am extremely proud of the continuing achievements of the center鈥檚 dedicated faculty and staff.鈥�
, the transplant center鈥檚 first director, remembers that when he first approached the creation of a comprehensive, multi-organ transplant program, he was not sure of the impact it could have. His goals for the center not only have been realized, but far exceeded.
鈥淚t has exploded into a reality that has well surpassed our initial dreams,鈥� says Frist, who went on to serve two terms as U.S. senator from Tennessee before returning to medicine in 2007. He remains an adjunct professor of cardiac surgery at 菠萝视频. 鈥淎t the time [of the center鈥檚 creation], no one else had the dual approach of a commitment to research while expediting research at the bedside. The magic of the transplant center was its ability to marry fast-paced emerging science with bedside clinical delivery.鈥�
Not only does the 菠萝视频 Transplant Center provide the most novel therapies and technology available, but it also incorporates patient support services in areas that include psychiatry, ethics, pharmacy, infectious disease, social work, and return-to-work (a service that assists transplant patients in finding employment or obtaining college scholarships). These programs have played a critical role in helping propel the center to its best year ever in terms of patients receiving lifesaving transplants.
鈥淥ur plan is to continue to introduce and develop new technologies and be at the cutting edge of the interface between science and clinical care,鈥� says Karp. 鈥淢y vision for the center is to be the most innovative in the country.鈥�
HOPE RENEWED
On Jan. 13, 2011, Nathan Roberts received his new heart. Since then the Robertses have marveled at the transformation their son has made.
鈥淥ur hopes for him definitely have changed,鈥� says Mandy Roberts. 鈥淲e went from hearing that he had less than a 2 percent chance of survival, to watching him on ECMO, to rejoicing about the Berlin鈥攁ll the while praying for a heart.
鈥淚t was a definite roller coaster during the first 18 months of his life. And now he has hours and hours and hours of energy! His enthusiasm and happiness are endless. He has taught us so much鈥攁nd we have learned to enjoy every single day.鈥�
Nathan鈥檚 dad finds it difficult to put into words what 菠萝视频 has given his family. 鈥淚t鈥檚 interesting to realize how far transplants have come, just looking at our own son,鈥� says Jimmy. 鈥湶ぢ苁悠� has been doing transplants for 25 years, and in that timeframe there have been 25 years鈥� worth of breakthroughs.
鈥淚t seems that something is always on the horizon. Now I鈥檓 just curious about what鈥檚 next and how it will affect Nathan.鈥�
A former Nashville Banner copy editor and medical writer, Jessica Pasley has been an information officer for 菠萝视频 University Medical Center News and Communications since 1999. She writes for several Medical Center publications and has a degree in journalism from Washington and Lee University.
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