Saturday, April 01, 2000

Device brings life, freedom


Ky. man is area trailblazer

BY TIM BONFIELD
The Cincinnati Enquirer

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A blood-pumping device like this one keeps Merrill Gadker alive.
(Tony Jones photo)
| ZOOM |
        For Merrill Gadker of Villa Hills, a muffled hum and a rhythmic hiss of air are the miraculous sounds of an improbable second chance at life.

        These mechanical noises were coming from Mr. Gadker himself. They could be heard Friday in the quiet of a press conference when the 58-year-old father of three looked up beyond the ceiling and took a moment to fight back tears of thanksgiving.

        It was hard for him to describe how it feels to be able to walk away from University Hospital, when just three months ago he thought he was going to die. It was amazing to feel so “human again,” even though it was a chunk of titanium inside his belly that was keeping him alive.

        “My strength is coming back. I'm not on IVs. I'm not on monitors,” Mr. Gadker said. “I get to go home this evening and wait for a phone call” that an organ is available for a heart transplant.

        “Until that day comes, I'm just going to live a normal life thanks to these doctors and thanks to this machine,” Mr. Gadker said.

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        The machine he was talking about is an improved version of the HeartMate blood-pumping device made by Massachusetts-based Thermo Cardio- systems Inc. The pump helps patients who otherwise would have died while waiting for a heart transplant to live many months — even years — of fairly normal life.

        Unlike earlier models, this 2.6-pound pump is truly portable. A cylindrical device, 2 inches thick and 4 inches across, throbs inside his abdomen. With every assisted heartbeat, the device releases a puff of air from a line pro truding from his belly. That line also supplies power to the pump.

        Mr. Gadker carries a control unit, batteries, spare batteries, even an emergency hand pump, in a set of shoulder holsters and a waist pack. His mechanically assisted heart can go up to six hours between charges.

        Three months ago, doctors say, Mr. Gadker was within days of death. After eight years of struggle with congestive heart failure, he was admitted Dec. 28 to the cardiac intensive-care unit in a nearly comatose state.

        On Jan. 24, he became the first Tristate resident to get the improved HeartMate pump. The device won FDA approval about a year and a half ago and has been installed in dozens of patients at transplant centers nationwide.

        Winding up first was a combination of good and bad luck for Mr. Gadker. Just as the hospital was completing internal staff training on the system, Mr. Gadker happened to be the patient with the most urgent need.

        Other would-be transplant patients at the hospital were doing well enough with more conventional treatments. But a second patient could get the device within a week, said Dr. Lynne Wagoner, director of the hospital's heart transplant program.

        The HeartMate isn't an artificial heart. If a patient's heart completely stops working, this pump will not keep them alive. Instead, doctors use it as a “bridge” treatment to keep people alive until they can get a transplant.

        Milford resident Ronald McKinney, whose life was saved by an earlier model of the HeartMate, said Friday that the new technology is a huge step forward.

        In 1997, Mr. McKinney was the first Tristate patient to get an older version of the HeartMate pump. The motor was so big it required a cart to push around and could not run for on batteries for more than a half an hour. While that pump kept him alive until he got a successful heart transplant, he had to stay in University Hospital for more than three straight months.

        “Going home is a great opportunity,” Mr. McKinney said. “I was tied down ... kind of like being in prison. I could go anywhere in the hospital, but I couldn't go home.”

        Patients using the new pump can do almost anything they feel up to. Some patients have gone bike riding; others have gone ballroom dancing.

        Researchers are one year into a three-year study looking at the HeartMate as a possible long-term alternative to heart transplants, said Dr. Lynne Wagoner, director of heart transplantation at University Hospital. The sheer number of people with heart failure illustrates how important such an advance could be.

        The American Heart Association estimates that up to 40,000 people a year would benefit from heart transplants. However, the supply of donated organs is so small that only 2,500 people a year actually get them.

        The improved HeartMate device may become a treatment for many heart-failure patients as they get sick enough to need a transplant, Dr. Wagoner said.

        The pump's value would expand dramatically if batteries and controls could be made small enough to allow the entire device to be implanted, thus reducing the risk of infection and other problems, Dr. Wagoner said.

        It cost University Hospital about $200,000 to acquire the HeartMate system. Beyond buying the device, surgeons, emergency room staff and emergency medical services workers had to be trained to work with people who get the pump.

        Counting weeks of intensive-care services, surgery, hardware and other costs, the patient bill for getting the HeartMate device will likely exceed $150,000, Dr. Wagoner said.

        To Mr. Gadker, the time he gets to spend with his family is priceless. For example, his son and daughter-in-law are about a week away from having a baby.

        “I just want to sit and relax and take it all in,” he said.

       



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