Heart Transplant

Welcoming New Medical Director of the Saint Joseph’s Hospital Heart Failure Clinic

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Dr. David Markham, MD, MSc

Emory Center for Heart Failure and Transplantation and Saint Joseph’s Hospital are pleased to welcome David Markham, MD, MSc, to the team as the medical director of the Heart Failure Clinic at Saint Joseph’s Hospital.

Markham is an experienced heart failure and transplant cardiologist and has performed groundbreaking work in the area of assist device physiology.

“I’m excited that Dr. Markham will be leading heart failure services and our partnership with Saint Joseph’s,” says Andrew Smith, MD, director of the Center for Heart Failure and Transplantation and chief of cardiology at Emory University Hospital. “He will continue the progress we’ve already made over the past few months with the Advanced Heart Failure Network and the consolidation of services for network patients at Emory University Hospital, Emory University Hospital Midtown and Saint Joseph’s Hospital. These steps benefit our patients and enhance the services we offer.”

Markham received his undergraduate and medical degrees from Emory in 1991 and 1995, respectively and is a native of Marietta, GA. He completed an internship and residency at the University of Virginia, a post-doctoral fellowship in clinical and molecular cardiology at the University of Texas (UT) Southwestern Medical Center at Dallas, and a fellowship in cardiology with advanced training in heart failure and cardiac transplantation at Duke University Medical Center.

Before his return to Emory, Markham was medical director of the Heart Failure Clinic at Parkland Memorial Hospital and associate director of heart failure, assist devices and cardiac transplantation at UT Southwestern Medical Center in Dallas.

About the Emory and Saint Joseph’s Center for Advanced Heart Failure

The Advanced Heart Failure Network is an enhanced cardiac collaboration that includes expert care from subspecialists at Emory University Hospital, Emory University Hospital Midtown and Saint Joseph’s Hospital of Atlanta. For over 20 years Emory Healthcare and Saint Joseph’s Hospital have had the largest advanced heart failure programs in Georgia. The new collaboration will focus on meeting the needs of patients and their families dealing with heart failure. Patients in need of advanced heart failure management, medical and surgical management of other heart conditions and related therapies, may now access treatment at any of the three facilities.

Related Resources

True Coordination of Care: Our New Advanced Heart Failure Program

Advanced Heart Failure ProgramWe’ve experienced quite a bit of growth and expansion over the last few years here at Emory Healthcare, and with that growth, our patients are continually afforded a more collaborative and integrated total care experience. When Saint Joseph’s Hospital became part of the Emory Healthcare family earlier this year, for example, two of the state’s leading heart and vascular care providers became one, making comprehensive cardiac care a seamless process for our patients.

Every day we take steps to make receiving care at any one of our Emory Healthcare facilities more convenient and our latest effort has resulted in one of the most comprehensive heart failure treatment programs in the country. The new Advanced Heart Failure Program, is a cardiac network that includes the expert care from subspecialists at Emory University Hospital (EUH), Emory University Hospital Midtown (EUHM) and Saint Joseph’s Hospital of Atlanta.

For over 20 years Emory Healthcare and Saint Joseph’s Hospital have had the largest advanced heart failure programs in Georgia and the new collaboration will focus on meeting the needs of patients and referring physicians across the Southeast. EUH, EUHM and Saint Joseph’s have established cultures of excellent multidisciplinary care with emphasis on the lives of patients and families dealing with heart failure. We are excited to expand the bond of physicians, nurses, dietitians, social workers, and others in improving outcomes for those we serve.

The surgical heart transplant services at Saint Joseph’s Hospital will be the only component of its current heart failure program to move to a new campus—transplants now will be performed by Emory Transplant Center surgeons only at Emory University Hospital. Heart failure patients will receive pre- and post-operative care from their physician of choice at Saint Joseph’s, EUH and EUHM. Patients in need of advanced heart failure management, medical and surgical management of all heart conditions and related therapies may access treatment at any of the three facilities. Saint Joseph’s patients on the heart transplant wait list are in the process of being transferred to transplant centers of their choice, including Emory. Their status and place on the wait list will not be impacted since it is regulated by UNOS.

The program’s services also will include the surgical implantation of ventricular assist devices (VADs) at Emory University Hospital and Saint Joseph’s—a growing enterprise because of improved technology—and the medical management of VADs at all three hospitals.

The goal of the program is for all of our heart failure and transplant patients to experience enhanced coordination of their overall care and increased communication between their medical and surgical specialists.

The program currently has five cardiologists who are certified in advanced heart failure and transplantation and a number of other cardiologists pursuing certification who will be available to see patients. The Emory School of Medicine has an accredited advanced heart failure and transplantation fellowship training program for cardiologists. In addition, Emory is one of only nine centers in the country that is a member of the Heart Failure Clinical Research Network (HFCRN), sponsored by the National Heart, Lung and Blood Institute. Earlier this year, Emory received a seven-year, $2.7 million grant to develop heart failure clinical trials, with additional funding down the road to carry them out. Dr. Javed Butler, professor of cardiology, is principal investigator. As part of our new merger, Saint Joseph’s will participate in upcoming HFCRN trials, too.

 

About Andy Smith, MD, Director of Heart Failure and Transplantation, Bahgat/Smith Endowed Chair in Heart Failure Therapy and chief of cardiology at EUH

Dr. Andrew Lee Smith, Emory HealthcareAndrew Lee Smith, MD joined Emory University’s faculty in 1992 and established the Center for Heart Failure Therapy and Transplantation, a specialty practice for treatment of patients with heart failure in all stages (early to end stage) of the disease. Under his leadership, heart failure outpatient visits have surpassed 5000 annually, over 500 heart transplant procedures have been performed since the program began, and the Ventricular Assist Device program is strong and growing. Dr. Smith is recognized as an innovative leader in the treatment of heart failure and most notably for his work in collaboration with electrophysiologists on cardiac resynchronization therapy which lead to FDA approval for these devices. To learn more about Andrew Lee Smith, MD, check out Dr. Smith’s physician profile.

A Very Special Thanksgiving For Sean Dookwah

It’s been a busy last few weeks at the Emory Heart & Vascular Center. Earlier in November, we shared with you a story of a recent milestone for our Heart & Vascular program when Emory physicians completed their 200th Transcatheter Aortic Valve Replacement. Milestones such as this one have tremendous implications for our patient community. We are consistently putting into practice innovative technology that means longer, fuller lives for our patients. For Sean Dookwah, from Athens, Georgia, this notion rings especially true this holiday season. Sean will be able to enjoy his first Thanksgiving holiday with a new lease on life after Emory physicians implanted his new ventricular assist heart device at Emory University Hospital. Sean’s VAD implant was the 100th such procedure performed at Emory.

The first ventricular assist device was implanted in Georgia at Emory in 2006 as a form of destination therapy (in place of a donor transplant) for individuals who are not eligible for–or unable to undergo–a heart transplant. Ventricular assist devices are battery-operated mechanical pumps that help a weakened heart pump blood throughout the body. They are most commonly used as a bridge to transplant for those whose medical therapy has failed and who are hospitalized with end-stage heart failure. More recently, the VAD is providing an alternative to transplant. VADs allow a near normal quality of life, with most patients returning home with their families while they wait for a donor heart to become available.

Sean Dookwah, Emory Patient

Sean Dookwah at Emory University Hospital

Sean, who is 39 years old, began his journey to receiving his ventricular assist device and returning home to his family just two years ago. He had spent years as a construction worker, which kept him fairly active and fit. But after pursuing an office-based career in IT, Sean fell into a more sedentary lifestyle, which included lack of exercise, poor eating habits, long, stressful hours, all accompanied by a 20-year smoking habit.

It was in 2009 that Sean began to feel weak and ill enough to justify a visit to his local emergency room in Athens. “I felt weak, tired, sick, terrible. I was not having a heart attack, but it was there that I was diagnosed with cardiomyopathy, which is basically a weakening of my heart. That was a wake-up call,” says Sean.

After receiving the news, Sean moved in with his family and immediately adopted a healthier lifestyle, which included exercise, healthier eating, and dropping the smoking habit. Within about 18 months he dropped almost 150 pounds – from 480 to a current 330 pounds. He attributes much of his success in turning around his lifestyle to his friends and family.

“My friends and family have been incredible help and an inspiration to me – helping to keep me encouraged and on track, and some of my friends have even quit smoking themselves – both for me and them. I hope to eventually be added to a heart transplant list, but I have some work to do to still lose weight and get down to a healthier frame.”

And after his successful ventricular assist device implantation just a few days ago, Sean is eager to return home to his family for the the Thanksgiving Holiday and continue making healthy progress and enjoy his already drastically improved health. “I feel incredible compared to where I was just a few weeks ago. I was so tired and weak I couldn’t walk from one part of the room to the other,” Sean says. “Today, I feel alert, strong, healthy and like I could run a marathon. It’s amazing, and I am definitely thankful for everyone who made this possible for me – from the doctors and nurses at Emory – to my friends and family. I can’t wait to get home.”

It is milestones like our 100th VAD implant and stories such as Sean’s that make us especially thankful for the positive impact our team is able to have on our community. “Until fairly recently, surgeons have been implanting VADs as a temporary bridge to heart transplantation. We now have the ability to also offer those patients who are unable to undergo a heart transplant to dramatically improve the quality with what we refer to as destination therapy – meaning the device will stay with the patient indefinitely,” remarks David Vega, MD, professor of surgery and director of the heart transplant program in the Emory Transplant Center.

“This technology offers new hope and a much greater quality of life. And with more than five million Americans who suffer from congestive heart failure, with another half million diagnosed each year, this device is a viable, and often-times live-saving – option for our patients,” Vega continued.

Sean will be released for home today, one day before Thanksgiving and just a few days after his procedure, where he will join his family and friends for what very likely will be the most thankful of holidays.

We too are thankful to have the opportunity to improve the lives of people like Sean. And for those of us that are part of the Emory team, but are not in clinical roles, we are tremendously grateful for and appreciative of our researchers and care teams who make saving lives like Sean’s possible.

Happy holidays everyone.

Heart Transplant Patient Story: ‘I Feel Really Good’

A year and a half ago, Rachel Moore was readying to have her heart transplant at Emory. The surgery followed years of heart troubles, and Rachel spent two years with an LVAD as she awaited her transplant. Still, she was unsure if the heart transplant could really return her to good health. “My doctor told me, ‘After the transplant, you are going to feel so much better,’” Moore recalled recently during a phone chat. “It’s almost like I didn’t know what that meant.”

Now, 18 months later, Moore knows. “Before, when I was ill, I often wanted to just take a nap,” she said. “Now, when I’m up, I’m up all day and I exercise about five days a week for about an hour a day. I don’t feel winded or short of breath.” Moore, 45, visits Emory every three months for her check-up. Her medical team here checks her blood work and runs tests on her heart. If everything is running smoothly, she continues to take medication, and she returns in three months.

You can listen to Rachel Moore talk about how much better she feels since heart transplant surgery by clicking on the play button below:

“Sometimes I don’t know the right words to use, but I feel really good,” said Moore. “It’s almost like sometimes you have to remind yourself that there used to be something wrong. Like sometimes I’ll think to myself, ‘You had a heart transplant.’” For more information on Moore’s heart transplant and the effect it’s had on her life, visit her website at http://www.heart4rachel.org/ and watch this video:

Ventricular Assist Devices: Hope for the Broken-Hearted

HeartMate II® LVAD; reprinted with permission from Thoratec Corporation

Many of you are aware of the benefits of heart transplant in patients with advanced heart failure; however, another form of therapy has been quietly emerging as a viable option for patients suffering from this condition.

A ventricular assist device (VAD) is a battery-operated mechanical pump that helps a weakened heart pump blood into the body. Essentially, it takes over the pumping action of the heart and drives blood into the aorta (the large artery that extends from the left ventricle of the heart and into the abdomen) and throughout the body. The device resides both inside and outside of the body, and is operated by an electric motor powered by a battery pack. The controller and batteries are typically worn over the shoulder or around the waist.

In most cases, VADs offer a short-term solution for patients awaiting a suitable donor for a heart transplant, particularly if their medical therapy has failed or if they’ve been hospitalized with end-stage heart failure. According to the United Network for Organ Sharing, over 2,900 Americans are currently awaiting a heart transplant (43 of which are in Georgia).

However, in some cases patients turn to VADs as an alternative to a heart transplant. We refer to this as ‘destination therapy’, meaning that the LVAD serves as a permanent solution for patients with advanced heart failure. Patients who are not heart transplant candidates but who have severe heart failure often pursue this course of treatment.

Ventricular Assist Devices support the left ventricle (LVAD), the right ventricle (RVAD) or both simultaneously (biventricular, or BiVAD). LVADs are used most commonly, and have been in existence for over twenty-five years.

A recent study comparing a new generation LVAD to an older model showed a marked improvement in survival at 2 years (58% vs 25%). In addition, patients reported an improved quality of life. As a result the FDA approved the Heartmate II as destination therapy for patients with end-stage heart failure.

Despite the severity of their illnesses, 70-80% of LVAD patients survive to transplantation.

There are several different types of LVADs, and I’ll go into more detail about specific devices and technology that the Emory Heart and Vascular Center utilizes in a later post. You’ll also hear from two very special patients who have been kind enough to share their stories with us.

Do you have any questions or thoughts about VAD technology or heart conditions in general? If so, please share them with me in the comments.

About Sonjoy Laskar, MD:

Dr. Laskar joined Emory Healthcare in 2005 and has devoted his career to providing direct care to patients with heart failure, heart transplantation and ventricular assist devices, as well as to teaching residents and fellows. He is an active researcher in the areas of echocardiography and ventricular assist devices as destination therapy, and is a member of the American College of Cardiology, Heart Failure Society of America and the International Society of Heart and Lung Transplantation.