Our country is the undisputed leader in the field of transplants, both in donations and in interventions each year. Despite this, there are situations in which a person with a serious heart problem does not meet the requirements to be a candidate for one. What happens then? What options are left for these patients?
Until recently, not many. And that was precisely the situation in which Nicolás Vega found himself who, after feeling bad one day at work, a colleague told him that he had “a crooked mouth” and, only then, he went to the hospital: “He had been 15 I didn’t sleep for days, my leg burned, but I didn’t go to the doctor much, I took paracetamol for the pain… when they saw me at the Clinical Hospital they diagnosed me with Guillain-Barré Syndrome,” he says.
It was in 2018. “As a result of this, we discovered the cardiac involvement by Chagas (what is called chagatic heart disease), for which the heart begins to contract less than normal,” explains Josebe Goirigolzarri, the cardiologist who attended him. “These are hearts that become larger than normal and therefore contract less, it is what is called heart failure (HF). Treatment was given, but there is a percentage that, despite everything, is getting worse and worse and advanced CI”, he continues.
Faced with this situation, and faced with the impossibility of submitting him to a transplant, it is when the option of the so-called “artificial heart” arises. In other words, a cardiocirculatory support device that allows these HF patients who are not candidates for transplantation to increase their survival and functional capacity. «When all of the above fails, we consider putting on ventricular assists. It is like an artificial heart, it takes blood from the heart and puts it in the aorta artery by means of a pump so that it can reach the whole body”, points out Goirigolzarri.
only alternative
Not a very common option, but an option nonetheless. Because although they had never done it before at the Clinic –and Nicolás was reluctant to intervene– the truth is that it was the only possible alternative. Because, at that moment, Nicolás could barely walk without falling exhausted. Not to mention that the medication was no longer working. So they all went ahead with the pioneering procedure that took place just before Christmas 2022. And the patient was able to spend the holidays with his family without a hitch. What’s more, now, at 68, Nicolás walks two kilometers a day, something that was unthinkable before.
The phrase that titles this report may seem like a license or an exaggeration, but it is literal. “My heart is out of me”, joke. He is referring to the device that, since then, has always been with him, which is connected with cables and a battery and reaches the left ventricle “with a cable that comes out of one side,” he explains. «I have three kinds of equipment: one that is like holsters, when I wear them and I run into someone I know I tell them “quiet careful”, like cowboys. I also have a little backpack that I bring when I come to the hospital and other equipment that is like a vest.”
The battery lasts about 16 hours, so you have to recharge them overnight. « At 8-9 at night I go to bed and sleep plugged into the current and when I get up I put them on. I have to sleep on my back, next to me I can’t because I have the cable”, details Nicolás who, despite these small “inconveniences” feels “privileged with this heart is the best thing that could have happened to me», he assures. «I already go out alone to the street. The change has been brutal, I speak well, forcefully, before I could hardly even speak, I did it as if I were ”patting it” », she recalls.
operation on the rise
Since the intervention every 15 days to the hospital to get the cures and check that everything is going well, but as time goes by the visits «will be expanded to once a month, that attendance is controlled, the batteries… You stay calmer and the cures will be spaced out. After that, it could be every three months depending on how he responds”, details Goirigolzarri.
«It is the first device of this type that we have installed, but they have already done so in some centers. They are getting better and better, they have less complications and they are getting more». For this reason, he predicts, “it is a therapy that is going to increase, because it greatly improves the prognosis of mortality but, above all, the quality of life.” In addition to the fact that HF is becoming more frequent due to the aging of the population, because the diseases that produce it are well treated and it becomes a chronic problem. «When you are young there is the option of a transplant, but in those who do not, they can receive assistance. Dr. Restrepo and I are very happy with the result, she can walk, she walks almost faster than you! You greatly improve their quality of life and survival. And, although those who do not respond to treatment are a small percentage within HF, as is so frequent, in the end there are many in this situation”, she concludes.
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