UK's collaborative nature has allowed the ECMO (Extracorporeal Membrane Oxygenation) program, which provides emergency support to patients, to thrive.

UK leads the way in life-saving ECMO transport

Technology plays an enormous role in advancing the quality and effectiveness of medical treatment. New technology tends to arrive first in larger, academic medical centers and subsequently spreads into the smaller city and community hospitals. As the technology continues its march to the far corners of the world, many academic hospitals consider it a moral responsibility to support the smaller hospitals, much like a big sister teaches her little sister how to ride a bike.

ECMO is a fitting example of this process. Extracorporeal membrane oxygenation (ECMO) technology provides emergency mechanical support for desperately ill patients by mimicking the natural function of the heart and lungs. This allows the patient to rest and heal from a variety of severe cardiac and respiratory illnesses, such as flu, pneumonia, cardiomyopathy or heart attack. External pumps and oxygenators remove carbon dioxide from the blood, replace it with life-saving oxygen and then return it to the patient’s circulatory system. The patient’s heart continues to beat, but stress on the heart and lungs is diminished because the ECMO machine does much of the pumping. While ECMO doesn’t fix the underlying problem, it supports the patient hemodynamically until they can get treatment or heal on their own.

A patient on ECMO is supported around the clock by a large, highly coordinated team, including specialized nursing care, nurse practitioners, physicians and perfusionists, as well as respiratory, physical and occupational therapists. It’s an expensive process, and hospitals with smaller patient volumes often cannot support its cost.

As the technology has been adopted by more hospitals around Kentucky, they have turned to UK HealthCare for support. UK HealthCare has been using ECMO to treat its patients since 1993, and today it offers an innovative, coordinated program to assist surrounding hospitals.

Getting the program off the ground

In some cases, a hospital already has ECMO technology but doesn’t have the infrastructure to support patients long-term. In other cases, a patient needs ECMO, but the hospital doesn’t have the technology. In both cases, a place like UK is well-suited to assist.

Michael Sekela, MD, now surgical director of the UK Gill Heart & Vascular Institute, first conceived the idea of ECMO transport in the early 1990s. But at that time, ECMO technology had not yet matured. “It took a long time to get the ECMO technology reliably to that level,” he said, “and it is best undertaken by a hospital with high treatment volumes and a relatively large catchment area.”

2016 data from Vizient (a think tank of hospitals around the country that embrace information sharing for performance improvement) ranks UK HealthCare No. 10 in adult ECMO patient volume, treating more patients than centers with loftier reputations, such as Cleveland Clinic, Mayo Clinic and Johns Hopkins.

As Sekela’s email inbox filled with requests for help, he recognized the need for a more formal model to support smaller hospitals and the patients they serve. “There is a large unserved need, as many institutions do not have the infrastructure in place to embrace this service,” he said. “We have the skills and the resources, and we already serve large swaths of regional and rural hospitals in and adjacent to Kentucky.”

But building such a program from the ground up would be no easy feat.

Positive reactions

For more than a year, a team at UK HealthCare worked on a blueprint for transferring ECMO patients safely to UK. The team included Sekela, Dr. Jay Zwischenberger (chairman of the Department of Surgery), Dr. Paul Tessmann, Dr. Anil Gopinath, Dr. Walt Lubbers and Patti Howard from Emergency Medicine, as well as EMS Manager Matt Ward, Mechanical Circulatory Support (MCS) Manager Julia Akhtarekhavari, MCS Coordinator Thomas Tribble and Chief Perfusionist Chuck McClendon. The plan had to support multiple scenarios (hospitals that offered ECMO but could not support a patient long-term, and hospitals that did not offer ECMO but had a patient who needed it). Any patient transport needed the space and equipment to accommodate a highly skilled team of EMTs, paramedics, critical care nurses trained in ECMO, and perfusionists. If the patient was at a hospital without an ECMO service, a surgeon was added to the transport to connect the patient to the ECMO equipment before they were transported to UK.

UK is the only center in Kentucky offering adult ECMO transport – in fact, you’d have to travel more than three hours in any direction – as far east as Charlottesville, as far north as Indianapolis, as far west as Nashville – to find another center with the same service.

Initial response to the fledgling program has been extremely positive. Wayne Lipson, MD, a cardiothoracic surgeon at Baptist Health in Madisonville, Ky., says the service helped save one of his desperately ill patients earlier this year. He describes the transfer process – from the phone call to patient transport – as seamless. “Mike [Sekela] showed up with his team at 2 a.m., less than five hours after we made the call,” he said. “Transporting a patient like this is a very difficult process, and it’s a testament to UK HealthCare that their system is so responsive.”

“Having this service available enables our team to treat more complex patients closer to home. We are armed with the knowledge that the UK HealthCare team will support us when we need it,” Lipson said

Sekela credits the team’s methodical approach to transport issues and meticulous planning and training for the service’s fantastic early success.

“This program exemplifies the collaborative culture at UK,” Sekela said. “Many months of planning and training with Emergency Medicine, Cardiovascular Surgery, Nursing and Perfusion were significant factors in the program’s success.”

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stroke

6 ways to prevent a stroke

When it comes to preventing a stroke, simple lifestyle changes can make all the difference.

Strokes occur when blood vessels that carry oxygen and nutrients to the brain burst or are blocked by a clot. When that happens, brain cells begin to die, affecting a person’s memory and ability to control muscles.

Stroke is the fifth-leading cause of death in the U.S. and in Kentucky, but there’s good news: Nearly 80 percent of all strokes are preventable.

In celebration of American Stroke Month, we’ve put together a list of things you can do to live a healthier lifestyle and better your chances of avoiding a stroke.

1. Get moving.

Regular physical activity will help lower your cholesterol and blood pressure, two of the biggest risk factors for stroke. Aim for 30 minutes of moderate activity five times a week. Something as simple as a brisk walk or bike ride with a friend will work wonders for your overall health.

2. Stop smoking.

Smokers are twice as likely to experience a stroke as nonsmokers. That’s because smoking thickens blood and increases the likelihood of clots. If you’re struggling to quit smoking, ask your doctor for help. And check out our blog with tips and resources that can help you or someone you know start on the path toward success.

3. Eat your vegetables.

And beans, whole grains and nuts, too – all of which are staples of a healthy diet. Improving your diet will help lower your cholesterol and blood pressure and help you maintain a healthy weight. Check out our guide for kick-starting a healthy diet.

4. Drink less.

Alcohol can increase blood pressure and the risk of stroke. Moderation is the key: For men, no more than two drinks a day, and for women, no more than one.

5. Learn about Afib.

Atrial fibrillation, also known as Afib, is a type of irregular heartbeat. If left untreated, Afib can cause blood clots in the heart that can move to the brain and cause a stroke. Talk to your doctor about Afib if you experience symptoms such as heart palpitations or shortness of breath. Learn more about the UK Gill Heart & Vascular Institute’s Heart Rhythm Program and listen to a podcast with our Afib specialist, Dr. Ted Wright.

6. Understand the things you can’t control.

Although improving your diet, ramping up your activity and living a healthy lifestyle can all decrease your risk for stroke, there are some risk factors you cannot control. Things like age, gender and race all play a role in stroke risk, and even though you can’t change those factors, it’s important to understand if you’re more susceptible.

Click the icon below to see our Stroke Quick Facts inforgraphic.

Stroke quick facts infographic from UK HealthCare


Next steps:

  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
  • Dr. Gretchen Wells, director of UK’s Women’s Heart Health Program, writes about why knowing your family health history can help you understand your own risk of disease. Read her blog.

 

DASH diet

The DASH diet is easy to follow and good for your health

Do you want to eat better, but don’t know where to start? Consider the Dietary Approaches to Stop Hypertension, or DASH diet.

The DASH diet was initially created to help lower blood pressure. But studies have also found the DASH diet to be one of the best options to prevent heart disease, stroke, diabetes and even some forms of cancer. Research also shows the DASH plan is safe and effective for short-term and permanent weight loss.

The best news is the DASH diet is easy to follow because it does not restrict entire food groups. Because the plan focuses on fresh fruits and veggies, controlling your calories is easier, too. Learn more about the DASH diet below.

What is the DASH diet?

The DASH plan is promoted by the National Heart, Lung and Blood Institute, part of the National Institutes of Health. The plan helps reduce the risk for serious health problems because it is low in:

  • Saturated fat
  • Cholesterol
  • Total fat
  • Red meat
  • Sweets
  • Sugary beverages

The DASH diet encourages:

  • Fruits
  • Vegetables
  • Fat-free or low-fat milk and dairy products
  • Whole-grain foods
  • Fish
  • Poultry
  • Nuts

The DASH diet is also rich in important nutrients such as:

  • Potassium
  • Magnesium
  • Calcium
  • Protein
  • Fiber

Tips for following the DASH diet

To reduce the amount of sodium in your diet, try these steps:

  • Choose fresh, frozen or canned vegetables that have low sodium or no added salt.
  • Use fresh poultry, fish or meat instead of canned, smoked or processed options.
  • Limit cured foods such as bacon and ham, foods packed in brine, and condiments.
  • Cook rice or pasta without salt.
  • Cut back on frozen dinners, packaged mixes, and canned soups or broths.
  • Rinse canned foods such as tuna and canned beans to remove some of the salt.
  • Use spices instead of salt to flavor foods.
  • Add fruit to breakfast or have it as a snack.
  • Treat meat as one part of the whole meal, instead of the main focus.

Some days you might eat more sodium or fewer foods from one group than the plan suggests. But don’t worry. Try your best to keep the average on most days close to the DASH plan levels.

Following the DASH diet

Here’s how much of each food group you should eat every day, based on eating 2,000 calories per day.

6-8 servings of whole grains. A serving size is about one slice of bread, 1 ounce of dry cereal or 1/2 cup of cooked rice or pasta.

4-5 servings of vegetables. A serving size is about 1 cup of raw, leafy vegetable or a 1/2 cup of cut-up raw or cooked vegetables.

4-5 servings of fruits. A serving size is about one medium fruit; 1/4 cup of dried fruit; 1/2 cup of fresh, frozen or canned fruit; or 1/2 cup of real fruit juice.

2-3 servings of fat-free or low-fat dairy. A serving size is about 1 cup of milk or yogurt or 1 1/2 ounces of cheese.

Up to 6 servings of lean meat, poultry, fish. A serving size is about 1 ounce of cooked meat, poultry, or fish, or one egg.

4-5 servings per week of nuts, seeds, legumes: A serving size is about 1/3 cup or 1 1/2 ounces of nuts, 2 tablespoons of peanut butter, 2 tablespoons or 1/2 ounce of seeds, 1/2 cup of cooked, dry beans or peas.

2-3 servings of fats and oils: A serving size is about 1 teaspoon of soft margarine, 1 teaspoon of vegetable oil, 1 tablespoon of  mayonnaise or 2 tablespoons of salad dressing.

Up to 5 servings per week of sweets: A serving size is about 1 tablespoon of sugar, 1 tablespoon of jelly or jam, 1/2 cup of sorbet or gelatin or 1 cup of lemonade.


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Congenital heart defects

48 years later, UK heart patient continues to thrive

Sonja Embry

Childhood photo of Sonja Embry

Sonja Embry was born with a congenital heart defect called tetralogy of Fallot. It’s a condition known as “Blue Baby Syndrome,” because valve defects and holes in the heart cause oxygen-poor blood to pump into the body, giving kids and infants with the condition blue-tinged skin.

Embry’s condition prevented her from having a normal childhood. She was often so tired that neighbors carried her to her one-room school every day.

At the time of Embry’s birth, most children with the condition did not survive to adulthood because no surgical procedure existed to repair the defects.

But Sonja did survive, and in 1969 at the age of 24, she underwent a new surgical procedure at the University of Kentucky to repair her heart defects. She went on to secretarial school and enjoyed a long career with the Department of the Navy in Washington D.C. and Memphis. At 71, she leads an active life and still drives to and from her home in Memphis to Western Kentucky to visit family and friends.

She is believed to be one of the oldest living patients with this defect.

Four decades of comprehensive treatment for heart defects

Now, nearly 50 years after Embry’s surgery, the UK Gill Heart & Vascular Institute is a leader in providing comprehensive, personalized care for adults born with congenital heart defects.

Adults born with heart defects face unique challenges. They outgrow their pediatric cardiologists, but their heart problems can be very different from cardiac conditions that begin during adulthood.

The Kentucky Adult Congenital Heart Program (KACH) at Gill is led by Dr. Andrew Leventhal and is the only such program in Central and Eastern Kentucky.

Unlike when Sonja needed treatment and follow-up care, adult patients with congenital heart defects can now turn to the KACH Program for lifelong care of their conditions.


Next steps:

When Jason Conn developed a heart infection, he needed a cardiologist that could provide advanced care. So he turned to the Gill Heart & Vascular Institute.

Team of experts at UK returns heart patient to his first love: restoring vintage cars

By his 13th birthday, Jason Conn had undergone three open-heart surgeries to repair his deformed bicuspid valve.

While he was cleared to enjoy typical childhood activities like skateboarding and bike riding, he was not allowed to play organized sports.

“My biggest disappointment was when my cardiologist told me that I probably couldn’t be a race car driver,” the Ohio native says with a smile.

Conn, now 41, was declared “cured” by his cardiologist and had, by his own account, a normal young adult life with few health problems. Eventually he moved to Lexington where he is now in his 11th year as a UK employee in the College of Agriculture  and began a lifelong love affair restoring vintage cars and motorcycles.

However, Dr. Andrew Leventhal, director of the Kentucky Adult Congenital Heart Program (KACH) at the Gill Heart & Vascular Institute, cautions that no one with a congenital heart defect is technically “cured.”

“Almost all congenital heart defect repairs should be followed by a cardiologist for a lifetime,” Leventhal said.

Conn learned this the hard way.

From sick days to something more serious

In late 2015, Conn developed a cough and fatigue that persisted all winter despite multiple rounds of antibiotics. By March, he could hardly muster the energy to walk the block from his house to the shop where he works behind Commonwealth Stadium.

“I had been losing weight, but at the time I didn’t think much about it,” he said. “When I went back and looked, I realized that I had been taking a lot of sick days.”

When Conn developed chest and abdominal pain, he came to UK Good Samaritan Hospital and mentioned his prior medical history to Leesa Schwarz, the KACH nurse practitioner. Schwarz alerted Leventhal, who ordered an echocardiogram to assess the structure and function of Conn’s heart.

“The echo revealed an abscess on Jason’s aortic valve, which explained why he was still having fevers despite repeated rounds of antibiotics,” Leventhal explained.

Conn had developed endocarditis – an infection of the heart’s inner lining. People with damaged heart valves, artificial heart valves or other heart defects are prone to endocarditis, and it can have deadly consequences, including stroke, organ damage and/or heart failure. In Conn’s case, he had an infarcted spleen, brain aneurysms and emboli in his foot causing nerve damage.

Leventhal knew that Conn needed a cardiologist with a keen clinical sense and an understanding of the complexities that his condition presented. He immediately called Gill Heart and Vascular Institute colleague Dr. Hassan Reda, an experienced surgeon who specializes in the treatment of diseased aortic valves, including congenital conditions.

In a 15-hour marathon surgery, Reda removed the infected tissue from around Conn’s heart and restored aortic valve function with a donor valve.

“Jason’s condition required a complicated, multistep team approach, including a skilled neurointerventionalist to treat his infected brain aneurysms, a delicate fourth-time reconstruction of the aortic root and attentive ICU and nursing care,” Reda said. “This sort of teamwork is a routine occurrence at the Gill.”

‘I can’t imagine a better place to be’

Conn began cardiac rehabilitation immediately after discharge and was back at work by early July.

“I feel terrific,” Conn said. “I’ve gained back all the weight I lost and am strong enough to carry tires and other heavy stuff.”

According to Leventhal, adults who were born with heart defects face unique challenges.

“It wasn’t that long ago that children with heart defects didn’t survive to adulthood,” he said. “Technical advances in cardiac surgery have improved outcomes dramatically, but that presents a new issue: Patients who reach adulthood have outgrown their pediatric cardiologists and the facilities that provide treatment – typically children’s hospitals. But simply transitioning to an adult cardiologist isn’t the best fit either, since their heart problems can be very different from cardiac conditions that begin during adulthood.”

Leventhal is among an elite group of cardiologists with special training to recognize and treat the issues that affect adults who have survived with congenital heart defects. He heads a talented group of physicians and staff at Gill’s KACH Program, which draws patients from all over Kentucky and West Virginia.

“People like Jason require a lifetime of follow-up care to ensure that their defect repair is sound,” Leventhal said. “If you had heart surgery as a child, be sure your doctor knows about it, and find a cardiologist who’s trained to help in situations like these.”

Conn calls his recent experience the “ultimate medical detective story” and is grateful that Leventhal was following his case so closely.

“It’s really a miracle,” Conn said. “I get to work here, and I get the best care here. I can’t imagine a better place to be.”

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Fainting

Women who experience a fainting spell should talk with their doctor

Dr. Gretchen Wells

Written by Dr. Gretchen Wells, director of the UK Gill Heart & Vascular Institute’s Women’s Heart Health Program.

Syncope, the medical term for fainting, is not uncommon in women. In fact, more than 40 percent of women will experience a fainting spell at some point in their life. Syncope refers to a temporary loss of consciousness and shouldn’t be confused with dizziness or feeling lightheaded.

The good news is that syncope is usually benign. Most of the time, it occurs in response to a trigger, such as standing too long, overheating or emotional stress. This is known as a vasovagal episode. Individuals with vasovagal syncope may feel lightheaded, have pale and clammy skin, be nauseated, have tunnel vision, feel warm all over, yawn, or have blurred vision before actually losing consciousness. This cause of syncope is best treated with lifestyle modification including adequate hydration.

However, it is important to consult with a physician after experiencing a fainting spell  particularly for patients who are 70 or older, as serious cardiac causes are more common in this age group.

Earlier this month, the American College of Cardiology, American Heart Association and Heart Rhythm Society released the 2017 Guidelines for the Evaluation and Management of Patients with Syncope. If you experience a fainting spell, your cardiologist will follow these updated guidelines in order to evaluate you. Your physician will perform a physical examination and obtain a detailed medical history, which can provide the most reliable information regarding the cause of syncope. An EKG may also be performed to check for problems with the electrical activity of your heart. In older women, risk factors for syncope include atrial fibrillation, heart failure, aortic stenosis and COPD (chronic obstructive pulmonary disease).

Participation in competitive sports is generally not recommended for patients experiencing syncope until a serious underlying cause has been excluded.

If you have a serious underlying medical condition (for example, a congenital heart problem) and experience syncope, hospitalization may be necessary, especially if syncope is related to this condition.


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"Broken heart syndrome" is a real diagnosis, also known as stress-induced cardiomyopathy, and can be caused by a sudden loss, like the death of a loved one.

‘Broken-heart syndrome’ is a real medical diagnosis

Samy-Claude Elayi, MD

Written by Dr. Samy-Claude Elayi, a cardiologist at the UK Gill Heart Institute.

A traumatic event, such as the sudden loss of a job, divorce or the death of a loved one, can cause us to experience overwhelming emotions. The term “broken-hearted” is often used to describe these reactions, but it’s rarely thought of as life-threatening.

However, broken-heart syndrome is a real diagnosis, also known as stress-induced cardiomyopathy. The condition is fairly new to researchers, but the recent deaths of a celebrity daughter and mother just one day apart – actresses Carrie Fisher and Debbie Reynolds, respectively – has shed new light on the heart condition.

What causes a broken heart?

Broken-heart syndrome is a disruption of the heart’s normal pumping process that leads to heart muscle failure. The condition is thought to be triggered by a surge of hormones.

This surge of hormones can be caused by stressful events such as an unexpected death of a loved one, news of a serious medical diagnosis, domestic abuse, losing or winning a large amount of money, loss of a job, or even a divorce.

The most common symptoms include chest pains and shortness of breath. These symptoms are similar to those of a heart attack, and the two are difficult to tell apart based solely on symptoms.

A heart attack occurs when blood flow to the heart is cut off due to clogged coronary arteries. However, unlike a heart attack, the broken-heart syndrome is not related to clogged arteries. Instead, part of the heart temporarily enlarges and is not able to pump efficiently, putting more strain on the other parts of the heart.

Diagnosis and treatment

To determine what is causing the chest pain and shortness of breath, doctors may order a chest X-ray, electrocardiogram, blood test, coronary angiogram or an MRI. Once the chest X-ray and MRI verify the condition of the arteries, the doctor will likely ask if you have experienced any recent stressful events or life occurrences.

Women and individuals with head injuries or seizure disorders are more likely to be affected by broken-heart syndrome. There is no clear reason why, and research is still ongoing. Other risk factors include sexual activity, neurological conditions and psychiatric disorders.

Treatment for the condition is similar to that of patients experiencing a heart attack. Patients are kept in the hospital during recovery and are prescribed angiotensin converting enzyme inhibitors or diuretics that reduce the workload of the heart.

Broken-heart syndrome is rarely fatal, and patients typically recover within a month. There are no long-lasting effects and although recurrence is possible, it is highly unlikely. However, if you’ve experienced a traumatic event and have noticed any of these symptoms, check in with your doctor immediately.


Next steps:

Kick-start your heart health with these nutrition tips

Heart disease is the leading cause of death in Kentucky and the nation, accounting for one in every four deaths. Fortunately, there are many things you can do reduce your chances of getting heart disease, starting with a heart-healthy diet.

Foods to eat

To help limit your risk for heart disease and stroke, eat these types of food:

  • Fruits and vegetables. Try to make fruits and veggies at least half of each meal.
  • Whole grains. At least half of your grains should be whole grains. Look for these ingredients: whole wheat, whole oats, oatmeal, whole-grain corn, brown rice, wild rice, whole rye, whole-grain barley, buckwheat, bulgur, millet and sorghum.
  • Fat-free or low-fat dairy products. These include milk, calcium-fortified soy drinks (soy milk), cheese, yogurt and other milk products.
  • Seafood, skinless poultry, lean meats, beans, eggs and unsalted nuts.

Foods to avoid

Avoid the following ingredients to improve your heart health:

  • Saturated fats. Saturated fat is usually in pizza, ice cream, fried foods, many cakes and cookies, bacon, and hamburgers. Less than 10 percent of your daily calories should be from saturated fats.
  • Trans fats. These are found mainly in commercially prepared baked goods, snack foods, fried foods and margarine. Choose foods with zero trans fat.
  • Cholesterol. Cholesterol is found in foods made from animals, such as bacon, whole milk, cheese made from whole milk, ice cream, full-fat frozen yogurt and eggs. Fruits and vegetables do not contain cholesterol. Eggs are a major source of dietary cholesterol for Americans, but studies show that eating one egg a day does not increase the risk for heart disease in healthy people. You should eat less than 300 milligrams of cholesterol per day.
  • Sodium. Sodium is found in salt, but most of the sodium we eat does not come from salt we add while cooking or at the table. Most of our sodium comes from breads and rolls, cold cuts, pizza, hot dogs, cheese, pasta dishes and condiments (like ketchup and mustard). Limit your daily sodium to less than 2,300 milligrams (equal to a teaspoon), unless your doctor recommends something else.
  • Added sugars. Foods like fruit and dairy products naturally contain sugar. But you should limit foods that contain added sugars. These include sodas, sports drinks, cake, candy and ice cream.

Next steps:

When Lester Walters, a 59 year-old Berea native, had a heart attack, his journey to heart transplantation began. But he first required an artificial heart.

Mechanical heart keeps Berea man living, loving as he waits for transplant

Relaxing in a recliner in the corner of his ICU room, Lester Walters is all smiles. His red hair askew, he casually jokes with his wife and the nurses who come in regularly to check on him. The 59-year-old Berea native is waiting to be listed for a heart transplant, but he’s already one step ahead of most patients on the list – as of Dec. 12, 2016, Walters no longer has a failing heart.

Instead, a special machine has replaced it: the SynCardia temporary Total Artificial Heart, a battery-powered device that contains the same components as a real human heart and serves as a bridge to transplant.

“I feel great,” Walters said, the machine humming and pulsing like an air compressor in the background. “I feel about as good as one can.”

The first sign of heart problems

Walters’ journey toward a transplant began 17 years ago when he suffered a heart attack. Because he was adopted as a child, he had no knowledge of any heart-related medical history that may have been a risk factor. Doctors discovered Walters had atrial fibrillation, an irregular heartbeat that can cause poor blood flow. He had a pacemaker and an implantable cardioverter defibrillator (ICD) installed to “shock” his heart back into a regular rhythm if he experienced a life-threatening arrhythmia.

Walters resumed his normal lifestyle. He retired from Berea College in 2013 after 31 years of service and spent time taking care of his farm in Madison County. Seven years ago, the widower met his second wife, B.J. Pittman, and the two have spent their retirement fishing, raising chickens and gardening.

But by January 2015, his heart problems began to worsen. After a stint in another local hospital and a bacterial infection, he was referred to the UK Gill Heart Institute for more serious treatment. By the time he arrived, his body was swollen from edema – fluid retention caused by poor blood flow, where pressure in the blood vessels increases and fluid is forced from the vessels into body tissues.

Dr. Maya Guglin, medical director of UK’s Mechanical Circulatory Support Program, was the first to see Walters at UK. Her initial course of treatment focused on using medications to eliminate the swelling.

“We treated him with diuretics, beta blockers and other heart-failure medications,” Guglin said. “We managed to stabilize him for many months.”

Three shocks in a row

Then in early December 2016, Walters’ ICD went off once, then twice and then a third time a short while later, which knocked him unconscious. Although Walters had been shocked before – including one memorable time where his son caught him mid-fall and received a shock himself – he’d never experienced three shocks in a row.

Pittman rushed him to UK Chandler Hospital, where he was admitted. Walters had developed ventricular tachycardia (VT), a regular but very fast heart rate caused by improper electrical activity in the heart ventricles. The VT became incessant – a “VT storm,” as Guglin describes it – and his ICD ultimately shocked him 21 times over the course of a single day. Despite two alcohol ablations to attempt to kill off the misfiring heart cells, Walters’ heart was simply too damaged and scarred for the procedure to work.

He needed a heart transplant, but he was far too sick to survive one. The team placed Walters on ECMO, a treatment that provides support for patients with extreme cardiac and respiratory failure, to stabilize his condition.

Most patients with end-stage heart failure like Walters would then receive a left ventricular assist device (LVAD), a mechanical device that helps the heart pump blood throughout the body and allows the patient the chance to recover and gain back their strength. But in Walters’ case, the LVAD wasn’t enough.

“The LVAD was not an appropriate option in this case because of the VT,” said UK cardiothoracic transplant surgeon Dr. Alexis Shafii. “It could help his circulation, but it wouldn’t stop the electrical problem with his heart.”

The solution: Go ahead and remove the heart.

A bridge to transplant

On Dec. 13, Shafii performed the surgery to install the Total Artificial Heart in Walters, making him just the fourth patient at UK to receive the device as a bridge to transplant.

After the weeks of rapid deterioration leading up to his emergency hospital visit, Walters was blunt about his expectations going into surgery.

“I expected to die,” he said.

But the surgery went well.

“He immediately had a better color,” Pittman said.

From there, it was just a matter of time and work to regain his strength. Walters spent 10 weeks in the cardiovascular ICU, carefully monitored by Shafii and ICU staff. With the Total Artificial Heart keeping his heart rate at a steady 125 beats per minute for optimal blood flow, Walters soon began walking with the rolling power supply for his Total Artificial Heart, called the Companion 2 hospital driver, and an entourage of nurses in tow.

At first, he could only make it to the door of his room before needing to return to bed. But as the weeks went on, he worked his way up to twice-daily laps around the ICU.

“Starting out, it was really tough,” Walters said. “But I got to where I could walk a little more each day.”

Taking it ‘one day at a time’

In early February, he was stable enough to be switched to the Freedom portable driver, a smaller, wearable power supply for the Total Artificial Heart. The Freedom driver can be carried in a small backpack or shoulder bag and allows the patient to leave the hospital while they wait for a donor heart. Because of his progress, Walters was moved down to the cardiovascular telemetry unit, with hopes of being both listed for a transplant and discharged soon.

Dr. Navin Rajagopalan, medical director of heart transplantation at UK, notes that Walters’ steady improvement is a testament not only to his personal strength, but that of Pittman, who has been her husband’s rock through it all.

“Mr. Walters has made tremendous progress in the weeks following surgery,” Rajagopalan said. “It’s a testament to his strong determination and courage. But his wife has also been by his side every step of the way, providing encouragement and optimism, which has helped him in his recovery.”

And on this day, when the heart is on the minds of people across the country, Walters marks it as just another day in the journey that began with his initial heart attack 17 years ago. He and Pittman try not to think too far ahead, but focus on living in the present.

“I just take it one day at a time,” he said.

Media inquiries: Allison Perry, UK Public Relations, allison.perry@uky.edu.


See Lester Walters talk about his journey toward heart transplantation.


Next steps:

Dr. Gretchen Wells writes a lot of prescriptions and orders a lot of tests. But she says the most rewarding thing she dispenses is hope.

Video: Dr. Gretchen Wells talks hearts and her passion for women’s health

Dr. Gretchen Wells writes a lot of prescriptions and orders a lot of tests. But the most rewarding thing she dispenses is hope, she says. As director of the Women’s Heart Heath Program at the UK Gilll Heart & Vascular Institute, she helps Kentucky women enjoy longer, fuller lives with healthy hearts.

In Kentucky, the mortality rate from heart disease is among the nation’s highest, and Wells understands that in the fight against women’s heart issues, prevention is especially important. There are other issues to tackle as well, she says, including:

  • The biology of heart disease is different in men than in women, so new ways of detection and treatment need to be explored to address those differences.
  • More women are surviving breast cancer only to develop heart problems relatedto chemotherapy.
  • Young women with pregnancy complications such as pre-eclampsia are at higher risk for heart disease later in life.

All of these and more are what bring Wells to the office every day. She spends her time collaborating across campus to establish testing, identify biomarkers and explore treatments tailored specifically to the needs of women with heart disease.

But Wells says the best part of her job is developing relationships with her patients. “They teach me about family, they teach me about forgiveness and they teach me about love,” she says.

Watch the video below to see why Wells says “the best is yet to come for the women of Kentucky.”


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