Advanced Heart Failure and Transplant Cardiology Program
The Advanced Heart Failure and Transplant Cardiology Program at Robert Wood Johnson University Hospital stands at the forefront of specialized care for patients with heart failure.
The Advanced Heart Failure and Transplant Cardiology Program at Robert Wood Johnson University Hospital offers the full spectrum of care for the advanced heart failure patient, including biventricular pacemakers, left ventricular assist devices, access to clinical trials, and a Medicare-certified heart transplantation service with shorter waiting times than hospitals in New York City and Philadelphia.
About Heart Transplant
To date, Robert Wood Johnson University has done numerous heart transplants with survival rates better than the nation average. The Advanced Heart Failure and Transplant Cardiology Program at Robert Wood Johnson University Hospital has access to sophisticated diagnostic techniques, the latest and best in cardiac therapy, and a close working relationship between Cardiology and Cardiothoracic Surgery. The statistics make Robert Wood Johnson University Hospital one of the leading heart transplant programs in the country.
In addition to patient survival rates, The Advanced Heart Failure and Transplant Cardiology Program at Robert Wood Johnson University Hospital is well-respected for its current and future heart failure and transplant research. Maintaining the delivery of the best patient care possible as a primary focus, the heart transplant team constantly strives to improve patient outcomes.
Indications for Heart Transplant
End-stage heart disease means that without some dramatic change in heart function, severe congestive heart failure will persist, and death is likely to occur within two years. Transplant becomes an important treatment option when all medical therapies have been utilized and no other surgical procedures will correct the underlying disease process. In general, patients with advanced heart failure who are taking maximal medication therapy should be considered for a transplantation evaluation.
It is important that candidates be in otherwise good health and free of other serious medical illness. Patients should also be psychologically stable and possess a willingness to be completely compliant with the rigorous medical regimens post-transplant.
While the requirements for transplant may differ slightly at various centers, there is a general consensus that certain risk factors are associated with higher morbidity and decreased compliance. There are also well-described exclusion criteria that have been shown to decrease short and long-term survival.
- Irreversible pulmonary hypertension, defined as a pulmonary vascular resistance index higher then 6-8 Wood units/m2
- Irreversible pulmonary parenchymal disease
- Irreversible renal dysfunction, defined as creatinine greater then 25mg/dl and a creatinine clearance less than 50 ml/min., unless combined with kidney transplantation
- Primary hepatic dysfunction, such as cirrhosis or hepatic dysfunction with resultant coagulopathy
- Significant peripheral and cerebrovascular disease
- Insulin dependent diabetes mellitus with end-organ damage or high insulin requirements without end-organ damage
- Co-existing neoplasm
- Acute pulmonary embolism or infarction
- Myocardial infiltrate or inflammatory disease, such as sarcoidosis and amyloidosis
The Evaluation Process
The evaluation process can be completed during an admission to the hospital or on an outpatient basis after you have seen a transplant cardiologist. You will also meet with other members of the cardiac transplantation team during the evaluation process, including the social worker, psychiatrist, and transplant coordinator. Potential candidates for transplant are first cleared by their health insurance company for coverage of the evaluation process. The financial coordinator handles most of the communication, but may ask the candidate or the candidate’s family to obtain and/or provide information to other community resources or employee relations/human resources/personnel staff as appropriate.
Lab tests will be performed to see how your other organs are functioning, and also to check what viruses you have been exposed to in the past. You will need to collect your urine for 24 hours and bring it to the hospital on the day of your blood work or admission for evaluation.
Other testing that you can expect includes a chest x-ray, Tuberculosis (TB) skin testing (PPD), exercise stress test, an echocardiogram, and a right heart catheterization (RHC). There may be more testing ordered depending on your current condition, the assessment of the cardiologist, and your specific past medical history. All tests and procedures are explained to you. Some examples of other diagnostic testing include a colonoscopy, Doppler ultra-sound studies of the arteries in your legs, neck, and abdomen, pulmonary (breathing) function studies (PFT's), and a left heart catheterization (LHC or coronary angiogram). The cardiologist may ask that you see other physicians who specialize in treating other conditions that the team might find during the evaluation phase.
Once all the necessary information is gathered, your case will be presented to the Transplant Committee. This committee meets on Monday afternoons and consists of the transplant cardiologists, transplant surgeons, nurse coordinators, pharmacist, social workers, a psychiatrist, a dietician, and cardiac rehabilitation nurses. The evaluation process assists the team to reach the appropriate decisions regarding treatment options.
The Waiting Period
Once you have been evaluated for a heart transplant, your name and other statistics will be entered into a national database. You will then be “listed” with patients from all over the country and from many other transplant programs. There are currently three categories for patients actively being considered for transplantation:
Status IA: Those who only have a few hours or days to live, or patients who are unable to leave the hospital because of the need for intravenous medications and invasive monitoring or those who require mechanical assist devices to keep them alive.
Status IB: Those who require intravenous medications but do not require invasive heart monitoring or are considered by the physicians monitoring them to be stable enough that their lives will continue beyond a few days or weeks without heart transplantation.
Status II: All others
A match is made for you based on body size, weight, and blood type. Listing status depends on the severity of your illness and to some extent the length of time waiting. Because organs are donated in a spirit of altruism and are considered a national resource, it is only right that those organs be allocated in an equitable manner. It is also important that all donated organs are well-matched donor organs and for as many people as possible.
If you are listed and at home, you will receive a beeper free of charge. We are not able to tell you how long the waiting period will be. You will be expected to follow-up in our outpatient clinic as directed and come in to have blood work drawn once a month for the Sharing Network. You will be encouraged to attend some of the support group meetings and may be asked to come in for educational classes.
Being listed does not guarantee continued listing at the original status. During the course of your care, unfortunate events and circumstances can arise. These circumstances may change your suitability as a transplant candidate and the transplant team might decide to remove a candidate from the list on a temporary basis or permanently. You will be informed of any changes of your listing status.
Heart Transplant: Third Time’s a Charm
A lifelong athlete, he enjoyed shooting baskets with his six sons. Then, in one stop-motion moment, as he prepared to take a foul shot, he blacked out. He woke up minutes later, lying on the sidelines, surrounded by concerned onlookers.
Mr. Chapman saw a cardiologist, who diagnosed an enlarged heart and ventricular tachycardia (irregular heartbeat). An implanted defibrillator (pacemaker) and medications helped, but symptoms, including fainting episodes, continued as the aggressive disease worsened.
At his wife’s suggestion, he saw a cardiologist at RWJ, who encouraged him to become a transplant candidate, but the tachycardia was so serious that he had to be admitted. The cardiologist recommended the implantation of an LVAD (left ventricular assist device) to support Mr. Chapman’s failing heart while he waited for a heart transplant.
Heart Disease: Implant is a Sure Bet
Heart Disease: Implant is a Sure BetWhen she wasn’t taking day trips with her husband, Tony, or spending time with her grandchildren, Mrs. Basile, 71, could be found working full time at the Pennington Quality Market.
The energetic grandmother had little trouble maintaining her busy pace and never felt ill until a strange sensation overcame her one day last May.
“I wasn’t feeling well that afternoon, but I thought it was a cold or flu,” Mrs. Basile recalled. “As I got ready to leave work, I felt very strange. When I went to step down, I couldn’t feel the floor — I felt like I was walking on clouds.”
Once at home, Mrs. Basile’s condition didn’t improve, but she ignored the symptoms. She showered and napped. As morning approached, the symptoms grew worse.
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