March 30, 2004

by Avis Thomas-Lester

 

Micheal King pulled out the tubes that have kept his heart pumping for the past two months and set about saving his own life.

 

''Take a deep breath. Relax. Calm yourself down,'' his transplant coordinator told him.

 

Over the next two minutes, King, 43, felt pressure build in his chest and sweat roll down his face as he pumped by hand to restart the device he will depend on to keep him alive until he receives a heart transplant, he recalled after the exercise last week.

 

Having passed that final test, King was set to leave Inova Fairfax Hospital in Virginia late last week for his home in Forestville, Md., -- the eighth patient in the nation to be sent home with this sort of heart pump since federal regulators approved the technology last year.

 

King and his doctors are taking advantage of one in a series of devices designed to extend the lives -- and improve the quality of life -- of people awaiting heart transplants.

 

On March 17, a panel that advises the U.S. Food and Drug Administration recommended that heart transplant centers be allowed to implant artificial hearts in such patients. Last year, the federal agency allowed patients to use heart pumps at home on an outpatient basis.

 

King, who has spent the past three months at Inova Fairfax, was to go home initially for a nine-day trial and will return to the hospital for tests and updates once a week. He must continue to rest and eat right and get enough exercise.

 

Before leaving the hospital, though, he had to master the heart pump, known as the Thoratec Biventricular Assist Device, or BiVAD. He had to learn how the unit works, how to change the dressing covering the incision, how to keep the pump going by hand in case of power failure.

 

Although awaiting a donor heart, he can now drive, take long walks outside with his stepchildren and return to the life he knew before his heart began failing, said Tonya Kraus, who works with transplant patients at Inova Fairfax.

 

''This technology turns patients back into people,'' said Kraus, who has worked with King for two years. ``It enables patients in end-stage heart failure to lead fairly normal lives . . . The patients can go home and enjoy their families and live outside the hospital. Micheal is a patient who before he got this, could barely get out of bed. Now he can go home.''

 

SUDDENLY EXHAUSTED

In 2002, King was engaged to the woman he loved and enjoying his work as an Air Force intelligence analyst when he noticed that he had begun to suffer bouts of extreme exhaustion.

 

''I went from running five or six miles to getting exhausted walking the 75 feet from my car to my office,'' King recalled.

 

A checkup showed an irregularity on his electrocardiogram. He underwent a catheterization on the right side of his heart. A biopsy followed. The diagnosis was cardiomyopathy, a word that covers several diseases and conditions that render the heart unable to pump normally.

 

King was put on medication to stimulate his heart and thin his blood. He was told to take it easy. He wasn't buying it.

 

''He was in denial,'' said his wife, LaRenda, 38, a former Air Force active-duty reserves medical technician who works as an intelligence analyst. ``He thought that he could beat it. He thought it wasn't as bad as the doctors said.''

 

But doctors were taking it seriously.

 

They placed King on the national transplant list on high-priority status, and began talking to him about a heart pump. King is unusual because his heart has failed on both sides. He needed pumps on both the right and left ventricles, a much more complicated situation.

 

King was initially referred to Inova Fairfax to determine whether he was a suitable candidate.

 

''Basically, we had to know if he was well enough to take it and sick enough to need it,'' Kraus said. ``He went through extensive tests and interviews in order to make the decision about 18 months ago.''

 

Kraus set about educating her patient. The pump, she told him, would not replace his heart. Instead, it would be connected to his heart and function where it failed.

 

In January, surgeons attached the device to King's heart.

 

Watch Video of Device Inside the Body

 

''It is a wonderful achievement and a great step in the right direction,'' said Nelson Burton, the hospital's director of heart and lung transplants. ``It is encouraging because there are tens of thousands of people who have severe, end-stage heart disease who can benefit from such mechanical devices.''

 

Although they don't expect a malfunction, King and Kraus had to make sure the paramedics would know what to do if the need arose.

 

''This is what is keeping me alive, so I had to know all about it,'' King said. ``Nobody needs to be more of an expert on it than I do.''

 

King said he is eager to get his transplant but feels blessed that technology allows him to go home until then. He's looking forward to spending time in the family room on the first floor that his family is converting to a bedroom. His 17-year-old stepdaughter has learned how to do minor repairs on the machine.

 

His two younger stepchildren are looking forward to watching the remaining March Madness basketball games with Dad.

 

King, who has dropped more than 40 pounds working out and walking two miles a day, will continue to exercise, but he will not be allowed to work again.

 

''I'm just going to take it easy, spend time with my family and wait for the transplant,'' he said.