Back in the game First patient in state to leave hospital with a total artificial heart

Going home from the hospital was an important milestone for Stan Larkin, a 24-year-old resident of Ypsilanti, and also for the state of Michigan. When Larkin was discharged on Dec. 23, 2014, from University of Michigan Frankel Cardiovascular Center in time to spend the holidays with his family, he went home without a human heart.

Larkin is the first in the state of Michigan to leave the hospital with a Total Artificial Heart.  Using a device called The Freedom® Driver, a 13-pound power supply that delivers compressed air to pump blood through the body, Larkin’s artificial heart is fueled by a portable driver, rather than the traditional “Big Blue” hospital driver that weighs 418 pounds and is the size of a washing machine.

All in the Family

Stan Larkin and his brother Dominique Larkin, 23, are in a simultaneous battle with heart disease. In 2007, Stan collapsed at a basketball game and tests revealed a condition called right ventricular dysplasia, a leading cause of cardiac arrest.

Stan Larkin, with his father, Eugene, is regaining his health while waiting for a transplant.

Stan Larkin, with his father, Eugene, is regaining his health while waiting for a transplant.

Because the heart condition can be inherited, doctors believed others in his family might be at risk. Just weeks after Stan’s diagnosis, his younger brother Dominique was also found to have familial cardiomyopathy. Some people who have cardiomyopathy — especially those who have hypertrophic cardiomyopathy (HCM) — may live a healthy life with few problems or symptoms. Others may have serious symptoms and complications. As the heart becomes weaker, it is less able to pump blood through the body and maintain a normal electrical rhythm.

Surgeons at the U-M  Frankel Cardiovascular Center implanted a defibrillator to help regulate Stan’s heart rhythm. For a time, the defibrillator kept Stan’s heart beating a regular rate, but he had to limit physical activity. It was not clear just how strong his heart was.

Running out of options

Over time, Stan’s condition worsened and his dysplasia progressed to both ventricles of his heart so neither chamber could collect and pump blood effectively. He became progressively weaker, and his doctors grew more concerned that he wouldn’t survive the wait for a suitable organ for transplant.

In October 2014, Stan was admitted to U-M Frankel Cardiovascular Center and underwent a series of physiological tests to determine if he was a good candidate for an artificial heart. With the test results and the knowledge that his time was running out, this became his best option. On Nov. 7, 2014 doctors removed his failing heart and replaced it with the SynCardia temporary Total Artificial Heart.

With the Total Artificial Heart, there are two tubes that exit the body, and those tubes have to be connected to a machine that can deliver compressed air into the ventricles to allow blood to be pumped through the body.

Prior to the development of the Freedom portable driver, the only FDA-approved driver for the SynCardia temporary Total Artificial Heart was the large Big Blue hospital driver, which confined patients to the hospital for months, even years, waiting for a matching donor heart. The Freedom Driver does the same thing as Big Blue — deliver the compressed air — except it is portable.

First connected to Big Blue, Stan was switched to the Freedom driver, which was approved by the FDA in June 2014 to power the total artificial heart as a bridge to transplant. His care marks two milestones: as the first U-M patient to make the transition to the Freedom Driver and first patient in Michigan to go home with it.

The wait continues at home

“Stan is still listed for a heart transplant and we hope to transplant him as soon as an organ is available. In the meantime he can be at home, CIC_game2he can be functional, and continue to rehabilitate himself so he’s in the best possible shape when his opportunity comes,” says University of Michigan cardiac surgeon Jonathan Haft, M.D.

Stan’s brother, Dominique, also progressed to bi-ventricular dysplasia and ultimately received an artificial heart. Since then, he received a heart transplant and continues to regain his health. Meanwhile, Stan worked with occupational and physical therapists to be well enough to navigate the world with the Freedom Driver.

The Freedom Driver is powered by two lithium–ion batteries that recharge with a standard electrical outlet, and is designed to be worn in a backpack or shoulder bag. Staying close to a power supply, eating low sodium meals and taking a bevy of blood-thinning medications have helped Stan remain healthy as he continues his wait for a transplant.

There’s no denying when he’s around because of the sound of the rhythmic pulses broadcast by the device strapped to his back, but Stan says, “I can honestly say I’ve gotten used to it. This is what’s keeping me going. I can’t wait to get a heart transplant so I can truly feel like myself again.”

A bridge becomes a destination

Ventricular assist devices have been used for well over a decade to improve survival and quality of life as patients wait for a heart transplant. When all other treatment options — including medications, lifestyle changes and heart procedures — have failed, the devices may be used as destination therapy. Unlike bridge therapy, destination therapy keeps patients on an LVAD for the rest of their lives.

The devices are most commonly used to support the left side of the heart, called left ventricular assist devices (LVADs), and others may be used to support the right side of the heart. If both sides of the heart require support, the total artificial heart may be used.

The U-M Ventricular Assist Devices (VAD) Program is one of only a few programs worldwide with access to many investigational and FDA-approved VADs, like the HeartMate II® manufactured by Thoratec Corporation for the REVIVE-IT trial. Specialists on the team work with referring physicians in the evaluation and selection of the most appropriate device based on each patient’s needs.

A team approach

Of the 5.7 million Americans living with heart failure, about 10 percent have advanced heart failure, according to the American Heart Association. Heart failure is considered advanced when patients feel shortness of breath even at rest. Even at an advanced stage, treatment options exist to help the heart pump as best as it can.

The Heart Failure Program at the University of Michigan Frankel Cardiovascular Center focuses on the complex management of advanced heart failure, circulatory support and heart transplantation. The Heart Failure Program team has extensive, high-volume experience in the treatment of patients with acute heart failure.  Heart failure services include a telemanagement team of nurses as well as an inpatient team of nurse practitioners and physician assistants to ensure safe, collaborative, patient and family centered care.

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