Posted by Brigham and Women's Hospital February 12, 2014
Sometimes a story hits your right in the heart. Matt Fogg’s experience with battling chronic heart failure to eventually overcoming it is one of those.
Typically, when patients receive a left ventricular assist device (LVAD), it serves as either a bridge to transplant, or as a lifetime therapy if the patient is not a candidate for transplantation. But one Brigham and Women’s Hospital (BWH) patient became the hospital’s first chronic implant patient in recent years to successfully recover heart function with targeted therapy and, ultimately, have the device removed.
When Fogg, now 24, arrived at BWH two years ago, he was suffering from heart failure. His heart was so damaged that it was unable to provide enough blood to his organs. After Matt had received care at BWH for a month, cardiologist Dr. Eldrin Lewis of the Center for Advanced Heart Disease advocated for him to have an LVAD implanted. “Given that Matt was so young, we thought he would do well on an LVAD,” says Lewis.
At the time, the Center had just begun to systematically study whether some patients eventually may be able to have an LVAD removed. The goal, in cases where heart failure was reversible, was to use the LVAD for a short time to recover heart function and then remove it.
“Less than one percent of patients can get an LVAD and recover heart function to the point of not needing the device, and those patients usually have heart failure caused by a virus or an issue related to pregnancy,” says Dr. Mandeep Mehra, Co-Director of the BWH Heart & Vascular Center. “These kinds of reversible heart failure are the situations where myocardial heart tissue recovery has been seen.”
Fogg was among a group of patients who participated in a study at BWH. “We systematically turned down patients’ LVADs to see how the heart would behave without the support of the device,” says Lewis. “Matt is our first patient whose heart responded very well to treatment and demonstrated good function despite reduced support with the LVAD.”
The squeeze of Fogg’s heart muscle went from 4 percent to 45 percent over the course of his LVAD therapy, compared to normal function at 50 percent. “By offloading the heart with the support of the LVAD, we enabled his heart to have time to rest and recover,” Lewis says.
In August of last year, Fogg had the LVAD removed. Since then, the New Hampshire native was able to get a job at a local deli, resume his hobby of swimming, and practice regularly with his metal band.
“It’s unique to take a chronic heart failure patient who was on an LVAD for more than 20 months and remove the device, but this is the kind of event we want to become more common,” says Mehra. “Whenever possible, we want to recover the heart, not replace it.”
Fogg will continue to take medications to keep his heart healthy, but the BWH Heart & Vascular Center is implementing a study to find out whether the use of stem cells for patients like Fogg could reduce the need for medication and allow the heart to rebuild on its own.
“This is a very beautiful story of healing the heart, not just supporting it,” says Mehra.– Liz M.