Second Opinions, Second Chances
Sixteen years ago, Jim Collins underwent bypass surgery. In 2015, after undergoing a right-heart catheterization to determine how well his heart was pumping, his cardiologist told Collins that his heart was too damaged to treat.
“He told me to go home and live the remainder of my life, which he estimated to be two to three months,” recalls Collins. Instead, he went home and made an appointment with Jason Smith, M.D., a cardiologist at The Christ Hospital, to seek a second opinion.
Smith reviewed Collins’ records and confirmed that his heart was not in good shape but prescribed medications that helped temporarily. When Collins started experiencing extreme heart failure — difficulty breathing and increased fatigue — he was paired up with Greg Egnaczyk, M.D., a nationally recognized heart failure specialist at Christ Hospital. In October 2018, Collins had a left ventricular assist device (LVAD), a mechanical heart pump to assist the heart in pumping blood to the body, implanted by a surgeon at Christ Hospital.
According to Egnaczyk, heart failure is the most common hospitalization in patients aged 65 and older, and there are two types of heart failure.
“The type of heart failure you have is based on your ejection fraction — the measurement of the percentage of blood leaving the heart each time it contracts,” Egnaczyk explains.
The heart can be normal strength in terms of how well it squeezes, but if it’s really stiff due to high blood pressure, diabetes or obesity, then people can still have trouble with congestive heart failure. The other type of heart failure is when the heart muscle has weakened, a condition commonly referred to as heart failure with reduced ejection fraction. Previous heart attacks, high blood pressure, and certain viruses can cause damage to the heart muscle. This can make it more difficult to pump blood throughout the body leading to shortness of breath, swelling, tiredness and confusion.
“Those are individuals who can progress to needing things like a heart transplant and mechanical heart pumps,” Egnaczyk says.
The patients who require this type of surgery usually have suffered years of heart disease after having tried different medications, treatments and procedures. Despite those therapies, their hearts continue to decline.
Egnaczyk notes how pleased he is with the evolution of technology where the LVAD has gotten smaller and easier to implant, decreasing complications.
“As these pumps get better and smaller — in fact, at some point they will be fully implantable — then we may be able to implant them in patients before they get so sick.”
Christ Hospital offers specialty programs for disease management that include nationally renowned experts who provide technology and expertise that are far different from other health care systems. They have doctors in the practice who are specifically focused in certain areas, and they do the type of work in volume that centers like Cleveland Clinic and Mayo Clinic do.
“Frankly, [here at Christ] we have better access to technology than those other more recognized centers,” says Dr. Dean Kereiakes, Medical Director of The Christ Hospital Heart and Vascular Center. “I put a valve in yesterday. It’s the first time it’s been done in Ohio. We’ve put in other TAVR (transcatheter aortic valve replacement) valves in the last 18 months for the first time.”
According to Kereiakes, most people in Cincinnati don’t know that Christ Hospital offers leading edge technology and expertise. In fact, even in a difficult COVID-19 year, Christ Hospital had 38 LVADs placed in patients in 2020 and ranked as the No. 1 program in the country without on-site heart transplant.
“That speaks to the scope of our heart failure treatment program,” says Kereiakes. “It’s the best in the region — possibly in the state.”
Recently, Christ Hospital launched a second opinion campaign to encourage patients like Collins to advocate for their own health.
“When you have physicians in this city who are experts at minimally invasive surgical procedures or fixing valves and arteries without open heart surgery as well as fixing high-risk patients with non-surgical treatments for heart disease, why would anyone in this region not offer themselves a second opinion?” asks Kereiakes, who recites a quote by Aristotle: “Education is the best provision for old age.”
“The more educated you are about your situation, the better decision you can make,” Kereiakes points out.
He maintains that informing oneself is the most intelligent thing anyone can do.
“We have an aging population, no question, and getting educated on your problem can only give you more options and a better understanding for what you’re up against,” Kereiakes says.
What often holds people back is the fear that seeking a second opinion will make it appear that they lack confidence in their physician.
“Honestly, that’s only a problem if your physician lacks confidence in themself,” says Kereiakes, who highly recommends seeking a second opinion. “It’s unfortunate that some patients don’t because they might have a different option, a better option, a new technology, and maybe a better outcome if they had.”
This year marks the 10th anniversary of the hospital’s LVAD program. In 2011, Christ Hospital performed 10 LVAD implants. Since then, they’ve done between 25 and 35 implants each year, totaling greater than 250.
Many patients come to Christ Hospital for an LVAD implant because they have experience in taking care of the sickest and most complex patients yet repeatedly see excellent outcomes that are better than the national registry. Like Collins, many of these patients are not transplant candidates, which means they spend the rest of their lives with an LVAD. The team at Christ Hospital takes care of whatever problems arise as these patients live with their LVAD, even if it’s not cardiac related.
“We’re there for them every step of the way and that’s an important part of our practice, too,” says Egnaczyk, noting that the robust team required to help these patients through surgery and the recovery that follows includes surgeons, physicians, nurses, advanced providers, and nurse practitioners.
Roughly 3,500 LVADs are implanted nationally each year; about the same number of transplants are performed annually. “That’s what I’m most proud of — the team we have assembled here at Christ,” says Egnaczyk.
It started small and as their patient pool has grown, so, too, has the team. “It truly takes a village to take excellent care of these individuals, and our team has a passion for caring for these complex patients,” says Egnaczyk. “Often we serve as their main source of medical care with their device because they are complicated. This pump has its own effect on physiology and comes with different medicines and potential complications that require a team of experts to take care of them, so they heavily rely on us.
“We definitely think it’s an underutilized technology,” continues Egnaczyk, who believes there are patients who are suffering from heart failure who would benefit from an LVAD but never get evaluated or offered this as a therapy. They either have repeat hospitalizations and don’t get referred along or they end up dying with their heart disease because it’s too late to put them through a major surgery.
“When we think of potential candidates for heart transplants and LVADs, we’re just at the tip of the iceberg, so to speak,” Egnaczyk says.
Now, 2 1/2 years later, Collins is living his best life.
“I can’t swim or take a bath, but I’m not really hindered,” says Collins. “My wife Jill and I still travel to see our grandkids. If I hadn’t gotten that second opinion, there’s no question I’d be dead. I’m very thankful I went to The Christ Hospital.”
For more information, visit TheChristHospital.com/heart. To schedule a second opinion with one of the hospital’s heart specialists, call 513.206.1180.