New heart device offers hope in Fort Worth

FORT WORTH -- Gustavo Esquivel Sr. was in his 60s when he had quadruple bypass surgery.

"I felt real fine for about 20 years," he said. "But not too long ago my breathing got bad."

His doctor told him that two blood vessels were clogged, but surgery was out of the question because of his age and fragile health. Instead, Esquivel underwent a new procedure in which a tiny pump was used to keep his blood flowing during the time needed to open his blood vessels with a stent.

"They didn't have to open up my chest," Esquivel said. "They just went into a vein and followed it to my heart."

This month, Esquivel, 82, became the first patient to undergo the procedure in Tarrant County. Plaza Medical Center of Fort Worth is the first area facility to use the Abiomed Impella 2.5 heart pump, an Abiomed representative said.

The device, considered the tiniest heart pump in the world, replicates the natural function of the heart. It is about the size of a coffee stirrer.

Before the pump was available, patients with advanced cardiac failure or those in shock after a heart attack had few options, said Dr. Farhan Ali, an interventional cardiologist with Heart Center of North Texas, a private practice with offices in Fort Worth, Weatherford, Granbury and Bridgeport.

Without surgery, they often faced disabling pain and heart failure. But if they underwent surgery, the odds were extremely high that they would die on the operating table.

For the 10 percent of cardiac patients who cannot withstand the stress of surgery, this procedure offers hope, Ali said. Candidates for the procedure include patients with kidney failure, chronic obstructive pulmonary disease or morbid obesity.

The Food and Drug Administration approved the pump in 2008. It has been used to treat more than 1,900 patients outside the United States. Nationwide, more than 500 hospitals are using the technology, including Baylor University Medical Center in Dallas.

The procedure is dramatically different from open-heart bypass surgery, which requires an incision in the middle of the chest from the top of the sternum to the bottom.

Instead it's performed in a cath lab and is far less invasive. In a matter of minutes, physicians can treat a condition that would typically take hours in the operating room.

During the procedure, a catheter is inserted through a small opening in the groin. The thin, flexible tube is threaded from the femoral artery all the way to the left ventricle of the heart. Once in place, tiny blades in the device spin around, pumping up to 2.5 liters of blood a minute from the left ventricle into the ascending aorta.

While the pump is in place, another cardio surgeon -- in Esquivel's case, Dr. Amir Malik -- uses a stent to open the blood vessel.

Before the procedure became available, the only option for patients who were not surgical candidates was medication to treat their pain. With the new treatment, the patient immediately finds it easier to breathe and does not become as easily fatigued as in the past, Malik said.

The pump is usually removed when the procedure is completed but can be left in the body for up to two weeks.

It is expensive. The pump costs $25,000 but is covered by Medicare and private insurance companies.

Patients typically go home after a day or two. Esquivel stayed in the hospital a little longer but returned to his Fort Worth home after three days.

The great-grandfather said he hopes to get back to the carpentry work he has long enjoyed. "I'm feeling pretty good now," he said.

JAN JARVIS, 817-390-7664