Ventricular Assist Device Surgery Provides a "Bridge To Transplant" For a Failing Heart

Kathy Elizabeth Magliato, M.D., recently served as cardiothoracic transplant fellow and clinical instructor of cardiothoracic transplant surgery at the University of Pittsburgh, one of the nation's most respected heart transplant centers. While there, she coordinated and participated in all aspects of heart transplantation.

One of perhaps a few dozen women who perform cardiac surgery, and one of only a handful who do heart transplants, Dr. Magliato may be one of a kind in the implantation of ventricular assist devices - the mechanisms that provide a "bridge to transplant" for a failing heart.

Alfredo Trento, M.D., chairman of the division of cardiothoracic surgery, said Dr. Magliato's surgical skills, research interests and transplant experience are a welcome addition, particularly as the heart transplant and ventricular assist programs rapidly expand.

"We are especially pleased to gain Dr. Magliato's expertise in the field of assist devices," said Dr. Trento. "This is an area we are focusing on as we continue to develop our leadership position in the field of cardiovascular therapy." Cedars-Sinai's cardiac and cardiothoracic surgery program was the only one of its kind in Southern California to be ranked among U.S. News & World Report's top 50 in the nation. It was listed as 12th in the nation and second in the entire state.

"The time that I spent in Pittsburgh this past year was devoted to heart transplantation, lung transplantation, and ventricular assist devices," said Dr. Magliato. "I am grateful to the University of Pittsburgh Medical Center, and in particular Dr. Robert Kormos, for the training I received. It has enabled me to gain a level of expertise which I will be able to apply here." Dr. Kormos, president of the International Society of Heart and Lung Transplantation, is a world leader in the field of ventricular assist devices.

Dr. Magliato has been invited to share her experience at a ventricular assist device conference Sept. 18 for cardiac surgeons and cardiologists. She will present the topic "The University of Pittsburgh Medical Center Experience: Clinical Results and Patient Considerations." The half-day conference in Los Angeles is sponsored by Thoratec Laboratories Corporation, one of the leading developers of ventricular assist devices.

Dr. Magliato already has begun to help fine-tune and enlarge Cedars-Sinai's ventricular assist device program. "I think we have a vast number of patients who can benefit from ventricular assist device surgery as a bridge to transplantation or a bridge to recovery," she said. "This is the forefront of what's happening in heart failure cardiology and heart failure surgery right now."

Ventricular assist devices currently consist of two parts: an implanted pump and an external console connected by wires to power and activate the pump. Several manufacturers make a variety of models, and company representatives work closely with surgeons to improve the products. Dr. Magliato said surgeons and manufacturers hope to introduce totally implantable machines in coming years.

"At the present time, patients can walk around with these devices but they have to carry a console and battery pack - essentially a shoulder pack about the size of a purse," she said. "We hope that in the future, everything will be implantable. Not only will this free the patient from being connected to a console, but it will reduce the risk of infection because anything that exits the body can become infected."

After leaving her hometown of Highland, a small town in upstate New York, Dr. Magliato attended Albany Medical College and received her medical degree with Alpha Omega Alpha honors from Case Western Reserve University in Cleveland, Ohio. She completed her internship and residency in general surgery at Akron (Ohio) General Medical Center, taking a year in 1993 and 1994 for a cardiopulmonary transplant research fellowship at the University of Michigan Medical Center in Ann Arbor.

From 1996 to 1998, she completed a residency in cardiothoracic surgery at Loyola University Medical Center in Maywood, Ill.

Now board-certified in general surgery and thoracic surgery, Dr. Magliato received the Milton B. Schweid Memorial Award for Excellence in Cardiovascular Diseases while at Case Western, several Surgical Society Research Presentation awards, and numerous other scholastic honors and awards.

Although her recent research interests have been directed toward cardiothoracic issues, Dr. Magliato previously participated in research programs ranging from neuroendocrinology and neurosurgery to surgical oncology and immunology. Her work has been published in a variety of scientific journals and she has been invited to present findings at meetings sponsored by such organizations as the Society for Neuroscience, the American Thoracic Society of the American Lung Association, and the American Federation of Clinical Research.

"One thing that strikes me about the cardiothoracic surgery program at Cedars-Sinai is how smoothly things run," said Dr. Magliato. "It's a very efficient place to work and there is a great sense of camaraderie. People work well together. The cardiac surgeons here are superb and the patients get excellent care."

Dr. Magliato said she is excited about the "innovative people" she has met at Cedars-Sinai: "It's very fertile ground upon which to cultivate a ventricular assist device program."

Shortly after arriving at Cedars-Sinai, Dr. Magliato implanted a new-generation ventricular assist device into the chest of Harland Allen (Al) Nuckols, a Mission Viejo resident who has suffered four heart attacks since 1992. Each crisis was followed by a balloon angioplasty to clear the arteries to the heart, but after the latest heart attack, which occurred this past February, physicians at his hometown hospital told Nuckols that his options were limited.

"They said that my heart was so badly scarred after those heart attacks that they didn't think I would last a year. So that's when the ball started rolling to have a heart transplant," said Nuckols, who celebrated his 57th birthday on Aug. 24.

Although he had been released from the Mission Viejo hospital after the February heart attack, extreme shortness of breath sent him back on July 7. He was transferred to Cedars-Sinai two days later to undergo testing and preparation for a heart transplant. By the end of that month, however, his heart was deteriorating so rapidly that the assist device became his final hope.

"He is one of several patients we are trying to bridge to transplant, who would otherwise die without this device," said Dr. Magliato, explaining that Nuckols suffers from ischemic cardiomyopathy, the result of long-term coronary artery disease. After being damaged by numerous heart attacks, the heart muscle has become fatigued, stretched and ineffective, leaving Nuckols weak and short of breath.

In fact, before the assist device was implanted, talking required a great deal of effort, Nuckols said. "Now it's not a strain. I'm doing fine. I don't have any shortness of breath at all," said the retired radar technician who worked at the recently closed Marine Corps Air Station, El Toro.

Because his ventricular assist device is highly portable, Nuckols is able to be up and around, even walking outside to get fresh air and sunshine. In fact, he would much rather be walking than sitting. "I'd rather go walking than sit in that chair," he said, adding that another motivation is to be in good physical condition when he undergoes the transplant operation and eventually returns to Mission Viejo.

"I want to be able to do a lot of things when I go home. I don't want to be sitting around the house all day," said Nuckols, who has a wife, Yolanda, three grown children and nine grandchildren awaiting his recovery.

At Cedars-Sinai, he has become a role model for other patients with heart conditions who may benefit from a similar operation. "I go around talking to them," he said, offering encouragement and his philosophy: "I definitely want to live, so if this device is going to help me, then by all means, do it."

Dr. Magliato said Nuckols - with his attached console - is a good sport about becoming the center of attention as he strolls around the hospital. He is often asked about his assist device by other patients and visitors. "Mr. Nuckols is very willing to help educate others," said Dr. Magliato. "We're very proud of how well he has done. His courage and conviction should be an example to us all."

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