HEART TRANSPLANT:
MORE CARE OPTIONS
FOR PATIENTS WITH
HEART FAILURE
For patients in severe stages of heart failure or
other serious cardiovascular conditions, heart
transplantation may be an option. The heart transplant
program is another part of the comprehensive care
delivered by the Scott & White Heart and Vascular
Institute. Since 2010, 40 heart transplants have been
performed at Scott & White Memorial Hospital.
Patients whose heart disease has progressed into
American Heart Association (AHA) stage D are potential
candidates for heart transplant. These patients have
irreversible heart damage that severely limits their life
span and ability to perform extended activity of daily
living. Because not all patients with terminal heart
disease are candidates for transplant, it is important
to limit the procedure to those seriously ill patients
who stand a reasonable chance of long-term survival.
Examples of diseases include coronary heart disease,
congenital heart defects, or cardiomyopathy.
All potential candidates may be referred to the
program by their specialist, primary care physician, or
by self-referral. If there are no contraindications based
on the initial review, an initial consult appointment is
scheduled with the transplant team. Information about
the overall process including the evaluation, waiting list,
surgical procedures, risks, post-transplant follow up
period, and transplant center specific information are
provided to the potential recipient.
After completing the evaluation, the patient and
the clinical findings will be discussed at the multidisciplinary patient transplant selection committee
meeting which includes cardiologists, surgeons, social
workers, nutritionists, nurses, and many other medical
specialists involved in the care of the patient. The team
considers medical, psychosocial and ethical factors
when making selection decisions.
Once a patient is approved for a transplant they
will be added to the United Network for Organ Sharing
(UNOS) list. Patients will then be matched with donors
based upon blood group, degree of medical urgency,
geographic location and age. Transplant candidates
wait an average of five months for a heart. During this
period their care team stays involved to keep them as
healthy as possible in preparation for their new heart.
After the transplantation procedure the patient will
stay in the hospital for approximately two weeks after
surgery. The care team will monitor the patient to
ensure the new heart remains strong and the body
does not reject it.
After the patient leaves the hospital they continue to
stay in close contact with members of their care team
and they will take anti-rejection drugs will for the rest
of their lives. While most patients suffering from heart
disease can be treated by less invasive procedures at
the Advanced Heart Failure Clinic, transplantation offers
one more option to help the heart patient gain a higher
quality and longer life.
A LOOK BACK
The Advanced Heart Failure Clinic was established in 2010 at the
same time that heart transplantation and LVAD surgery came to
the Scott & White Clinic in Temple. Those procedures allowed the
clinic to offer the full spectrum of heart failure therapies. Dr. Scott
had been part of the clinic since its inception and recalls how heart
failure treatment has evolved since he joined the staff at Scott &
White in 1999. “We went from an initial clinic that solely treated
symptoms with diuretic-type medicines to these therapies that not
only make patients feel better but help them live longer,” he says.
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THE CATALYST May 16 | sw.org
“Having all these experts
and resources in the
healthcare system allows
patients to get the same
quality of care no matter
which location they go to.
That really doesn’t exist
in a lot of other places.”
no longer able to do that, and I’m very
unhappy. Life isn’t meaning a whole
lot unless I’m able to do this.’” The
patient by now has become very weak,
says Dr. Sai-Sudhakar. “At that point
the patient is unable to do anything at
all and is practically moribund.”
In addition to advanced therapies,
communication between patients and
caregivers is vitally important. While
the clinic offers cutting-edge medicine,
technology, and surgical therapies
by talented caregivers, treating heart
failure begins with communication
between the healthcare team and the
patient. “Our approach to patients is
to educate them thoroughly because it
is a lifelong illness for most of them,”
Mrs. Day says. “It’s similar to diabetes.
It’s something that every day you’re
going to have to monitor and make
smart decisions.”
A collaborative approach
It gives many families peace of mind
to know that the care they receive at
the Advanced Heart Failure Clinic
isn’t just excellent, it’s collaborative
with many caregivers working together
to optimize each patient’s experience,
with input from their loved ones.
A cardiothoracic surgeon meets with
the patient and the cardiologist, and
this sort of consultation makes the
Advanced Heart Failure Clinic at Scott
& White Clinic in Temple, part of the
Heart and Vascular Institute, stand
apart, says Jacki LaFerriere, director
of operations at the clinic. “I don’t
know a lot of places that have a
The Advanced Heart Failure team: (Back row) Emmanuel A. Amulraj, MD;
Tammy Abbott; Jacki LaFerriere; Nance Conney; Lazaros A. Nikolaidis, MD;
Teresa Harvatin, NP; Jennifer Day, NP; Jennifer Lord, NP; Yazhini Ravi, MD;
(front row) Robert C. Scott III, MD, PhD, FACC; Chittoor Bhaskar Sai-Sudhakar,
MD; Allan L. Anderson, MD, FACC, FAHA
clinic where the surgeon and the
cardiologist see the pat ient together
so that they can discuss both medical
and surgical treatment options,”
Ms. LaFerriere says. “It’s a big deal that
cardiothoracic surgeons are actually
in the heart failure clinic collaborating
with the cardiologists.”
Dr. Scott agrees that the
collaboration between cardiologists
and cardiothoracic surgeons works
well. “Often, there can be a disconnect
between the medicine physician and the
surgeon. Here, we think of ourselves as
a team.” Dr. Sai-Sudhakar agrees. “We
have to work as a team to identify what
is the right thing for each patient. It’s a
group effort,” he says.
The Advanced Heart Failure Clinic
comprises specially trained physicians
and surgeons, nurse practitioners,
clinicians,
dieticians,
physical
therapists, pharmacists, social workers,
administrators, and others. “All these
different specialists and caregivers
come together to help the patients
throughout the disease process,”
Dr. Scott says. “It’s really a team
approach; all team members help
educate patients and work with them
to ensure the best care and outcome
possible.” The multidisciplinary team
helps patients create a lifestyle that
will help them live with and hopefully
avoid the effects of their disease.
“Baylor Scott & White Health is
unique in that we’re very fortunate and
blessed to have a lot of resources, not
only instruments and equipment, but
also people,” says Dr. Scott. “We’ve
got a lot of combined experience,” says
Nance Conney, director of transplant
and mechanical support for the
department of cardiothoracic surgery.
“Having all these experts and resources
in the healthcare system allows patients
to get the same quality of care no
matter which location they go to. That
really doesn’t exist in a lot of other
places,” Dr. Scott says. n
—Robert C. Scott III, MD, PhD
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