Heartmate – a lifeline for patients waiting for transplants


HEALTHIER AND HAPPIER: Doctors found Choong had an enlarged heart when he was admitted to KKH for appendicitis in February 2011. He had HeartMate II implanted and has to carry a bag – with batteries that need to be recharged every day.

THE NEW, improved HeartMate II left ventricular assist device is a lifeline for patients waiting for a heart transplant.

Financial adviser Mr Senthil Nathan, 35, was living precariously with heart problems until the HeartMate II left ventricular assist device stabilised his condition and became a lifeline before his heart transplant.

In 2005, he had what appeared to be the flu bug, but the cough persisted and he had difficulty breathing and sleeping. He also gained weight despite losing his appetite.

His condition worsened and, one evening, he struggled to the clinic for help. “The doctor took one look at me and knew something was wrong. He did an ultrasound which showed my clearly enlarged heart. He said I needed to go to the hospital immediately.”

There, doctors informed him that a viral infection could have attacked his heart, causing it to enlarge and result in heart failure. “I was utterly shocked because I’d never had any heart problems before. The doctors said my heart was pumping at only 10 per cent of its full strength.”

In 2009, he was referred to National Heart Centre Singapore (NHCS), where he was evaluated and put on the heart transplant waiting list. “I couldn’t eat, sleep or walk. It took me 10 minutes to walk three metre and I was so breathless that, when I slept, I had to be in a sitting position.”

As a bridge-to-transplant, HeartMate II was implanted in him by NHCS doctors. The device helps the heart pump blood to the rest of the body. Placed just below the diaphragm in the abdomen, it is attached to the left ventricle and the aorta – the main artery that carries oxygenated blood from the left ventricle to the entire body. An external wearable system that includes a small controller and two batteries is attached by an external cable, which the patient wears all the time and charges every day. Since May 2009, 19 patients have been implanted with it.

“I walked around with five kilogramme of batteries all the time. Every night, I plugged myself into a machine that kept my heart beating. But none of it mattered as HeartMate II allowed me to work again and I was much stronger than I’d been in years,” said Mr Nathan.

Transplant must wait

BACK TO NORMAL: Jessie Tan-Neubronner carries the external system in her bag, which looks ordinary save for the white cable, which links the system in her bag to the device through a small opening in her body.

Insurance adviser Mdm Jessie Tan-Neubronner, 46, developed heart failure in 2006 following an adverse reaction to chemotherapy for breast cancer.

Her doctors said she needed a heart transplant to survive, but did not think it was advisable to have the operation until she was in remission. In the interim, her heart condition was so bad, she was practically bedridden and needed a device to help it function.

Her doctors put her in touch with NHCS where, after a series of assessments, she was implanted with the HeartMate II left ventricular assist device in 2009. Since then, things have gone well – she’s regained normalcy and gone back to part-time work.

HeartMate II allows more patients to stay alive while waiting for a suitable heart. Currently, about 15 patients are supported on left ventricular assist devices, while five patients are on the active waiting list for heart transplants, with a waiting time of about a year.

The youngest recipient of a mechanical heart-assist device in Asia is 14-year-old Choong Wei Tzen. He had a rude shock in February 2010 when, upon being admitted to a children’s hospital for acute appendicitis, it was discovered that he had an enlarged and weak heart.

In August 2011, he was admitted with severe heart failure and was transferred to NHCS for further treatment. There, he was put on a temporary life support system known as the Extra Corporeal Membrane Oxygenator (ECMO) before receiving the HeartMate II device five days later.

Since getting the device, he has regained his appetite and feels better. “I’m feeling very good. Before this, my appetite was poor but, now, I can eat better. I was breathless before, but not anymore,”  said Wei Tzen, who has returned to school.

His mother Mdm Jacqueline Liau said: “He’s happier, healthier and more positive. Before the operation, especially when he was reaching the heart failure stage, he was very weak and knew it. Every time we visited him in hospital, he would keep a tight hold of his father’s and my hands.”

His surgeon Dr Tan Teing Ee, Senior Consultant, Department of Cardiothoracic Surgery, NHCS, said: “HeartMate II gives most patients a very good quality of life. Most are able to go back to their normal activities after it is implanted in them. Before surgery, quite a number of them cannot even walk a few steps without becoming short of breath.”

About HeartMate II

HEARTMATE: Flu-like symptoms led to a viral infection that caused Senthil Nathan’s heart to be enlarged. His condition worsened and doctors finally implanted Heartmate II in him. It kept him fit and healthy till his heart transplant in 2011 allowed him to travel freely without it.

IN THE Last decade, National Heart Centre Singapore (NHCS) has implanted over 50 mechanical heart devices in patients. Ten of these patients went on to receive successful heart transplants.

Dr David Sim, Consultant, Department of Cardiology and Co-Director of the Heart Failure Programme, NHCS, said people with weak hearts generally have them functioning at below 50 per cent. Prior to this programme, about 30 per cent of patients died while waiting for a transplant, due to the lack of suitable donors.

HeartMate II, the latest mechanical heart device, was introduced in Singapore in 2009. Compared to older devices, it has a much smaller pump that is fully implantable in the patient’s body. It was designed to significantly improve survival and quality of life, and provide several years of circulatory support to patients with advanced heart failure.

It is also more durable and can potentially be used for chronic long-term support for patients with irreversible heart failure. The first recipient in May 2009 was a 30-yearold female patient and she is still doing well today.