Louisville Magazine

AUG 2016

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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Page 65 of 140

LOUISVILLE MAGAZINE 8.16 63 size of a football. It went from one side of my chest to the next," he says. He'd had a suspicion he'd eventually need his heart replaced — his mother, father and grandfather all had heart disease. Despite leading a fairly healthy lifestyle — a little extra weight, perhaps — he had his first heart attack at 42, and has had several other heart-related incidents since: A stroke. Cardiac stents. Arrhythmia. Cardiomyopathy after two bouts of pneumonia. A ruptured blood vessel from the LVAD, which moves blood but doesn't pulse it. Garcia was put on the transplant list at U of L in 2010. Patients usually wait at least a year before a donor heart becomes available. Dr. Mark Slaughter implanted the LVAD during a five-hour surgery in August 2010. After the procedure, wires protruded from Garcia's abdomen and attached to heavy lithium batter- ies — or into the wall at night while he slept, necessitating the installation of a whole-house generator. Garcia cut holes in his pockets, looped the battery connectors behind his shirt and tie. An extra 10 pounds, batteries rotated every few hours, hidden. When he traveled, he made a spectacle at the security stops, sounding the batteries' alarms — which usually warn of low power — and taking them out, proving their use. "My quality of life went like this," he says, panto- miming a rising line on a graph with his flattened hand. "en it went like this for a number of years." e line evens out, horizontal. "en my right heart failure started and I started going down." His hand drops. His right heart failure caused lung hypertension — another high risk during surgery. e estimated 12-month waiting period passed — fivefold. Two close calls: One heart came up, a match, but when the heart was tested — arteries inflated to check their usage — it was faulty. e next heart was given to Garcia by a family in his church whose grandson had passed. But it was too small. He attempted to switch his care to Van- derbilt, but they rejected his case. "Too old, too tall, too complex," he says. But the device regulating his blood flow was not meant to last six years: ere's a 60 percent mortality rate after five years, 90 percent after eight. Sometimes you have to advocate for yourself. Garcia says this several times. Being a doctor himself, he knows the right questions and when to ask them. He knows the shoptalk, the jargon. He does his research. "If I had not known about the heart-failure clin- ic, I would probably be pushing tulips right now," he says. Sometimes advocating for yourself means listening to prophetic phone calls. Garcia drove the 75 miles to UK on a Friday afternoon in January just to see what specialists there had to say. If they gave the same prognosis as Van- derbilt, he'd live with it. After all, the University of Kentucky and the Uni- versity of Louisville pull from the same procurement pool. "I had a mindset that I was going to live maybe two or four years, and that's it," he says. "I was trying to get some things in order." Back at home, after the consulta- tion, Garcia was passing time before a planned movie date with his grandchil- dren, twins. His wife was sewing. It had been only a week since he'd added his name to UK's transplant list when he got the call. "We've got a heart for you," a nurse said on the other line. "We need you here within three hours." "I wasn't ready for it," Garcia says. "I thought it was going to be another month, or three or four, or another year." ey'd had their bags packed, waiting — a change of clothes, tooth- paste, deodorant. "And my curling iron," Garcia jokes. Tracing their path from a week earlier, Garcia sent mes- sages to his family while his wife drove — prayers and gratitude, all good vibes. Garcia says he felt confident on the journey. "One way or the other, I was going to win," he says. e University of Kentucky is ag- gressive in searching for donors. It will take hearts that might be at the edge of optimal, ones that other places won't accept. "Typically the ones that have been turned down by other people are usable if we have time to manipulate the donor's criteria before the harvest goes on," says Dr. Michael Sekela, the lead surgeon for Garcia's transplant. e donors he's talking about are typically patients declared brain dead. "Dr. Garcia was up in years and had other issues that made him high-risk, but we had a donor that would fit him that nobody else would use. But it's really not the edge of what you can do with donor (hearts). ose donors work out just fine if you take some time to get them better." e UK heart transplant team has performed nearly 30 operations. eir first year survival rate is above 90 percent, higher than average. Sekela says Garcia's transplant was fairly standard. "Just the usual stuff. Tough getting in, tough getting out." Blood and nicotine tests, a surgical staph bath, a psychological test, echocar- diogram, kidney and pulmonary checks and X-rays before anesthesia. e most complicated part was coordinating the extraction and transport of the donor heart with the removal of the assist device and the patient's heart. In a span of 12 hours, the surgical team cracked his sternum, revealing the heart and the LVAD, connected in two places. Scar tissue had built up around the LVAD device, the toughest part of the surgery because scar tissue means bleeding. It took eight hours to remove the LVAD. e surgery is a matter of arrange- ment: extracting the heart from the donor soon enough to transport — the organ, on ice, traveling by jet with a han- dler — to the operating room without having the patient waiting on bypass support for too long. But not so soon that the donor heart sits unconnected. From the moment of extraction it begins shutting down. e longer it takes for the heart to reach the recipient, the higher the chances of graft dysfunction, of rejection. But it can't arrive too late into the process of LVAD removal, lest something happen during transport of the donor heart, and the LVAD needs to be replanted. "at's the toughest part of the operation," Sekela says. "Once the heart's in the operating room, putting a heart in is really not technically difficult." "If I had not known about the heart-failure clinic, I would probably be pushing tulips right now," Garcia says. Continued on page 131

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