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Monday, August 20, 2018

How to Save a Life

Posted By: Advancing Care

An Albany woman is alive thanks to two transplanted organs, one miracle drug and four medical teams at WMCHealth.

By Lisa Cesarano

In 2003, Josephine Irving, the mother of two and grandmother of eight, had developed congestive heart failure, which she managed with medication. But by January 2012, her heartbeat had grown so erratic, she required the implantation of a cardio defibrillator to correct it. After five years of relative stability, the machine’s monitor revealed frequent life-threatening arrhythmias no longer controllable by medication.

In May 2017, when the machine gave her “a shock,” and she began feeling shortness of breath, Irving went to her local cardiologist. After leaving the office, her husband, Robert, left her in the lobby while he returned the wheelchair they needed for her visit.

“I sat down in the lobby and leaned my elbow on the arm of the bench. My defibrillator went off again. That’s the last thing I remember.”

Irving fainted and was rushed to a local hospital, where her diagnosis turned dire.

“The surgeon came in to speak to me. He said, ‘You need to listen to me very carefully. You are seriously ill. You need to go to Westchester Medical Center for an LVAD [left ventricular assist device], or you won’t make it through the weekend.’”

Transferred by ambulance to Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth), Irving was immediately evaluated for an LVAD, a mechanical pump that takes over the pumping function of the heart. It was then that the full gravity of her condition emerged.

“They then told me an LVAD would not help me, because it would place too much stress on the right side of my heart,” says Irving. “They told me I needed a new heart.”

Irving was placed on the transplant list. She was advised that because her blood type was O negative, it could take six months to a year to find an appropriate match.

Irving, however, did not have the luxury of time. In fact, according the Alan Gass, MD, FACC, Medical Director, Heart Transplant and Mechanical Circulatory Support at Westchester Medical Center, the confluence of multiple organ failures and infections had brought her to the brink of death.

“Josephine came to us in cardiogenic shock,” he recalls. “She had very bad heart failure, renal failure, liver failure and pneumonia.” As far as transplant, like many women, Irving carried blood antibodies from her pregnancies that increased her risk of organ rejection. “All of this made her an extremely high-risk patient,” explains Dr. Gass. “I have been doing this work for 27 years, and she was one of the sickest I have seen.”

Not a candidate for an LVAD, which typically serves as a bridge to transplant, and with little hope of a donor organ becoming available in time, the cardiac team rose to the difficult challenge of keeping her medically stable. Irving was connected to an extracorporeal membrane oxygenation (ECMO) machine – a heart-lung bypass machine – working day and night to pump and oxygenate her blood, as her own heart was no longer able to function.

Josephine Irving with husband Robert Lee at their home in Albany.

“We know the work we do is not just for the patient, but for those who love them,” says Dr. Gass. “The support Josephine received from her husband was incredible. He was constantly at her bedside.”

After only two months, a donor heart and kidney became available. While an appropriate match to Irving’s body type and blood type, the donor had also been infected with hepatitis C, a virus that causes chronic liver disease if left untreated. Thanks to the creation of a new class of direct-acting antiviral drugs, just a few short years ago, Irving could now receive a twofold gift of life: dual heart and kidney transplants, followed by a course of treatment to eradicate the hepatitis C.

A breakthrough in the cure of hepatitis C has opened the door for patients in need of transplants to receive a suitable lifesaving organ much sooner.

“It is challenging because there are simply not enough donor organs in New York State,” says Roxana Bodin, MD, a physician specializing in gastroenterology and transplant hepatology at Westchester Medical Center. “That created the need nationally to expand the pool of donors to include those who have been exposed to hepatitis C.”

The heart team met with Hiroshi Sogawa, MD, FACS, the Surgical Director of Kidney Transplantation at Westchester Medical Center, along with Dr. Bodin, who would treat the hepatitis C infection post-surgically. “If she had waited even a week longer,” says Dr. Bodin, “the chances were very low she would have been able to recover.” With time running out, “we agreed that this was the best course,” says Dr. Sogawa.

Days later, the heart transplant was conducted by David Spielvogel, MD, Chief of Cardiothoracic Surgery and Surgical Director of Heart Transplantation at Westchester Medical Center. Once stabilized from the first procedure, Dr. Sogawa then performed the kidney transplant. “There was a high level of coordination with the heart team,” says Dr. Sogawa. “Because the donor heart is more fragile and delicate to maintain, the heart is done first.” The kidney, he explains, can safely remain outside the body for up to 48 hours with the help of a mechanical pump.

Though the transplant was complete, Irving was by no means out of the woods. However, according to Dr. Gass, “She progressed incredibly quickly given how sick she had been when she came to us.”

Dr. Gass also credits Irving’s husband as having been a large part of her miraculous recovery. He rarely left her bedside and was a constant source of spiritual and emotional support, he adds.

As soon as she was stable post-surgery, Irving began a three-month course of antiviral medication to treat the hepatitis C, under the watchful care of Dr. Bodin. “And now,” Dr. Bodin says, “she’s cured.”

“I’ve come a long way,” Irving says of her recovery. “All the doctors were excellent; they never gave up on me!”

“We always see amazing stories in transplant, but this was special,” reflects Dr. Bodin. “We have to give credit to the cardiac team. They were very competent and very aggressive in carrying this out. We do great things at Westchester Medical Center.”

Cardiac Care at WMCHealth

Westchester Medical Center 914.909.6900

Maria Fareri Children’s Hospital 914.493.8372

MidHudson Regional Hospital 845.483.5720

Good Samaritan Hospital 845.368.5620

St. Anthony Community Hospital 845.987.5147

HealthAlliance Hospitals 845.210.5600

Photos By Thera Horgan