What Cheney's heart transplant says about medical technology

In this Feb. 10, 2011, file photo, Former Vice President Dick Cheney addresses the Conservative Political Action Conference in Washington. (AP)

Much has been said about the fact that former Vice President Dick Cheney, who just had a heart transplant at 71 years of age, is among the oldest recipients. But in fact the survival rate for those over 65 is still quite high, 84 percent in the first year.

Also notable is the fact that Cheney waited 20 months for his new heart, despite his stature, testament to the integrity of the heart transplant list, which focuses on severity of illness.

But the most striking factor at the heart of Cheney’s transplant is the left ventricular assist device, or mechanical pump, also known as a “bridge to transplant,” which has improved to the point where it may sometimes take the place of a transplant itself. This battery-driven device has advanced to the point where it preserves flow to the other vital organs of the body, including kidneys, liver, and brain, as the patient waits for his new heart. Cheney received one in 2010, and his health appeared to improve almost immediately.

In the immediate post-operative period, Cheney will be observed in the hospital for signs of infection, bleeding, blood clot, or stroke. After a few weeks he will be allowed to go home, and will continue on strong anti-rejection drugs for the rest of his life. Despite these drugs, over half of heart transplant recipients are faced with at least one episode of rejection in their lives. A study published in the New England Journal of Medicine in 1994 determined that rejection is less in patients who are most HLA (human leukocyte antigen) compatible. In part because of the immuno-suppressive drugs a heart transplant patient receives, 7 percent of patients are faced with kidney failure.

Other problems the former vice president could face include plaques forming at an accelerated rate in the “new” coronary arteries and risk of malignancy from the anti-rejection drugs. Down the line he must conform to a careful diet, take statin drugs, and exercise regularly.

More than 2,000 heart transplants are performed in the U.S. every year, while more than 3,000 patients wait on lists. Despite the risks, a transplant represents a new lease on life to a patient such as Dick Cheney, whose own heart had been badly damaged from five myocardial infarctions. Such a transplant in a man over 70 would not have been possible just a few years ago.

The LVAD is no longer just a bridge to transplant. It has evolved to the point where it can shore up an ailing heart and keep a patient alive indefinitely. In former Cheney’s case, it is almost as much of a miracle as the transplant itself.

Dr. Marc Siegel is a professor of medicine and Medical Director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A Team and author of The Inner Pulse; Unlocking the Secret Code of Sickness and Health.