Monica Davenport has a life again after nearly a decade with a failing heart that imposed increasingly oppressive limits. She had to retire from her secretarial job in 2000 because she grew too weak even to carry file folders. As time wore on she was less and less able to stray too far from her bed. But today, at 52, she is driving, shopping, doing housework, cooking – and enjoying all the things the healthy heart that Oregon Health & Science University surgeons implanted late last year now gives her license to do.
Her new heart is an unceasing source of wonder to her. “The first thing I thought when I woke up after the surgery,” she recalls, “was, ‘I’ve got a really powerful pump now!’ I hear it in my ears when I’m lying on my side at night; it’s really strong.”
Monica has the unique distinction of harboring the 500th heart to be transplanted at OHSU in its history, a significant milestone for the oldest and, for 15 years, the only heart transplant program in Oregon. The first heart transplant in the state was performed at OHSU 22 years ago, on Dec. 4, 1985, by Portland heart surgeon Albert Starr.
Since then, OHSU’s transplant program has achieved outcomes that are among the best in the country. A dozen OHSU patients have passed the 20-year survival mark, joining the fraternity of the world’s longest surviving heart transplant recipients.
“Survival of our patients has met or surpassed national benchmarks at all points of follow-up,” said Howard K. Song, M.D., Ph.D., who with Matthew Slater, M.D., lead OHSU’s heart transplant surgical team. “That’s largely because of a multidisciplinary approach that brings together cardiologists, surgeons, clinical transplant coordinators, nurse practitioners, social workers, anesthesiologists, critical care specialists, pharmacists, physical therapists and patient services coordinators. The team approach assures that patients get comprehensive care and access to the most advanced medical and treatment options there are.” Song and Slater are both on the faculty of the cardiothoracic surgery division of the OHSU School of Medicine.
To date, a total of 485 patients have received 503 hearts at OHSU. (A few received a second heart when the first was rejected or because of other complications.) The one-year survival rate has exceeded 94 percent and the three-year rate is better than 81 percent. OHSU has ranked as one of the top two institutions among the University HealthSystem Consortium’s 100 academic medical centers in recent quarterly surveys. It is the only medical center in Oregon and one of only six on the West Coast where heart transplants are certified for coverage by Medicare.
“Advances that have made the biggest difference in survival rates since the OHSU program was started have come in the post-operative care of patients, the effectiveness of immunosuppressant drugs to prevent rejection of the graft and the early detection and treatment of the acute rejection,” said Rami Alharethi, M.D., interim director of the OHSU heart transplant program, assistant professor of cardiology in the division of cardiovascular medicine, OHSU School of Medicine.
Monica Davenport, who lives in Longview, Wash., with her mother and brother, was on the waiting list for a new heart for four months before a compatible one became available. The typical wait at OHSU, however, has been less than three months.
Her transplant was the latest chapter in a long saga. She was living in Houston when she had open heart surgery to replace her aortic valve. For four years after that her health, she felt, was reasonably good. But then, a decade ago, the symptoms of congestive heart failure—serious fatigue, fluid retention and other signs—began to take a serious toll. She took disability retirement from her secretarial job with a Houston oil field equipment broker and, on the advice of her physicians, moved back to Washington State, where she was raised, to escape Houston’s debilitating heat and humidity.
The patients who have received new hearts at OHSU over the last 22 years have ranged in age from 116 days to 70 years.. They have come from Washington, Idaho, California, Alaska and every corner of Oregon. OHSU teams do 15 to 25 heart transplants annually, which are down somewhat from the peak years of the early 1990s.
“Transplants remain the gold standard for patients with end-stage heart failure,” said Song. “But they no longer are the only option for a broad range of advanced heart failure patients. Ventricular assist devices have become a viable option for supporting heart transplant candidates until a donor heart is available and, for some patients, as an alternative to transplantation.”
Oregon Health & Science University is the state’s only health and research university, and its only academic health center. OHSU is Portland’s largest employer and the fourth largest in Oregon (excluding government), with more than 12,400 employees. The university’s size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU also is the source of more than 200 community outreach programs that bring health and education services to each county in the state. As a leader in research, OHSU earned $307 million in research funding in fiscal year 2007. OHSU serves as a catalyst for the region’s bioscience industry and is an incubator of discovery, averaging one new breakthrough or innovation every 2.7 days, with more than 4,100 research projects currently under way. OHSU disclosed 132 inventions in 2007 alone, and OHSU research has resulted in 33 startup companies since 2000, most of which are based in Oregon.