Losing weight is no easy task for Robert "Mikel" Defoor, whose weakened 68-year-old heart allows him to walk only 30 to 40 feet before he gets short of breath. But the Bakersfield, California, resident is critically aware he needs to shed pounds, considering his current weight disqualifies him for a heart transplant.
To help Defoor with his dilemma, Lawrence Czer, MD, at the Smidt Heart Institute introduced him and his family to the CardioMEMS HF System. The implanted device, which at first glance looks like a tiny paperclip with a wire loop on each end, enables doctors and clinicians to remotely monitor the status of a patient's heart.
Defoor quickly agreed to the implant, making him the first patient at Cedars-Sinai to receive it.
"I was a little apprehensive, because who really wants to be the first for a medical device," Defoor said after the procedure on May 27, 2015, in which Czer took less than 30 minutes to implant the miniature sensor permanently in his pulmonary artery. "But the more I understood how beneficial it would be for me, it became a no-brainer. I want to be able to do some of the things I used to do without feeling faint."
The CardioMEMS HF System includes an implantable pulmonary artery pressure sensor, monitor and special pillow with antenna. Data is sent remotely to a secure site for physician review.
The CardioMEMS HF System, which operates without a battery, includes a portable electric unit and a special pillow containing an antenna. It is the only FDA-approved heart monitoring system proven to significantly reduce hospital admissions and improve patients' quality of life.
"This little device has shown it substantially decreases re-hospitalizations among this patient population," said Michele A. Hamilton, MD, director of the Heart Failure Program at the Smidt Heart Institute. "And we are among a select few centers in the United States to start implanting them in patients as part of a post-market study."
Heart failure is the leading cause of re-hospitalizations among patients, Hamilton said.
In Defoor's procedure, the device was fed through a catheter inserted near the top of his right thigh and fed up to the right side of his heart and into the pulmonary artery, the vessel that carries deoxygenated blood from the heart to the lungs. The procedure uses the Swan-Gantz catheter, which was invented by two Cedars-Sinai cardiologists in 1970.
"When [Defoor] came to us, he had all the symptoms for a transplant," said Czer, a cardiothoracic surgeon. "But he gained some weight, which is a disqualifying event. Now, our goal is to keep him in the best possible shape while he's making efforts to lose the weight. The advantage of this device is it allows us to keep tabs on him and manage him day-to-day and week-to-week."
That monitoring has been a welcome relief for Defoor and his wife, Peggy, who live 110 miles from Cedars-Sinai — a 2.5- to three-hour drive, depending on traffic.
"Since 2008, we've been in and out of hospitals for a pacemaker, defibrillator, ablation or something," Peggy Defoor said. "At some point, our Bakersfield cardiologist referred us to Cedars-Sinai and Mikel was getting better, although we knew he still needed a transplant. Then he gained the weight."
Heart failure occurs when the heart is unable to pump enough blood to meet the body's demands. When this occurs, pressure in the vessels of the heart and lungs increases, eventually causing congestive symptoms such as shortness of breath. Closely monitoring blood pressure and heart rate is critical in heart-failure care.
Patients can also self-monitor their condition with blood pressure cuffs and electronic scales, and provide that information to physicians. However, that data is less accurate than the data from the CardioMEMS HF System, which is sent wirelessly to a secure website, where Czer and other clinicians can monitor it.
Defoor and his wife have already seen its benefits. Nearly a week after his implant, they rented a car and drove to the East Coast for her 50th high school reunion. During the trip, the device alerted clinicians at Cedars-Sinai that pressure in Defoor's pulmonary artery was becoming elevated. Czer and his staff quickly intervened by ordering an increase in Defoor's medication to lower the pressure.
Defoor still has to deal with the challenge of losing weight, but having the device has removed some of the uncertainty for the couple.
"All I want," Peggy Defoor said, "is to worry a little less."