Heart transplant team doesn’t skip a beat during COVID

The call came at 3 a.m. Allison Addis was getting a new heart. 

The rest of South Carolina had spent the month of March using its best hurricane prep know-how, attempting to prepare for something that hadn’t occurred in generations – a global pandemic. Addis had spent the month following the advice of the MUSC Health Heart Transplant team in anticipation of one day getting a new heart, as well as spending time with her ailing father, who died March 14.

She never expected the call to come so soon.

“I couldn’t believe it,” Addis said. “This was a miracle. I really felt like my daddy went to heaven to get me a heart.”

In three weeks, the 55-year-old Addis went from being listed for a heart transplant to receiving news she was about to have a new heart.

But the novel coronavirus pandemic meant things were a little different than usual at hospitals across the state. Newly implemented visitor restrictions meant that Addis would be alone. No one from her large, close-knit family would be allowed at her bedside. Instead, family members waited out the surgery at a nearby hotel.

Heart transplant coordinator Benjamin Thomas, R.N., recognized the burden these restrictions placed on both patients and families. He went to the hotel to explain the entire process to the family and answer their questions.

“Imagine our surprise when Ben Thomas, the nurse coordinator, visited us at the hotel,” said Addis’s sister Ashley Wargula. “He sat with us in the lobby for two hours and walked us through everything. It really impressed us with how he went that extra mile to make us feel comfortable.”

Thomas said he knew the coronavirus pandemic was so unusual, and the heart transplant such a big operation, that he wanted to give the family comfort any way he could.

 

That was just the start of the many ways the doctors, nurses and therapists stepped in to make this transplant journey as stress-free as possible.

“They understood the added stress of not having family by my side and did so many things on a daily basis to help get me through the recovery,” Addis said.

The nurses and her care team helped her FaceTime with family and even took videos of her walking so she could share them with her family. They spent extra time with her throughout the day, realizing how hard a heart transplant was to go through alone, especially after the loss of her father.

The compassionate care reinforced to Addis that she had made the right decision in choosing MUSC Health. As a resident of Abbeville, South Carolina, it would have been just as easy to drive to Georgia or North Carolina as to Charleston when her cardiologist told her it was time to pursue a transplant. But she had two powerful personal connections to MUSC Health. One of her sisters had had a positive experience with a different type of surgery here. And Addis had gotten to know the family of a pediatric heart patient when she granted the child’s wish through the Make-a-Wish Foundation.

“The child’s mother spoke so highly of the care her son received, the surgical expertise and how caring and kind everyone was to her family,” Addis said. “Her experience clinched my decision that MUSC was the best place for me.”

 

Addis first met with Ryan Tedford, M.D., in October 2019. Tedford is an advanced heart failure and transplant cardiologist and medical director of cardiac transplantation at MUSC Health. He's one of eight such specialized cardiologists, with a ninth slated to join the team in August, who work with three heart surgeons, with two more set to join in late summer. Despite the pandemic, he said, the transplant team has remained busy. As of June 1, the team had performed 22 adult heart transplants, compared to 26 in all of 2019.

“Symptomatic cardiac disease doesn’t wait,” agreed Marc R. Katz, M.D., chief of cardiothoracic surgery. He said there have been a few patients who have been low risk enough that procedures could be postponed, but for the most part, it’s been business as usual for the heart team.

The team has plenty of precautions in place, including rapid testing of patients for coronavirus before surgery and testing of all donor hearts before transplantation. These are in addition to the precautions that MUSC Health as a whole has implemented, like increased telehealth visits and a universal masking policy.

 

“I tell people MUSC is safer than your grocery store, with all the different precautions we have in place,” Tedford joked.

Tedford evaluated Addis’s ischemic cardiomyopathy, a condition of heart muscle weakness, most likely a result of her two previous heart attacks.

He agreed that transplantation was her best option, and after the vetting and evaluation process, she was placed on the transplant waiting list on March 2. Most patients on that list wait months for a new heart. Happily, Addis was well enough to wait at home, rather than having to be admitted to the intensive care unit.

Her general good health prior to the surgery also contributed to a quick recovery – she was discharged only eight days after surgery, rather than the usual 10 to 14 days. Katz, her surgeon, said she was able to leave the hospital so early because the surgery itself went well and because she worked at her recovery.

“She was motivated and was diligent in her activities and was really able to progress nicely,” Katz said.

Tedford also attributed her early discharge to the care of her Greenwood cardiologist, Paul E. Kim, M.D., who recognized when it was time to refer her to a transplant cardiologist.

Too often, Tedford said, patients undergo multiple hospitalizations for heart failure as their conditions worsen and their other organs grow weaker before they are finally referred for possible transplantation. At that point, they are much worse candidates than they could have been. Addis was referred early enough that she could establish a relationship with the MUSC doctors and absorb the patient education information, rather than having to be admitted directly to the ICU.

Addis had already been planning to come to Charleston on March 24 for a clinic visit when she got that middle-of-the-night phone call. It wouldn’t be a clinic visit – it would be surgery.

She and two sisters drove as fast as they could to get to MUSC. With the COVID-19 visitation restrictions newly activated, access was limited, but Addis’s family did have time to speak with the transplant team before she was admitted to the hospital. Once it was time for surgery, they had to leave and wait it out in their hotel while Katz led the transplant team through the successful seven-hour surgery.

“We were able to breath a big sigh of relief when we learned Allison was out of surgery and everything went well,” Wargula said. Although they couldn’t visit her in person, Addis’s family made sure she knew she was loved. Her son and his family drove seven hours from Tennessee to stand in front of Ashley River Tower and take a photo, just so she knew they were there.

“The staff helped me get through it all. And they helped me heal through laughter.”

Allison Addis

And then, of course, there were the somber moments when Addis was reminded that she had a new heart because someone lost his or her life and chose to give the ultimate gift. She mourned for that family the same way she mourned for her other son, who died in an accident in 2012. He also was an organ donor, and over time, she gained solace knowing others were able to live because of his gift of life, just as she hopes her donor’s family will someday feel.

“The staff helped me get through it all,” she said. “And they helped me heal through laughter.” Addis recounts the day the staff moved her from the ICU to her own room. The nurses told her she was “breaking out of there.” She had no idea where she was going as they joked with her while walking her down the hallways. Just when she got tired, they told her she should lay down and rest. Turns out she had walked herself to her new room.

“They were all so remarkable,” Addis said. “Not only did they help me heal medically, they helped me heal emotionally.”

Like all transplant patients, Addis had to remain in the Charleston area for several weeks after surgery. The first year after surgery, in particular, is filled with regular follow-up appointments. But she and other patients in the Upstate will soon be able to take advantage of a new MUSC Health clinic in Greenville dedicated to transplant care. The clinic began seeing patients through telehealth in April and will open for in-person visits in June.

Tedford said MUSC Health has put a real focus on developing and expanding its heart and vascular team. The team has had good outcomes with its transplant patients, but he pointed out that there are other options for people who don’t qualify for transplants, including left ventricular assist devices and regular clinical trials of new procedures.

Katz agreed, noting that the MUSC Health team works hard to build good relationships with physicians across the state.

“I hand my cell phone number out to all our referring docs, and they know they can call me anytime, day or night, whenever – and they do. The attitude is ‘just say yes’ to the referring docs,” Katz said.

Addis was able to return home in late May.

“I’m just so blessed,” she said.