Resolute Patient and Her Committed Care Team Work Together to Overcome Advanced Heart Failure
When Saraa Basaria started having stomach problems, she wasn't too concerned. The then-34-year-old was active and generally in good health. A subsequent visit to the doctor assured her that it was probably food poisoning or a stomach bug.
But the symptoms, including struggling to keep food down, wouldn't go away. Saraa saw a series of specialists and underwent a number of tests. She even went to the Brigham and Women’s emergency room once. Nobody could figure out what was wrong.
"I went six weeks without an answer but with a very, very clear understanding that something was wrong with my body," she said. "That's a scary place to be."
As Saraa was about to learn, her heart was in terrible shape. She would soon begin a 21-month journey that would take her from the brink of death to a remarkable, lasting recovery.
'All hell broke loose'
Saraa's symptoms eventually worsened to the point that she was admitted to Brigham and Women's Faulkner Hospital for an echocardiogram. The results were alarming. "All hell broke loose," Saraa said. "A cardiology team quickly rushed in, and I heard terms like 'end stage heart failure' getting thrown around."
In fact, Saraa had the most severe form of heart failure, known as cardiogenic shock. With this condition, the heart is unable to pump enough blood to meet even minimal needs of many of the body's organs. Prompt treatment is needed to restore perfusion (blood flow to the body's organs) and prevent further deterioration so that the heart can recover without suffering end-organ damage.
Saraa was rushed via ambulance to the critical care unit (CCU) at Brigham and Women's Hospital. Under the leadership of Mass General Brigham cardiologist Robert Giugliano, MD, SCM, the critical care team consulted the Advanced Heart Failure group and got to work.
"My parents and sister were there. One of the cardiology fellows told them, 'It's worse than we thought. The next 24 hours are critical. We're not sure she's going to make it,'" Saraa recalls. "That was obviously a huge shock for my family—we had no idea it was so serious."
Exploring cardiogenic shock treatments
The first treatment for cardiogenic shock is usually medications. As Mass General Brigham cardiologist Mandeep Mehra, MD, explains, these drugs aim to "whip" the heart to improve blood pressure and overall function but only temporarily stabilize heart function.
If the heart doesn't show signs of recovery soon, though, a more intensive solution is needed. That would be Saraa's path. First, she'd have a temporary mechanical support device implanted to boost the heart's function. Within a couple years, she'd almost certainly need a heart transplant.
Fortunately, Saraa couldn't have been at a better place given her circumstances. The type of device that would be implanted in her heart was a left ventricular assist device (LVAD). For over a decade, Dr. Mehra has led a team at Mass General Brigham that has been at forefront of LVAD research. Their work played a major role in the launch of the HeartMate3™, now the primary pump in the world for supporting patients with advanced heart failure.
At first, Saraa resisted the idea of having an LVAD. But in speaking with her family—as well as cardiologists Neal Lakdawala, MD, and Erin Bohula May, MD, DPhil, along with ventricular assist device coordinator Krystin Montoya, RN—she came around.
"It was a big decision to get the LVAD, but the alternative wasn't great," Saraa said. "I later found out they told my family that I'd only have three to six weeks to live if I chose not to get it.”
A dramatic turnaround
Saraa had the LVAD procedure at Brigham and Women's. "It was shocking how significantly better I felt afterwards even though I'd just had open heart surgery," she said. "It was in those moments that I realized how badly I'd been feeling while I was in the CCU with a severely failing heart."
Over the next two weeks, Saraa's care team prepared her and her family for life at home with an LVAD. The device requires a lot of attention. The battery pack and controller are located outside the body and connect to the LVAD via a driveline (wire) sticking out of the skin. The dressings covering this area must be kept clean to avoid infection. The patient must also remember to keep the battery pack charged and carry a backup unit at all times.
Since Saraa was living alone, her mother and sister received training on LVAD maintenance and troubleshooting. Her mother and father even moved in with her for a few months.
As Dr. Mehra says, caring for an LVAD patient requires a substantial infrastructure and multidisciplinary expertise. It's not as simple as taking a device off the shelf and putting it in the patient. In general, only academic medical centers like Brigham and Women's and Massachusetts General Hospital are capable of managing patients like Saraa.
"It really takes a village," Dr. Mehra said. "The Advanced Heart Failure team engages with patients and their families on education. A psychologist talks with the patient and their family. Social workers, dietitians, physical therapists, and infectious disease specialists are involved as well. Hematologists work with the rest of the team to develop care plans that are very, very complex and difficult to manage."
Learn more about or contact Mass General Brigham Heart services
Lifestyle changes promote LVAD recovery
After returning home, Saraa adopted a low-sodium diet, as too much salt is bad for the heart, and gradually ramped up her exercise. Soon after, she embraced yoga, which has had both physical and emotional benefits.
With the help of her multidisciplinary care team, Saraa also shed 85 pounds over a 20-month period. The weight loss, combined with her commitment to sticking to her care plans and caring for her LVAD, reduced the stress on her heart and promoted healing.
"From the moment I got my LVAD, I've been extremely aware of how lucky I am," she said. "It was like something flipped in me; I had such a deep desire to live and to take advantage of the gift I'd been given."
About five months after surgery, Saraa was able to return to work. While she was regaining some sense of normalcy, a large shadow still loomed: An LVAD is meant to be a bridge to a heart transplant. Sooner or later, she'd need a new heart to survive long term.
