Written by Michael Phillips and Sarah McCloskey
Liz Moore traveled to Asheville in late 2023 to enjoy a life of freedom that once seemed out of reach.
Moore was born with a congenital heart defect, and although a surgery known as Fontan temporarily saved his life, doctors at VCU Health's Pauley Heart Center and Hume Lee Transplant Center believe that ultimately He advised me that I would need a transplant.
However, Moore's surgery was complicated by the fact that his liver was failing due to heart failure. To survive, he will need both a heart and liver transplant.
Dr. Jozu Cherry, director of heart transplant surgery who assisted in Moore's heart transplant, said the procedure is so dangerous that most transplant centers won't allow it.
“Most people don't want to take risks because it's much easier not to take risks,” Cherry said. “But on the other side of that coin, these patients have no other choice. So we need centers like Hume-Lee that are pragmatic and say yes. We know it can happen, but we are willing to take the risk and work to get the best possible outcome.”
“This is evidence of care coordination. From early detection to skilled surgical intervention to patients and their families trusting our team…it's been a long journey and a truly remarkable accomplishment. .
Dr. Keyur Shah, VCU Health Pauley Heart Center
Moore is no stranger to VCU Health, having been visiting health system providers since she was a teenager. For her dual transplant, team members from Hume Lee Transplant Center and Pauley Heart Center worked closely together to develop a plan that would give her the chance to live her best life ever.
“They encouraged me to get the transplant and they were great to work with,” Moore said. “I know there aren't that many double transplants going on every day. All the doctors are always checking on me…I'm really glad they're here.”
Dr. Aamir Khan estimates that VCU Health surgeons perform about five double transplants a year. In 2022, 79 surgeries were performed nationwide, a number that has increased over the past decade thanks to technological innovations that preserve organs while patients are transferred to the operating room.
“There are very few centers in the country that have the capacity or expertise to do heart and liver care at the same time. [transplants]''Khan said. “That's something very unique to Hume Lee.”
Additionally, there are not many centers in the United States that transplant as many patients as Hume-Lee's heart transplant program. The program is ranked in the top 20th percentile in the United States by the Organ Procurement and Transplant Network, and VCU Health's potential is endless thanks to the expertise of its team members and dedication to exceptional patient care.
“Desire to live”
Normally, the human heart has two ventricles that pump oxygenated blood to the lungs and body. Moore was born with a single ventricle. She says this prevented her from participating in activities such as gym class when she was a child.
Moore has been a patient at VCU Health since she was 15 years old and has had several surgeries here, including the Fontan procedure during her college days. This surgery is performed on patients at a very young age when her one ventricle of the heart is too small. Because only one chamber is functioning, oxygen-deficient blood flows into the body, causing many health problems. After the Fontan procedure, the single ventricle is able to pump only oxygenated blood to the lungs and body.
However, as the years pass, the effects of the corrections fade. Moore recognizes that the Fontan procedure is “a treatment, not a cure,” and that the benefits of the procedure wear off after about 15 to 20 years. She developed an arrhythmia called atrial fibrillation, or AFib for short. She also had weakness on the right and left sides of her heart.
Moore's care team at Pauley Heart Center's Adult Congenital Heart Disease Program advised her that she would need a heart transplant.
“You want to live as long as possible, and at VCU Health we have all the subspecialties needed to care for adult congenital heart disease patients,” said Sangeeta Shah, FACC, FASE, medical director of the Adult Congenital Heart Disease Program. the doctor said.
Dr. Josue Chery, director of cardiac transplant surgery at VCU Health, assisted in Liz Moore's double heart and liver transplant. (VCU Enterprise Marketing and Communications)
Moore's liver also needed to be transplanted, adding to the complications of the surgery.
“Once you start to see evidence of organ damage, in this case the liver, and more commonly the kidneys, there are things you can do to measure and estimate survival rates,” said Keyul, head of heart failure.・Dr. Shah said. at VCU Health Pauley Heart Center. “Given the multiple organs involved and the complexity of what's going on, this is something we started preparing for a long time ago.”
Professor Cherry, from the Hume-Lee Transplant Center, said surgical teams should not be hesitant to treat high-risk patients, even if it means planning for special cases like Moore, who had a heart and liver transplant at the same time. That's what he said.
On the other hand, the benefits could be transformative, he says.
“What I noticed in Mr. Moore was a desire to live,” Cherry said. “She has had multiple surgeries to fix her heart problems, and even though she had the surgery years ago, her heart continued to fail.”
Cherry said that after many conversations, the care team assured Moore that they could provide these life-saving measures, noting the importance of trust that forms between the patient and the care team.
Experts from both centers came together to conduct extensive pre-planning, and the resulting plan was sophisticated, calling for 24-hour care during and immediately after the transplant.
Living life to the fullest after double organ transplant
The surgery was not easy because of Moore's previous surgeries and the anatomy of his heart. Doctors, nurses and support staff stayed at Moore's bedside for several days to make sure his body could accept the new heart and liver.
Due to the complexity and complications of the surgery, Khan noted that the surgical site must be closely monitored for more than 24 hours.
“The post-surgery period was difficult,” he said. “And she still did it. She can't tell you how happy she was.”
While recovering in the hospital, patients and their caregivers learn about new medications, steps to stay healthy after a transplant, and important symptoms to watch for, such as fever and infections. If a transplant patient needs help, the VCU medical team is also on hand.
After recovering from surgery, Liz Moore was able to participate in her local Tacky Light Run. (Contributed by Liz Moore)
Patients are also learning to accept and live with a new normal after such major surgery. Team members hope it means patients like Moore can listen to their bodies and feel much better.
The double organ transplant dramatically improved Moore's quality of life. Now she's doing things she never imagined: traveling, exercising, and owning a foxhound.
“It was a scary experience, but it's so worth it to be able to see my family and do the things I love as a normal person after my recovery,” she said. “Of course, there are still things I have to monitor, but just being able to live my life every day is great.”
The surgery is also the latest evolution in a decades-long commitment to patients at Hume Lee Transplant Center and Pauley Heart Center, as team members pursue innovative ways to improve patient care at VCU Health. It emphasizes the unmistakable evidence that there is.
“This is evidence that care is being coordinated,” Keyur Shah said. “It has been a long journey from her early detection to skilled surgical intervention to the point where her patient and her family can trust our team and focus on her subsequent rehabilitation. , a truly remarkable achievement.”
