Joey Wahler (Host): They can save lives. So we're discussing heart transplants. Our guest is Dr. Benjamin Mackey. He's co-Chief of the Heart and Vascular Institute and Medical Director of the Heart Transplant Program at Tampa General Hospital. This is Community Connect presented by TGH. Thanks for joining us. I'm Joey Wahler. Hi, Dr. Mackey.

Welcome.

Dr Ben Mackie: Hey Joey, how are you doing? Really appreciate you inviting me on the show today.

Joey Wahler (Host): Excellent. So first, can you explain for us, doc, in a nutshell, what the specialty of yours of advanced heart failure and transplantation is? What's it all about?

Dr Ben Mackie: you know, within medicine there's multiple different specialties And then subspecialties in. Advanced heart failure and transplant is a subspecialty within cardiology, and our clinical focus is to take care of patient's who have heart weakness or a condition that limits their heart's ability, to perform the level of work needed for people to get through their day-to-day lives.

and you know, heart failure is a very, very common problem in America. It's one of the most common cardiac diagnoses that people carry and, associated with a lot of hospitalizations and people not feeling well and things of that nature. there's a spectrum of disease within heart failure And the focus of.

my specialty is really on those patient's that have advanced end-stage heart failure and, really trying to help usher them through the different therapies that we have to prolong their life and improve their quality of life.

Joey Wahler (Host): Absolutely. So speaking of which, what in a nutshell is heart failure? What's usually going on there specifically? for those that are unfamiliar And what are some of the common causes?

Dr Ben Mackie: so heart failure, I think. People most commonly associate the term heart failure with people who have heart weakness. Meaning that, You know, your heart is a muscle And that muscle can weaken, because of, many different circumstances or conditions, which we can discuss in a little bit more detail here in a second, but.

If the heart weakens as a pump, then it's not able to pump enough blood to the body in certain cases. And when that happens, people are quite sick And we need to do something to intervene and, help the heart. Or in extreme cases, replace the heart. with heart transplantation, There are many other conditions that, can also lead to heart stiffness.

That's about half of the cases of heart failure. So we would call that heart failure with preserved ejection fraction. Where heart weakness is heart failure with reduced ejection fraction, the most common cause of heart failure with reduced ejection fraction is, coronary artery disease. Or when people have blockages in their arteries, plumbing problem with blood flow to the heart, they have heart attacks, they end up with muscular damage to the heart, And then the heart is weakened in that respect.

for heart failure with preserved ejection fraction. Those are usually patient's that have longstanding high blood pressure, diabetes, things of that nature, that over time, contribute to sifting of the heart muscle.

Joey Wahler (Host): And so what are the usual symptoms of heart failure?

Dr Ben Mackie: most commonly shortness of breath and, in many cases some fluid retention. So swelling in the legs, swelling in the abdomen, overall fatigue. But, usually the hallmark symptom would be shortness of breath, particularly with exertion. So when people are performing physical activity of any sort, they notice some limitations beyond what they would expect if they had, normal cardiovascular health.

Joey Wahler (Host): And how about some healthy habits that can decrease the chances of developing significant heart disease?

Dr Ben Mackie: So that's a great question and I will, also add that I don't think that we spend enough time focusing and discussing prevention. We spend a lot of time talking about treatment. But at the end of the day, I think the successful path forward for our patient's and our population in general is to try to prevent these things from happening in the first place.

So, heart failure is, Consequence, usually of other heart diseases. So if we take blockages, which I mentioned here recently, how do we prevent somebody from having a heart attack in the first place, which can lead to heart failure. So that's gonna be some lifestyle habits such as exercising regularly, eating well.

We usually recommend the Mediterranean diet. not smoking, not consuming large amounts of alcohol. Seeing your primary care doctor, getting your blood pressure checked, making sure That is well-controlled, having your cholesterol level checked, and making sure that Those are, within range, as per the guidelines that we have with American Heart Association.

And if you do those things and you do those things from an early age, you know, the chances that someone goes on to develop clinically significant heart disease gets decreased substantially.

Joey Wahler (Host): So let's talk transplants. You mentioned at the top of the conversation that unfortunately, heart failure is very common. How common are heart transplants in the United States and what's the usual expected survival rate for those that have one?

Dr Ben Mackie: Yeah. So if you look at all heart failure patient's, somewhere around five to maybe 7% of those patient's, would meet criteria to be labeled as truly advanced heart failure patient's. and within that patient population, transplant is, a therapy that we rely upon heavily, I would tell you it's a therapy of last resort.

we wanna make sure we've exhausted our ability to try to recover heart, strengthen those patient's to the best of our ability, and despite all of our best efforts. Patient's have progression of their disease and they reach true end-stage, heart failure and have failed all other options. And Those are patient's in whom we, consider heart transplantation.

survival post heart transplant is quite favorable. So, on average 14 to 15 years and many times longer, sometimes shorter, kind of depending on if the course was complicated or not. And some other factors, primarily immunologic factors and how adherent we're able to be to the medical regimen post-transplant, which is.

Relatively complex and extensive, from a standpoint of how common are heart transplants. So in America, every year there's four to 5,000 heart transplants done. So we do. Operate in, um, somewhat of a donor constrained environment, which, we're working through as a heart failure community, trying to find ways to have more hearts available, to help the patient's who end up needing a heart transplant.

Joey Wahler (Host): And so having said that, doctor, what's the biggest challenge? In caring for a patient that's on the waiting list, they're obviously in a vulnerable situation health-wise. What's the key to getting them through that, both physically and emotionally as well?

Dr Ben Mackie: I think first and foremost, the earlier that patient's get to us, so if, someone is labeled as having advanced heart failure by their primary cardiologist, the earlier we're involved in their care. The more likely, we are to be able to successfully usher them through their journey with heart failure.

And in those cases where patient's do end up requiring a heart transplant and do end up on the wait list, the care becomes pretty intense and is very, very hands-on at that point. About 75% of our patient's that, successfully get transplanted at some point, end up in the intensive care unit here at TGH, where we're doing, day-to-day management of those patient's to ensure that they're clinically stable, and ready to go for a heart transplant surgery at any time.

I think the second part of your, comments around what do we do to emotionally support the patient's is really important. it's really a tough journey for these patient's. They're in a life or death situation. not a lot of creature comforts here in the hospital And in the intensive care unit setting.

So as you can imagine, there's a lot of. Just, day-to-day conversations. You know, we treat these patient's, like family. We grow very close to them and I think they grow very close to us. We have teams of people that provide, emotional support. We have an integrative medicine team that comes and helps patient's, with finding some things to do to pass the time while they're waiting here, in the intensive care unit.

So it's definitely something that we focus a lot on. From an emotional standpoint,

Joey Wahler (Host): couple of other things. Any way to tell, generally speaking, roughly how long the average recipient might have to wait.

Dr Ben Mackie: Absolutely. So This is a very data-driven space as you can imagine. both from a standpoint of how long do we think someone's gonna have to wait for a heart to, how well are they gonna do afterwards? And tracking and trending multiple different data points to inform those conversations and decisions.

it's really dependent upon a number of different. So, when we do a heart transplant, there's a few things that have to happen for that to work. Few big things. One, they have to be a BO compatible. So from a blood typing standpoint, you have to have compatibility, The donor and recipient have to be immunologically compatible.

There's multiple different antibodies that we all have. some people have higher levels than other's, And we have to match those as well. And then we have to match size. So, we can't take a heart from a really, really small person and put it in a very, very large person.

It won't be able to do the amount of work required in that larger body. So based upon all of those things, we're able to calculate on average how long someone's going to wait, for a heart. At any given clinical status on the transplant list, and that can range from weeks to months, to days to weeks, depending on how those factors are coming together in each case.

Joey Wahler (Host): And in summary here, doctor, what benefits can patient's typically expect post-transplant, And what's the recovery like?

Dr Ben Mackie: the benefits are profound. it's a transformational therapy, when it goes well, which is the vast majority of the time. And these are patient's that are literally on desk doorstep, oftentimes, leading up to their transplant, and they go and have their transplant done. And when all goes well, they're usually up and walking around within 24 hours and generally out of the hospital and around two weeks.

And they feel like new people. They can breathe again. They have energy again. They can walk around without limitation. Obviously they're recovering from, complex surgery, but they're back up on their feet. And then usually within six weeks, they're driving again, doing most of what normal people do. And at three months, for the most part, we consider them to be fully healed.

And then other than, surveillance for rejection and infections and having to take their medications every day, they go on to. Live, very normal lives. there's something called the Transplant Olympics that's done every year. It's a, international type of thing. Many of these patient's go on and compete and, events that require high levels of cardiovascular fitness and, do great and feel great, and it's a really wonderful thing to see happen.

Joey Wahler (Host): Wow. So walking within a day and going home within a couple of weeks. I guess last question for you, doc. On one level, what you and yours do along these lines is, fortunately, somewhat routine nowadays, but on another, even after all these years of it being done. If you take a step back, I would imagine even for a professional like yourself, it's really pretty amazing, isn't it?

Dr Ben Mackie: absolutely. I think, the histotripsy journey of, heart transplant is, really an amazing one to read about. I think it's really a testament to, not just physicians, but scientists and many, many other people, always striving to push the boundaries of what's possible. at one point people thought this couldn't be done right?

And, We got it figured out in the early eighties and it's just improved, you know, dramatically even since then. But I think solid organ transplantation in general is just a very, very impressive feat, I think, of the medical profession.

Joey Wahler (Host): Yeah, I mean, it's really gotta still be one of the medical marvels that exists. So certainly, always interesting to hear someone like yourself that's involved in it on a daily basis. Well, folks, we trust you're now more familiar with the remarkable world, really, of heart transplants. Dr. Mackey, keep up all your.

Literally lifesaving work and thanks so much again.

Dr Ben Mackie: Thank you, Joey. I appreciate the time.

Joey Wahler (Host): Absolutely. Same here. And for more information, please do visit tg h.org. And if you enjoyed this episode, please do share it on your social media and be sure to like, subscribe and follow Community Connect presented by TGH on your favorite podcast platform. I'm Joey Wahler and thanks again for being part of Community Connect presented by TGH.