Man's heart one of few to improve with left ventricular assist device

Two years ago, on a family skiing trip to Colorado, Toby Wise was struggling to keep up.

Wise, 45, had always been in good health, played football in high school and played in a softball league and a flag football league as an adult. He worked out three to five days a week.

By May 2021, though, Wise had learned that his heart was enlarged and failing. He had a leaking mitral valve that doctors had been watching and an irregular heartbeat — atrial fibrillation.

"His heart was tiring out," said Dr. Jerome Thomas, explaining that Wise wasn't getting enough blood flow, which affected his organs.

But with treatment from his medical team in Heart Hospital of Austin's Advanced Heart Failure program, Wise survived heart failure by using a left ventricular assist device, which did the pumping for his heart for almost two years, until his heart could take over again.

Wise is one of only 1% to 2% of patients who receive an LVAD and whose heart recovers from heart failure so that they can be taken off the LVAD, according to the Journal of Heart and Lung Transplantation. Most patients with an LVAD either stay on the device, which can last seven to 10 years before needing to be replaced, or it becomes the bridge until they receive a heart transplant.

Wise's goal was to be healthy again to toss a football to his son, Rees.

Wise had always been at every practice, every game for both kids: Rees, a sophomore high school quarterback, and Taylor, a junior at Texas Tech who played softball in high school.

Making the decision to go to an LVAD

When Wise first came into the hospital, it was to have an ablation to his heart — a procedure to improve his atrial fibrillation. After that procedure, his heart rate remained high for a month. The cardiologists performed a cardioversion, which shocks the heart back into rhythm.

When he awoke from that procedure, his vitals were crashing. He returned to the operating room, where doctors inserted a balloon pump into his heart to increase blood flow to the heart.

Wise remembers thinking: "This is it. It's real. Prepare for the end."

The balloon pump was not a permanent fix. Wise wouldn't be able to leave the hospital with it. Instead, the team began discussing with the family two options: remain hospitalized and wait for a heart transplant or have the LVAD inserted and be discharged while waiting for a heart transplant.

The Wises chose the LVAD.

"We have a family, and we wanted him home," his wife, Amber, said.

An LVAD sits at the bottom of the heart and pumps for the left ventricle. A tube from the LVAD carries blood to the aorta. The LVAD runs on external batteries that are connected to the pump through a driveline that goes from the pump to a hole in the belly. Outside the body, the driveline connects to a controller, which connects to a battery pack. The batteries last about 16 to 18 hours.

Doctors said once the LVAD took over the work of the left ventricle, the heart would have time to rest and could improve, but that is rare.

"I know what to pray for," Amber Wise remembers thinking.

Life with an LVAD

Toby Wise stayed in the hospital another month while his body adjusted to the LVAD.

"It was definitely a life-changer," he said.

Within a day, he was up and walking.

The day he came home, as they got closer to their house, "I started bawling," Wise said. "I made it."

By the end of July 2021, two months after his heart scare, Wise had returned to work in sales and marketing for a general contractor.

He said he was grateful for the LVAD but did not like always being connected to the batteries and controller. At night, he had to be plugged into the wall, and he was always charging batteries. He was careful when showering and couldn't go for a swim in a pool or the lake.

The Wises tried several ways to carry the batteries and controller. Most people carry everything in a backpack. That wasn't Toby's style. They thought of converting a fishing vest or creating a wearable holder.

The Wises then found a man of a similar age on a Facebook site for people with LVADs. He suggested buying football tights. They have pockets big enough for the batteries and the controller. It meant that Toby Wise had to wear baggy shorts or pants to fit on top of the tights with all the LVAD accouterments in them.

Wise's football pants system often confused the cardiac staff.

"Where's your batteries? Where's your controller?" they asked.

"They look at me and shake their heads," he said. "I got to keep them on their toes."

"He just looked like a regular guy," Thomas said. "I would pay you money if you can tell he had an LVAD."

The possibility of life without an LVAD

For the next year, Thomas checked Wise's blood levels to see how his organs functioned and examined his heart through ultrasounds and catheters. They began to increase his medication and turn down the LVAD to see if his heart function improved.

Soon every test showed that "his heart function was just fine," Thomas said. Wise's heart, instead of being enlarged, shrank to a normal size.

The team began talking about decommissioning the LVAD or removing it eventually.

Before they could consider discontinuing the LVAD, doctors had to fix the leaky mitral valve by replacing it or putting a clip on it to help it close and stop leaking. Dr. Jonathan Yang, the cardiac surgeon who treated Wise, chose the clip, and the subsequent procedure stopped the leak.

A month later, on May 8, Yang was ready to decommission the LVAD, which required heart surgery to remove some connections. The LVAD would remain at the bottom of the heart but no longer help pump it.

Yang performed the surgery by making a small slit between Wise's ribs, instead of cracking open his chest.

This less invasive decommissioning, Yang said, "saves a lot of risks."

A stronger heart

While Wise's heart isn't that of a normal 45-year-old, Yang expects he will have "solid heart function."

"He will continue to live his active life free of symptoms for 10-plus years," Yang said. "I wouldn't be surprised if it's longer than that because we've addressed the underlying issue that caused his heart to fail."

Wise is recovering well. He has a small heart flutter that will be fixed with another cardioversion.

He's looking forward to getting out on the lake on the Sea-Doo. He has three golf courses he wants to play. Next winter, he's hoping to ski again.

"I'm looking forward to working out and playing sports and being the old me," Wise said.