Monday, February 18, 2002
Getting a second heart transplant is considered unusual and controversial in the medical field.
By LAURE CIOFFI
VINDICATOR NEW CASTLE BUREAU
HILLSVILLE, Pa. -- The heart is one organ Bob Varano knows about. He should -- he's had three of them.
The 41-year-old Mount Jackson, Pa., man recently underwent a retransplant, meaning he received a second heart transplant.
"I feel good. This is the best I've felt in a couple years," said Varano, who had the surgery on Dec. 29 at The Cleveland Clinic.
An undiagnosed birth defect led to breathing problems when Varano was 30 years old. Doctors eventually found his aorta was damaged and tried to repair it with surgery.
He ended up needing a new heart after going into congestive heart failure. His first transplant was Jan. 14, 1991, at The Cleveland Clinic.
"Everything was going real good until March [2001] when I had two heart attacks," he said.
Blockage: A blockage in his aorta had developed sometime between his yearly visits to The Cleveland Clinic for checkups. Doctors again tried to repair it, but by August they realized he would need a second new heart -- something considered unusual and controversial in the medical field.
"There are outspoken opponents of this program who feel you get one chance at a heart and there are others who feel if you have a good patient whose transplanted heart fails, that patient should be evaluated for a new heart," said Dr. Robert Hobbs, cardiologist at The Cleveland Clinic and past president of the Cleveland Metro Division of the American Heart Association.
There have been few retransplants -- Varano was No. 13 -- at The Cleveland Clinic since they started doing heart transplants, he said. The hospital has performed a total of 948 heart transplants since 1984, according to the hospital.
What goes wrong: The most common reasons a person needs a second heart transplant include when the donor heart develops coronary artery disease -- Varano's problem -- and suffers many tiny heart attacks or when there is scarring on the heart and small growths develop which restrict it, Hobbs said.
A third, more rare cause for retransplantation is when a person's body immediately rejects a new heart, the doctor said. That has only happened once at The Cleveland Clinic, he said.
Cardiologists are unsure why any of those problems occur and not every heart transplant patient is affected, Hobbs said.
Retransplantation is rare, he said.
"It's not increasing in frequency, but with the limited number of donor hearts available, one has to think very carefully about retransplanting a patient," Hobbs said.
They often only consider younger patients who have taken care of themselves after their first heart transplant, Hobbs said.
Health habits: Varano is an avid weight lifter who once owned a gym, called Bessemer Barbell in the basement of the American Legion Hall on West Poland Avenue in Bessemer, Pa.
He also watched his diet and made sure he kept all appointments with his cardiologist.
"They won't just do it to anybody," Varano said of his second heart transplant. "You have to take care of yourself. If they feel you neglected taking care of this heart, they don't want to waste another one. It may sound cruel, but they want to give them to people who really want one."
Hobbs said they also factor in a person's age and quality of life after surgery before considering retransplantation.
"You always look to how well a patient is going to do afterward. Are they going to be an active, productive member of society or are they going to be confined to a rocking chair?" he said.
Varano says he's been working on getting back to his normal activities since coming home from the hospital in early January.
He spends a few hours each morning at Bessemer Barbell, where he walks on a treadmill and does stomach exercises. He's not allowed to lift weights yet, he said.
"I'm just trying to lead a normal life. ... . I do my exercising and I hang out here [at Bessemer Barbell]," he said.