Vern Morgan, a 78-year-old rancher from Arlee, takes pride in working his pastures, spending time with his numerous children and grandchildren, and even killing a rattlesnake or two when he comes across them.
But he wouldn’t be able to do any of that, or be in this world at all, if not for a relatively new technology at the International Heart Institute of Montana at Providence St. Patrick Hospital in Missoula.
Last year, Morgan’s heart was failing. Blockages meant his heart was only pumping a fraction of the blood it should have been.
“It was really, really, really low,” explained Dr. Dan Spoon, an interventional cardiologist at the International Heart Institute. “He’d been having heart failure symptoms for the last week or two. He’s an active guy. He ranches, he does everything there.
"But for the last number of weeks he couldn’t really do anything. He came in and we identified that he had really no blood flow to his heart. He had three blockages that were very tight.”
In fact, at one point, Morgan’s heart stopped for a total of 20 minutes, and then again for another 15 minutes.
That’s when Spoon and an entire team of doctors stepped in with what Spoon calls a “fantastic technology” called the Impella device, which in layman’s terms is a sort of pump that can be inserted via a catheterization procedure to help pump blood.
Without it, Morgan would have needed open-heart surgery, and Spoon is confident that Morgan wouldn’t have survived.
Spoon and the team conducted an angioplasty first and put a stent in Morgan’s main vessel and removed the other two blockages.
They also intubated him, which means a tube was inserted into his windpipe, while he was unconscious, to maintain an open airway. He was put on a number of blood-pressure medications.
“In a lot of those situations, it’s a very dangerous procedure because there’s very little room for error when somebody’s pumping, so they can go into a bad (heart) rhythm that we can’t get them out of,” Spoon explained. The Impella device, inserted into Morgan’s heart through a small cut just under his arm, gave doctors some breathing room.
“The Impella is nice for two reasons,” Spoon explained. “One, it allowed us to do a high-risk percutaneous (under the skin) intervention with improved pump support, because the Impella device provides 3.5 liters per minute of blood flow.
"So even if his heart stops during our procedure, if he goes into a bad arrhythmia, it gives us time to revascularize him while still perfusing his brain (supplying blood). So that’s one of the keys about this. It can make a very high-risk procedure somewhat safer by giving you a little bit of a buffer.”
The Impella also helped give Morgan time to recover.
“The other component to him was he was in heart failure,” Spoon explained. “We had to give him some time to improve. And so we left the Impella in him for six days after the procedure so we could we could wean him off blood pressure medication and give his heart a chance to regenerate some so we could successfully take this device out.”
Spoon says he has “very low confidence” that Morgan would have survived without the use of the Impella device.
“It’s a fantastic technology that we have that allows us to do other things and procedures that we wouldn’t otherwise be able to do,” Spoon said.
Now Morgan says he looks and feels much better.
"I'm doing good," he said, beaming at his daughters.
Morgan’s daughters Brenda McReynolds and Brandy Morgan were with him almost constantly while he was at the hospital. They say their dad, who graduated from Arlee High School in 1958, is nearly back to his old self.
“He killed a rattlesnake with a shovel just the other day,” Gonzalez chuckled, shaking her head at her smiling father.
Spoon said they’ve performed the procedure on more than two dozen patients, and many are elderly. He said the procedure is a “team effort,” meaning other members of the cardiac team like Dr. Mike Reed, Tod Maddux and numerous anesthesiologists, echocardiologists and other specialists help out.
“We called that team together in a 15-minute period at 8 p.m. one night to get this in (Morgan),” Spoon said. “I spent the last 15 years at the Mayo Clinic in Minnesota and just assembling a team like that, I don’t know that I would have been able to do that there that quickly. We’ve got a lot of flexibility here and a great team and that gave him every opportunity to get out of here and cause more trouble.”
Spoon said that having the technology in Missoula allows people like Morgan to save the time, trouble and money of going to Seattle. It also allowed Morgan’s two daughters to be there to help out.
“We get sent people from all over the region for these type of procedures,” Spoon said. “It’s interesting. The three interventional cardiologists, Dr. Reed, Dr. Maddux and myself, all trained at big academic centers and then came back home. We’re all from Missoula. And the big part of the reason we did is we all want to provide major academic care in the Missoula environment. And this is another tool that allows us to do that. My goal was to never have to send someone like Mr. Morgan to Seattle or Minneapolis. And to get that type of care in a community this size is pretty rare.”
On July 20-21, the International Heart Institute is hosting the 27th Rocky Mountain Valve Symposium, a conference focusing on surgical techniques and other discussion topics related to mitral valve therapies. For more information visit rockymountainvalvesymposium.org.