Despite 1000,000s of fatalities related to COVID-19, heart disease and cancer were again the leading causes of death in the U.S. last year. Now, some researchers worry that health struggles related to fighting off COVID-19, and postponed doctor visits during the pandemic, will lead to more heart deaths in the coming years.
Two prominent Milwaukee-area heart surgeons have experience with new methods to try to keep people from dying, and some ideas for the future.
Dr. Lyle Joyce and Dr. David Joyce are not only father and son, but at Froedtert and the Medical College of Wisconsin, they occasionally perform heart surgeries together.
The career of Lyle Joyce, the elder Joyce, includes serving on the surgical team that implanted the first totally artificial heart meant for long-term use — the Jarvik-7.
Lyle Joyce says not only did that 1982 operation on Seattle dentist Barney Clark have its medical challenges, but there were ones from more conservative members of the public as well.
"Some people thought that we had literally taken this guy's soul. You know the heart is the seed of the soul, and by taking this man's heart out, we just had tampered with his soul," he says.
Clark lived another 112 days after being given the artificial heart. Today, some of the sickest heart patients still receive a newer model, called the Total Artificial Heart, but that's meant as a temporary situation of up to a few years, until a heart transplant can take place.
Of course, most heart surgeries stop well short of total replacement. More common operations are for coronary artery bypasses, heart valve repair or replacement and inserting a pacemaker.
>> Listen to an interview about how COVID-19 has impacted these doctors' work
There's also been the increased use of mechanical pumps that assist heart chambers known as ventricles. While much of the focus over the years has been on helping the left ventricle, David Joyce says during the last decade, physicians have realized many need right ventricle aid as well.
He says he remembers telling an early patient that the effort was like a last ditch football play called a Hail Mary, to which, the patient responded, "'I think I should share with you that my brother is the wide receiver that caught the original pass from Roger Staubach for the Dallas Cowboys, when the name Hail Mary was invented. So, I get what you're telling me, and I want to do this.'"
David Joyce says the percutaneous right ventricular assist device, which is not implanted but is connected to the body's circulation system, has been a game changer.
Looking ahead, he expects more technological innovation in heart surgery. But David Joyce says the real opportunity is to make better use of existing resources. For example, he sees promise in a newer heart transplant method from donors whose heart is in good condition but has ceased functioning for other reasons.
"Now of course, in the past, we would have never thought about doing a transplant on a patient whose heart had stopped ... anyway. We'd do all the other organs, but we would never transplant their heart. But what we're realizing is that the reason their heart stopped wasn't because there was something wrong with their heart. There was an injury to their brain, and then when we pull the breathing tube out, then they don't have a signal delivered to their lungs that allows them to breathe and it's when they stop delivering oxygen to their body that the heart stops," he explains.
David Joyce also says COVID-19 restrictions on travel may lead to more situations where instead of a medical team flying in to remove a donated heart, the host hospital does the procurement from the deceased patient and ships the organ to where the transplant is scheduled to take place.
Lyle Joyce also sees the need for an increased emphasis on delaying heart disease, including in younger people.
"If we all live long enough, we probably will eventually see heart failure. But there's no reason we need to be seeing it in people in their 30s, 40s and 50s," he says.
So, Lyle Joyce calls for more focus on better diet, exercise, weight loss and controlling blood pressure and diabetes. His son, David, also would like to see all people have easy access to a physician anytime they want it, so doctors can diagnose possible heart problems earlier.
Equal access is already part of the national health care debate, and the COVID-19 pandemic could stoke more calls for that opportunity.
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