Andrei and Matti received similar ventricular assist devices – one of them still has it, the other has a new heart
Andrei Podgoretskii and Matti Tervonen received ventricular assist devices at HUS Heart and Lung Center almost at the same time in 2019. The same ventricular assist device is still pumping in Matti’s chest, while Andrei now has a transplanted heart. Heart surgery gave both men a new life.
For Andrei Podgoretskii, this year is a year of anniversaries, as he celebrates both a major birthday and a 4-year anniversary. He will turn 70 in the autumn, and the 4-year milestone was already reached in January.
The anniversary in January is to celebrate the new heart, which Podgoretskii received at the beginning of 2020.
His heart symptoms had already begun quite suddenly a few years before that. Podgoretskii, had been in his favorite place, the summer house in Pihlajakoski by Lake Päijänne, on his own in autumn 2017. The pain in his back was fluctuating, easing and becoming worse, and medicines did not help.
In the end, the pain was so severe that Podgoretskii asked his spouse to come and get him from the summer house and take him back home to Tampere. He felt unable to drive the two hundred kilometers himself.
On the way, the pain became so intense that the doctor's appointment he had made changed into a visit to the emergency department of Tampere University Hospital. Less than half an hour after his arrival at the emergency department, he was already in the operating room.
The examinations revealed that Podgoretskii had had a heart attack, which in fact was already a second one. He just had not recognized the first attack himself. Quite a process started from the visit to the emergency department, as Podgoretskii describes the events that followed.
“I was visiting the Tays Heart Hospital all the time. I was really swollen as a lot of fluid was accumulating in my body. Procedures were carried out once a month to ease the situation, but it didn’t help much.”
In the end, the doctors decided that Podgoretskii needed a ventricular assist device to cope until the heart transplant.
“The ventricular assist device cured everything”
In March 2019, Andrei Podgoretskii was the first Finnish person to receive a HeartMate 3 left ventricular assist device. The next one in the waiting list was Matti Tervonen from Raahe, who was in hospital at the same time. A story about the beginning of the men’s life with the ventricular assist devices was published straight after the operations.
Tervonen’s story sounds familiar: an active man whose heart problems came as a surprise. In 2010, Tervonen was skiing in Saariselkä in Lapland when he started to feel faint and had to see a doctor. The doctor sent Tervonen directly to Lapland Central Hospital in Rovaniemi, where he was diagnosed with dilated cardiomyopathy.
For almost ten years, Tervonen was trying to cope with a heart whose ability to pump was declining. He felt worse and worse year after year. In 2019, Tervonen’s treatment was transferred from Oulu to HUS as it was not possible to help him in Oulu anymore.
"As soon as I woke up after the surgery, I noticed it was easier for me to breath.”
“I was ill a lot during the last six months before getting the ventricular assist device. I had breathing difficulties and felt unwell in other ways too. The ventricular assist device cured everything. As soon as I woke up after the surgery, I noticed it was easier for me to breath,” Tervonen recalls.
Five years have now passed from the installation of the device and Tervonen has a check-up at Meilahti. The ventricular assist device has been working very well and he is not due for a heart transplant.
He currently goes to Helsinki for a follow-up appointment twice a year and has two other appointments at Oulu University Hospital, which is closer to where he lives. Tervonen has been satisfied with both the ventricular assist device and his treatment.
“The treatment has been smooth, although I have had to travel between Oulu and HUS. The treatment in Helsinki is very good, even though you might think that this is a huge institution with a lot of patients and a lot of work to do. They have taken good care of me.”
Although he is not quite as fit as he used to be, Tervonen is still physically active. He goes hunting in autumn and plays golf and goes fishing in summer. However, sauna and swimming are not allowed when a person has a ventricular assist device because the control unit and the batteries are sensitive to humidity and heat, and to cold.
“The pacemaker threw me to the ground”
The only serious incident after the ventricular assist device was installed happened in autumn 2022. Tervonen was hunting in a familiar forest in Raahe, when he had arrhythmia. Because the ventricular assist device has a defibrillator, it started his heart again.
“The jolt given by the defibrillator was so strong that it threw me to the ground. In Oulu, the remote equipment showed that I had ventricular fibrillation. The defibrillator hit four times. I was sitting on a turf waiting to see what would happen.”
"I had ventricular fibrillation. The defibrillator hit four times. I was sitting on a turf waiting to see what would happen."
Tervonen managed to call his son, who was able to direct the ambulance to get him from the forest. He has not had any problems after that.
If Tervonen lies very quietly, he can hear the clicking sound of the ventricular assist device. On the outside, the only sign of the device is the rucksack he carries with him. Inside are the batteries of the device, which he must remember to change every morning and evening. After 360 charges, the batteries are replaced.
A new heart, a new life
Podgoretskii’s life with the new ventricular assist device did not go as well as Tervonen's. The exit location of the electrical lead running from the device through the skin to the control unit became infected, which resulted in renal failure and dialysis. In short, he felt terrible.
However, the long-awaited news came less than one year after the ventricular assist device had been installed: he would get a new heart.
Podgoretskii had been celebrating New Year at the summer house with his spouse and a family they were friendly with. When the phone rang a few days later, he guessed what it was about.
“They asked me how soon I could get to the Tower Hospital in Meilahti. I said I would come as fast as I could. I booked a taxi to Kuhmoinen, which was twenty kilometers away, and quickly packed the razor and other things to take with me. I was in Helsinki just over a couple of hours later.”
"They asked me how soon I could get to Meilahti. I said I would come as fast as I could. I was in Helsinki just over a couple of hours later."
The next day, he had a new heart. Podgoretskii recalls that he was confused for a couple of days after the operation. The strong medication made him have wild dreams and visions from space to the bottom of the sea.
His recovery was slower than after the installation of the ventricular assist device, and he suffered a setback a couple of weeks after the operation. Podgoretskii remembers that he went to have a walk on the ward and suddenly woke up on the same ward that he had been on straight after the operation.
The pericardium had been filled with blood. It was discovered that the recently inserted new dialysis catheter had got directed outside the blood vessel. A new operation was required for that.
After one month in hospital, Podgoretskii was already missing home. The doctor’s order was that he had to be able to walk on his own before he could be discharged. Finally, that day came.
“The device was easier to understand than another person's heart”
Podgoretskii has been living with his new heart for just over four years. There have not been any major problems since then. Miraculously, his kidneys have also recovered, and he no longer needs the dialysis that paced his life for years.
“A new heart was a much bigger thing mentally than the ventricular assist device. It was easier to understand than an organ from another person. I don’t really think about it much anymore, but feel grateful for that person. The accident was unfortunate for them, but I was lucky,” Podgoretskii says.
Whereas a ventricular assist device restricts life to some extent, no restrictions have been imposed on the new heart.
“Nothing has been forbidden. At HUS, they said that you have a new heart now, go and do what you want!"
“Nothing has been forbidden. At HUS, they said that you have a new heart now, go and do what you want! Other complaints, such as a painful hip and my age restrict what I can do, of course. However, I don’t want another operation because I’m afraid that my kidneys would not like it again. I don’t want to go back to dialysis.”
Podgoretskii finds he has changed mentally over the years. Whether it is due to age or the illnesses, his values have softened. Ultimately, one's own life is the most important thing.
“When the situation was at its worst, I was thinking that I had many reasons to live for. Great children and grandchildren, and all the people close to me. My spouse has been an invaluable support to me.”
The pace of life has slowed down in general and the “juggling” he used to do when he was young is no longer possible.
“Before, I did everything as quickly as I could. Today, I think what’s the rush. I prefer to take my time,” he says.
The man who has been an entrepreneur all his life confesses that he has not always been a great fan of taxes. The situation is different now.
“When I saw the equipment worth millions of euros before the transplantation, I thought that the taxes we pay really go to the right place. The people treating me have been superb. Their expertise is top class, rocket science.”
"The taxes we pay really go to the right place. Their expertise is top class, rocket science.”
All heart transplantations and installations of ventricular assist devices in Finland are performed at HUS
All heart transplantations and installations of ventricular assist devices (LVADs, left ventricular assist devices) in Finland are performed at HUS Heart and Lung Center. Approximately 15–20 ventricular assist devices are installed every year. “The need for ventricular assist devices could be three or fourfold if the situation in proportion to the population is compared, for example, with the United States or Germany,” says Chief Physician, Professor Karl Lemström.
However, treatment practices vary across Finland. According to Lemström, it would be possible to perform even more of these procedures at HUS.
A ventricular assist device is suitable for persons with severe left ventricular heart failure if the right side of the heart is still functioning sufficiently well. The criteria for a patient getting a ventricular assist device are the same as for a heart transplant.
In the case of an older patient, a ventricular assist device is an alternative to a heart transplant. A ventricular assist device can also be used as a bridge for heart transplantation if the patient cannot wait any longer. A ventricular assist device is not suitable for persons with a disease causing thickening of the myocardium or if the left ventricle is small.
About 20 heart transplants per year are performed on adult patients. Considering the patient’s condition, a heart transplant can be performed on persons of any age. However, the upper age limit for a transplant is 65–70 years. A ventricular assist device can be installed even to persons older than that. The majority of those who have received a heart transplant are between 50 and 59 years.
Of these treatments, a heart transplant is the best alternative. Its use is limited by the insufficient availability of hearts that can be transplanted.
The installation of a ventricular assist device and heart transplantation are extensive open-heart surgery operations. The period of intensive care lasts between two days and a couple of weeks, and the length of hospitalization varies from a few weeks to a few months. The recovery time depends on how ill the patient is or how critical the patient’s condition was before the surgery.
The aim of the procedure is to reduce the symptoms of heart failure to the minimum and to enable the patient to be mobile and live as normally as possible. The use of a ventricular assist device requires adapting to the situation and learning, but the guidance needed is provided at the hospital. For example, the exit location of the cable from the ventricular assist device must be kept clean and the patient must take anticoagulant medication.
After a heart transplant, the patient must take antirejection drugs for the rest of their life. In spite of the risk of complications, patients have been satisfied with how comprehensively their quality of life has improved after both operations.
Specialist: Professor Karl Lemström, Chief Physician from HUS Heart and Lung Center. Lemström also coordinates the heart and lung transplantation and VAD activities at HUS.
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