“Mommy is coming home for Christmas!”
You can almost hear squeals of delight from a toddler who couldn’t possibly understand the harrowing fight for life that her mother has survived.
Carrie Thornley Fisher was in heart failure near the end of her second pregnancy. After giving birth to a healthy boy, the 32-year-old spent nearly two months on life-saving mechanical support until she received a heart transplant Sept. 19 at UR Medicine’s Strong Memorial Hospital, upstate New York’s only comprehensive heart failure service.
“She was extremely sick, she was in cardiogenic shock, meaning her heart was very unstable,” said cardiologist Jeffrey Alexis, M.D., of UR Medicine’s Advanced Heart Failure Program. “She may not have realized how sick she was because a young person’s body can tolerate a lot and hide heart failure.”
This is the second time Fisher has escaped life-threatening illness. A decade ago she received aggressive treatment for acute lymphocytic leukemia.
“I made it through and finally going home is like a dream,” the Corfu woman said. After five months in the hospital, she is shifting from needing care, to joining husband Andrew, in providing care for 2-year-old Brooke and infant Trevor. “I have a long way to go to rebuild my strength and am grateful for my family for helping us.”
Saving two lives
Fisher’s heart problems began in early July. She was having difficulty sleeping and shortness of breath. Her obstetrician recognized the problem was serious and referred her to Strong Memorial where Heart and Vascular experts diagnosed cardiomyopathy, or a weakened heart and she was admitted to an intensive care unit. A multidisciplinary team of physicians worked together on a delivery plan that protected both mother and son through delivery.
“We wanted Carrie to have a vaginal delivery, because it would be safer for her overall health,” said Courtney Olson-Chen, M.D., of Obstetrics and Gynecology. “We had to monitor her labor closely because when women are in heart failure, even pushing during active labor can put a large strain on the heart.” The team was successful. Her son was born July 11, yet what followed was a frightening journey for Fisher.
The Advanced Heart Failure team hoped medications would help Fisher’s heart rebound after giving birth, which sometimes happens with pregnant women with weakened hearts.
“She continued to be quite unstable,” Alexis said, and the team, led by cardiac transplant surgeon Bryan Barrus, M.D., and anesthesiologist Konstantine Tzimas, M.D., quickly provided extracorporeal membrane oxygenation (ECMO), a technique that uses a machine to oxygenate the blood when the heart or lungs fail. Cardiac Surgery Chief Sunil Prasad, M.D., is an expert in this life-saving approach, which has been used on more than 100 people this year at Strong Memorial.
Prasad, the Dr. Jude S. Sauer Family Distinguished Professor in Cardiac Surgery, helped pioneer the next generation therapy, known as “walking ECMO,” using lightweight, portable devices that allow patients to walk around, which helps reduce complications and improves outcomes.
‘Time was ticking’
Fisher needed that support for nearly two months. It was a long and arduous wait as she missed her family desperately and worried about bonding with her newborn. The situation was as difficult for her husband, who balanced work and family, and the fear of whether a heart would come in time to keep the family whole.
“I focused on being as healthy as possible for when a heart came,” Fisher said. “That was my job, but it was really hard when I knew how hard it was for everyone at home.”
Time was ticking, because while ECMO saves lives, it is best used for a short period of time due to the toll it takes on the body. “We were basically battling time,” said cardiac transplant surgeon Igor Gosev, M.D., “because the longer you stay on ECMO, the more it weakens your body.”
Fisher was bed-ridden by the time a matching heart became available and the heart transplant team jumped into action. Gosev and anesthesiologist Wendy Bernstein, M.D., M.B.A., performed the transplantation surgery.
A generous organ donor provided her with a “very good heart, a strong heart,” Gosev said. “However, because she was so sick before the surgery, recovery was long for her.”
Fisher needed extensive physical therapy to rebuild strength and stamina. Her chest had healed, but she spent a month in rehabilitation before returning to her Genesee County home with a busy toddler and infant son. “Our families continue to help us and we couldn’t do this without them,” she said as a lump grew in her throat.
A double-edged sword
Fisher’s heart problems most likely stem from the chemotherapy treatment she’d received for leukemia when she was in her early 20s. While the medication stopped the blood cancer in its tracks, it was among the many chemotherapy agents known to cause damage to the heart.
Since Fisher’s treatment a decade ago, UR Medicine Heart and Vascular and the Wilmot Cancer Institute established a Cardio-Oncology Program to provide collaborative care for people with cancer who may be at risk of chemotherapy-induced cardiotoxicity.
This program is one-of-a-kind in Upstate New York and it brings oncologists and cardiologists together to effectively treat cancer with chemotherapy, while minimizing the potential impact on a patient’s heart. Led by cardio-oncologist Eugene Storozynsky, M.D., Ph.D.,the program also provides valuable follow-up care focused on the heart, to detect any changes early and minimize long-term problems.
The ultimate gift
Organ transplantation success stories like Fisher’s are not possible without the generosity of organ donors. UR Medicine has provided the gift of life to 228 people since Strong Memorial’s heart transplant program began in 2001.
New York has poor participation in its organ donor registry, ranking last among the 50 states. As a result, residents can wait months or years for a match.
According to the Finger Lakes Donor Recovery Network, the organ procurement organization affiliated with the University of Rochester Medical Center and SUNY Upstate Medical University, there are 10,000 people in the state waiting for organ transplants, including about 450 people on waiting lists for a new heart, liver, kidney or pancreas transplant at Strong Memorial.
FLDRN coordinates organ donation in 20 counties with a population of 2.4 million, serving 38 hospitals in the Finger Lakes region, central and northern New York. You can register as an organ donor online at passlifeon.org or at the Department of Health and Department of Motor Vehicles.