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Friday, November 20, 2020 - Against all odds: How talent, teamwork and technology gave one patient a new lease on life

Sheila and Tony Magee, center, reunite virtually with representatives from St. Tammany Health System and Ochsner Health, including the surgical team that saved Magee’s life. They are, clockwise from upper left, Dr. Hamid Salam, director of Cardiovascular Services at St. Tammany Health System; Ochsner nurse Desiree Hyver RFNA and Ochsner surgeon Dr. Gregory Eckholdt; St. Tammany Health System Chief Operating Officer Sharon Toups; STHS Intensive Care Nurse Jennifer Yaeger and STHS Critical Care RN Supervisor Jennifer Corcoran; Adam Cantrelle, a clinical consultant with medical device manufacturer Abiomed; STHS Assistant Vice President of Communication Melissa Hodgson; Abiomed Patient Advocacy Specialist Jamie Pernaa; and STHS Cath Lab Nurse Jenn Collins and STHS Cath Lab Nurse Practitioner Karolina Ruthner.

By Mike Scott, mscott@stph.org

Like everybody else this time of year, Tony Magee is thankful, although the list of things for which he’s thankful is a little different than those of most other people.

As exhausting as it is, he’s thankful that he gets pressed into babysitting duty for his two energetic grandchildren three days a week. He’s thankful for being able to mow his lawn. He’s thankful for a lot of things – a lot of little things.

That’s because, above all, he’s thankful to be alive – and for the surgical team at St. Tammany Health System and its partners at Ochsner Health that, through a marathon display of planning, skill and deployment of technology, rebuffed a cascading list of worst-case scenarios to make sure that he is.

“There’s a lot of this I don’t remember,” Magee said during a recent reunion with his St. Tammany and Ochsner care team, held virtually in deference to the COVID-19 pandemic. “… But I’m thankful I’m here now. I’m thankful that I’m able to carry on my life.”

Even if Magee doesn’t remember much, Dr. Hamid Salam sure does. As the medical director of Cardiovascular Services at St. Tammany Health System, he remembers every minute of it, and vividly.

“I feel like this is a celebration of life,” Dr. Salam said to Magee and wife Sheila during the reunion. “We are so excited, because at one point we thought we were not going to pull through this situation. But we are so excited to see both of you sitting here.”

Magee’s story started earlier this year when, like so many others around the world, he contracted the COVID-19 coronavirus. Although he had a pre-existing heart condition, including having undergone a heart valve replacement in 2011, he survived his bout with COVID, but his cardiologist detected what Dr. Salam called “significant dysfunction” in his old valve.

Although Magee was considered a high-risk candidate for another valve replacement, the alternative – to leave the old valve in place – was a non-starter.  

Rather than replacing his old valve through a traditional open-heart procedure, the decision was made to go with a transcatheter aortic valve replacement – or TAVR – a relatively new, minimally invasive procedure being performed at St. Tammany Health System that, barring unforeseen complications, doesn’t require a patient’s chest to be opened. That means generally quicker recovery times.

As with all TAVR patients, a full battery of diagnostic tests was conducted to identify possible complications that might crop up during surgery. Plans were put in place for the procedure, as were backup plans.

On the day of Magee’s surgery, a small army of about 20 surgeons, nurses, surgical techs and others stood at the ready to address any problems, along with an array of high-tech tools. Anticipating the possibility that Magee’s coronary could become blocked – or “occluded,” in medical parlance – by his old surgical valve, Dr. Salam and his colleagues inserted a series of wires and balloons so they would be prepared should things go sideways.

All those precautions proved to be prescient – and lifesaving.

“The valve comes in. We deliver the valve as planned,” Dr. Salam explained. “Then, suddenly, things did not go as planned. The coronary was occluded. Suddenly, the rhythm went off.”

In layman’s terms: Magee’s heart had stopped functioning.

Dr. Gregory Eckholdt, a cardiothoracic surgeon with Ochsner Health System who was part of the surgical team, remembers the room, as crowded as it was, falling silent. He’s not sure who said it, but he remembers somebody saying, “I think we need to start CPR.”

“It was almost a slow-motion kind of thing, where everybody was deciding, ‘Well, what’s up?,’” Dr. Eckholdt said. “And obviously, the guys at the table – including Dr. Salam, of course – knew this was bad.”

But as bad as it was, it wasn’t game over. Not yet.

“Now, this is really (where) the teamwork and the efficiency of this team played a major role in saving the life of Mr. Magee,” Dr. Salam said.

Thanks to the balloons that Dr. Salam and his team had the foresight to put in place earlier, they were able to re-establish blood flow to Magee’s heart quickly. The only problem was that it wasn’t enough blood flow.

After four or five minutes, another critical decision was made, Dr. Salam said.

He and his team stepped back, and Dr. Eckholdt stepped in to put Magee on a heart-lung bypass machine. The bypass machine would do the pumping for Magee’s heart, maintaining the circulation of blood and oxygen in his body.

“After that, our surgical team did their part and then the interventional cardiology team jumped in and worked on establishing the flow back in,” Dr. Salam said. “(It was) extremely difficult, but we were able to get a stent in the left coronary artery, and then we reinforced it with another stent inside that stent to get radial strength to keep the artery open.”

That took care of the left side of Magee’s heart. A transesophageal echocardiogram, however, showed that the right side was distended and not functioning properly. Turns out, there was almost no blood flow at all to that side of the heart.

“So, we worked hard to open up the right coronary and, with some of my other colleagues’ help, we were able to deliver a stent and re-establish blood flow in the right coronary,” Dr. Salam said.

Ochsner surgeon Dr. Charles Dicorte then took over to remove Magee from the bypass pump. A balloon pump was inserted to support the left side of the heart, and an Abiomed Impella device – another kind of pump – was inserted into the right ventricle, essentially bypassing the function of the heart until it could recover.

“The right-side Impella device really did the trick, and the recovery process had started and we were able to take him off the table and take him to the ICU,” Dr. Salam said.

From start to finish, the entire procedure had taken some eight hours, which Dr. Salam said speaks volumes about the dedication and tenacity of his team and his colleagues.

“I think this case would not have had the same outcome without the relentless effort and teamwork,” he said.

After about 48 hours, Magee went back into surgery to have the Impella device removed. His heart, having been given enough time to recover, began working on its own. It still is.

As with any serious heart procedure, recovery has been slow – but it has been happening, and that’s what’s important.

“Since all this, we’ve been to the beach, we’ve been able to take the kids to the state fair in Jackson, Mississippi,” Sheila Magee said. “We went trick-or-treating with them, Tony’s been back hunting once or twice. … He’s up and at it again.”

And that, according to Dr. Eckholdt, is no small thing considering all the challenges that played out – and were ultimately overcome – on that particularly long day in the operating room.

In fact, although Magee’s case is an undeniable testament to the talent and training of all of those present, as well as to the value to the community of the partnership between St. Tammany Health System and Ochsner, Dr. Eckholdt suggested that maybe something else was at work that day.

“I’ve been doing this for about 25 years, and I’ve seen some amazing things, and this ranks in the top three maybe. Maybe one,” he said. “It’s a real tribute to all the people involved – the preparation, planning and then performance. … We see some amazing things, and I think it was truly a miracle, and I don’t say that lightly.”