Former vice president Dick Cheney, at 71, who has survived five heart attacks and years of heart failure, is recuperating in intensive care at a Northern Virginia hospital after undergoing a heart transplant Saturday. He had been on the waiting list for 20 months.
Cheney is not the oldest person to receive a heart transplant, say experts who note that older people today are more likely to be healthy enough to benefit.
Mr. Cheney could stay in the hospital for about another week, barring any complications, as doctors work to get the donor heart acclimated to his body, medical experts said. After that, patients tend to continue their recovery at home, usually taking treatments to prevent rejection and fend off infections. “The critical adjustment period is the first three months,” said Robert Michler, surgeon-in-chief at Montefiore Einstein Center in New York, who isn't connected to Mr. Cheney's case.
Prominent cardiologist Eric Topol, who consulted on Cheney's care during his first run for vice president, said that people Cheney's age “don't generally do so well” after a heart transplant. “I wish him well,” said Topol, chief academic officer at Scripps Translational Science Institute in La Jolla, Calif. But he added, “We have a profound shortage of hearts for transplantation. …It's not that he shouldn't get a transplant; it's a question of 'Who didn't get one?'”
“This has been discussed since the beginning of transplantation: How old is too old?” said Gregory Fontana, chair of cardiothoracic surgery at Lenox Hill Hospital in New York City. Mary Norine Walsh, medical director of cardiac transplantation at St. Vincent Hospital in Indianapolis explained that rather than age, doctors consider a patient's overall health. Doctors won't give a transplant to a patient who has significant health issues other than heart disease, such as cancer. She added that the waiting time for a heart transplant varies based on a patient's body size and blood type, which must match the donor. Fontana noted that wait times for organ transplants vary greatly from region to region.
At Inova, only two out of 19 heart recipients last year were over the age of 64. The previous year, the hospital had only one recipient in that age range, according to the United Network for Organ Sharing, an independent agency that manages the U.S. organ transplant system for the federal government and collects national transplant data. UNOS spokesman Joel Newman said the age of recipients is increasing due to advances in cardiovascular technology.
From the information made public, it doesn't appear that Cheney jumped the line to get a transplant sooner than anyone else, said Walsh, who has no personal knowledge of Cheney's current case. For a man in Cheney's condition, 20 months on a transplant list “is a fairly long waiting time,” Walsh said. In terms of urgency, Cheney would have been considered “moderate,” Walsh said, because he had been living with a left ventricular assist device, or LVAD, since 2010. These implanted devices help to pump blood in patients such as Cheney, who have end-stage heart failure, a condition in which the heart has been weakened by heart attacks or other issues. Fewer heart failure patients today die waiting for a transplant because of LVADs, Walsh said.
“He's obviously received superb care,” said Dr. James Kirklin, director of cardiothoracic surgery at the University of Alabama at Birmingham and a recent past president of the International Society of Heart & Lung Transplantation. “He's an elderly man who likely has taken very, very good care of himself to be in this good shape at age 71. It appears that he has been relatively lucky to have avoided major organ problems that would have precluded a transplant,” said Kirklin, who is not treating Cheney. “Dick Cheney's overall risk would probably be a bit higher than a 60-year-old, but the most important thing would be the function of his organs, which we analyze in great detail.”
Dr. Valluvan Jeevanandam, chief of cardio-thoracic surgery at the University of Chicago Medical Center, said his hospital has been doing transplants on increasingly older patients. “They're not that different. The key is co-morbidities,” he said, referring to other chronic conditions that affect the health of the transplant recipient. Jeevanandam said a 71-old-year-old man has a 10-year survival rate of 60 percent to 65 percent. “I can't predict how Cheney will do,” he said.
About 5 million Americans have heart failure, and an estimated 400,000 to 700,000 new cases of heart failure are diagnosed each year, according to the Heart Failure Society of America.
Integrating social determinants of health to enhance heart failure risk prediction