In August 2016, Stephen Love, a professor of agriculture at the University of Idaho, suffered a massive heart attack.
Love was photographing and collecting native wildflowers in the isolated backcountry of the Frank Church-River of No Return Wilderness in Idaho when it happened.
Given the geographical isolation, it took almost 24 hours before he arrived at University of Utah Hospital to receive the lifesaving care he needed.
The incident left him severely injured with poor odds for survival and a very uncertain future.
After two weeks on various mechanical circulatory support devices, Love's cardiac team assessed him to see if he could benefit from the implantation of a left ventricular assist device (LVAD).
An LVAD is a battery-powered mechanical pump that does the work of the left heart chamber, pumping blood throughout the body. After LVAD implantation, the patient carries a battery pack that connects to the device through a power line in the abdomen.
Love's heart sustained a lot of damage from the heart attack, but his doctors believed that the right side of his heart would return to near-normal function once the left chamber was pumping blood properly.
For Love, the LVAD was the life-saving medical intervention that he needed. Once implanted, the LVAD would help him to heal and recover while he waited for a heart transplant. Without the LVAD, Love's health would rapidly decline, leading to an early death.
But given the residual severe damage to his brain and major organs of the body, it still wasn't an easy decision for Love and his family.
"The surgeons presented the LVAD implantation option and its accompanying risks to me and my wife," Love said. "It should have been an easy decision given that the only other option was an early death. But it wasn't. Ultimately, we decided it was worth the risk to take this step toward possible recovery."
Seven months after LVAD implantation, Love returned to work as a professor at the University of Idaho. A year after surgery, he considered himself adequately recovered. Although the LVAD was awkward, it proved to be remarkably effective.
"My stamina and strength improved constantly and for a period of several years, much longer than I expected," Love said. "I wore the LVAD for a total of six years, the last three of which I was able to resume hiking, camping, and my work collecting and photographing wildflowers. I could do almost anything with the LVAD that I was doing before the heart attack. I just had to make sure that every night I had access to a reliable source of electricity to charge my batteries."
Love was also able to fulfill all of his duties as a professor at the University of Idaho. He even played a little basketball with his grandkids, although he never did participate in the more aggressive pickup games he used to love.
Even still, Love made such sufficient progress that he became the poster child for University of Utah Health's LVAD team, helping other patients understand the pros and cons of wearing an LVAD.
LVAD implantation can be successful as bridge-to-transplant therapy, or as destination lifetime therapy. Bridge-to-transplant therapy is for patients who—like Love—get the device to keep them healthy and alive while they wait for a heart transplant.
For Love, the wait was longer than he anticipated. After LVAD implantation in 2016, he was told that he would have to wait up to two years for a much-needed heart transplant. "They told me it would be at least a two-year wait on the list," Love said. "But I had recovered so well that anyone in more critical condition was given priority."
During the period of time that Love had his LVAD, the rules for receiving a heart transplant were revised. More emphasis was placed on emergent patients and status designations were revised. These revisions to policies were not favorable for Love to receive a donor heart, as he was too healthy with LVAD support. Love was placed in status 4, a class of patients that almost never receive a transplant. Something had to change for him to receive a new heart. The situation did change in a dramatic way when problems with the LVAD began in late January 2022. "I began to detect strange vibrations in my upper chest," Love said. "At first, symptoms occurred infrequently and were very subtle."
In late February 2022, Love went to a routine clinic visit with the U of U Health LVAD team. He described the symptoms he was having, which by then were occurring nightly. Sometimes they were even strong enough to startle Love awake.
"The team was puzzled by these events, having never seen them in any past LVAD patients," Love said. "Nor did they seem overly concerned. So, I went home and continued my daily professional and personal activities."
A week later, Love was having lunch with his son when he experienced numbness in his left arm and severe pain in his upper back.
"Leaving half a sandwich on the table, my son and I quickly drove to the hospital," Love said. "By the time we arrived, I could no longer stand on my own. The emergency room staff quickly assembled a large team and began to work on me."
Love soon saw puzzled looks on the faces of the hospital staff.
"I had physical symptoms of a heart attack but none of the usual physiological signatures," he said. "Within a half-hour, I had returned to my usual chipper self. But the mystery deepened, and no one could explain the reason behind the incident."
Love's worsening symptoms began to express during daytime hours when they had previously been limited to nighttime.
"In April, I became concerned enough that I called the LVAD team and requested another appointment," Love said. "They set a date for the middle of May."
Unfortunately, by the end of April, the vibrations in Love's chest became so constant and severe that he had difficulty sleeping.
"I called the LVAD team and asked if I could get in to see them sooner," Love said. "They asked me how soon I could be to the hospital. I said, 'Tomorrow.'"
The next day, on April 29, 2022, Love and his wife made the drive from their home in Idaho to University Hospital in Salt Lake City.
After a clinic visit, Love was kept at the hospital overnight for observation. One night turned into four as doctors did their best to understand what was happening in Love's chest.
"One of the doctors detected a slight grinding noise in my LVAD," Love said. "But there were still no clear answers."
Omar Weaver-Pinzon, MD, cardiac director of the Hypertrophic Cardiomyopathy Program at U of U Health, surveyed cardiac units across the country searching for someone who had experience with anything that created similar symptomology.
He finally found that someone.
"Turns out the model of LVAD I was using had a slight risk of developing corrosion on the inside of the pump," Love said. "Apparently, when that happens, it throws the impeller"—the internal spinning element of the pump—"out of balance, and it begins to rub against the sides of the pump housing. Thus, the vibrations. My LVAD pump was ripe for catastrophic failure."
With a diagnosis in hand, Love's care team met to determine a course of action. On May 3, 2022, Love and his team met to discuss options.
"Actually, the number of options was one," Love said. "I was told, in essence, that I would not be leaving the hospital until I had received a heart transplant."
In the early afternoon, Love's doctors wrote a letter to the transplant board, requesting a change of status on the transplant list. By 4pm, they had news: the appeal was successful.
Just hours later, at 7pm, Love got more news.
"They found me a new heart," he said. "An amazing five hours to complete a task that often takes several weeks, even for someone at the top of the transplant list. One of the attendant nurses said she had never seen the process move so quickly and efficiently."
The next day, May 4, 2022, the donor heart arrived at the hospital. More than six years after LVAD implantation, Love finally received the heart transplant he desperately needed. The surgery was completed by Craig Selzman, MD, chief of the Division of Cardiothoracic Surgery at U of U Health.
The surgery, which lasted eight hours, was made even more difficult by the need to remove the LVAD pump, a defibrillator, the associated wires and tubes, and the titanium wires used to support Love's sternum.
Love's doctors had to trim scar tissue to create room for his new heart. His chest cavity was left open for two days to allow inspection and ensure the grafts were sound.
When Love woke up three days after surgery, he felt something he hadn't felt in six years: a strong heartbeat.
It has been nearly two months since Love's transplant. For up to six months after surgery, Love is required to be near the hospital.
"Today, I sit in a room at an extended stay motel," he said. "I am working with the heart rehab team to regain my strength and stamina. My progress is much more rapid than after LVAD insertion surgery. I attribute that to, in part, having a fully functioning heart."
In the two months since his surgery, Love has already gone on a few small hikes in the mountains east of Salt Lake City, looking for, collecting, and photographing wildflowers.
"Ironically, I am now enjoying the same activities that started this whole sequence of events in the first place," he said. "The LVAD supported my health prior to the transplant, and now I am on road to full recovery. I am humbled by the tender services of others during my trials, the caring staff at the University of Utah Hospital, my employer who showed great patience and reserved a place for my return, my family who has given unending support, my friends who have kept my spirits high, and my wife who changed bandages for six years—and with whom I have formed a deeper love than I ever thought possible."
Love's deepest gratitude extends beyond his immediate circle of friends, family, and care providers.
"I express thanks to the family members of the donor who were willing to extend the life of another by donating the organ of a lost loved one," Love said. "I hope they are finding peace in this heart-wrenching situation."