Advanced Heart Failure/Transplant Program
The Houston VA has a comprehensive disease management program for Veterans with heart failure, with the goal improving survival and quality of life.
Surgical Options for advanced heart failure are Heart Transplant and Mechanical Circulatory Support or Left Ventricular Assist Device (LVAD).
- Heart Transplantation – your heart is replaced with a new one
- Mechanical Circulatory Support or Left Ventricular Assist Device - a pump is placed in your heart to add to what your heart can do, often replacing the function of your heart entirely. An LVAD can be put in to allow you to wait for a transplant; or it can be a durable, or destination device if a transplant is not an appropriate option for you.
The evaluation is essentially the same for Transplant and LVAD. The medical team may know early on that you may not be a candidate for one option or the other. But often we do not know which option might be the most appropriate until well into the evaluation process.
To ensure that you will be a good candidate for surgery many tests must be done. We must be certain that it is your heart that is making you sick enough to require either a transplant or LVAD. This is done by asking you many questions about your past medical and surgical history, performing a physical examination, and special tests. We will also ask you about having a support person or persons, as this is important to your health and success with either a transplant or an LVAD.
We understand that you may have many questions, and even uncertainty about what to do next. The Houston Heart Initiative has a team of specialists to work with you and to help you with this important decision.
Meet our Team
Dr. Savitri Fedson and Dr. Steve Antoine are the transplant cardiologists. One of them will be responsible for providing medical care before and after your transplant. They will consult with your referring doctors and assist in your management prior to transplant in an effort to keep you in the best possible shape before your operation.
After your transplant, they will monitor your health and examine you at your clinic visits. They will review biopsy results and lab tests and adjust your immunosuppression as necessary. Either they or the transplant staff should approve all changes in any of your medications after transplant or addition of any medications.
Dr. Alexis Shafii and Dr. Alex Schutz are the transplant surgeons. They are responsible for the actual operation and everything that goes along with it. You will meet them prior to your transplant. Right after the operation, you will be under the care of the cardiac surgery team.
Nurse Transplant Coordinators
Rechel G. Delantar, FNP, Elsa Abraham ,RN, and Roby Philips, RN, are the nurse transplant coordinators. They are responsible for ensuring that all the transplant workup is completed. They coordinate the surgical team and assist in follow-up along with your cardiologist. They make sure you receive appropriate education before your discharge, arrange your clinic visits and tests after transplant, including biopsies.
One of them will be your primary contact person after you go home. They may see you in clinic in the absence of your cardiologist. They will phone you with changes in your medications or with test results.
Left Ventricular Assist Device (LVAD) Coordinators
Erwin Bedia APN, Verna Deinla RN and Jocelyn Revilla RN, are the left ventricular assist device (LVAD) coordinators. They also help with the management of transplant patients and assist the cardiologists in the care of your heart failure before and after transplant.
Although you will be assigned to a particular transplant coordinator during your workup process, any of the coordinators may call you with updates and information. If there is an emergency or you have questions, you should contact either your cardiologist or your coordinator, as either one will be able to assist you.
Dr. Kimberly Usher is the transplant psychologist. She works with the team to help address additional mental health needs and services that you may require. She is also able to help with counselling and therapy to cope with some of the stressors related to having heart failure and needing a heart transplant.
Dr. Mauro Garcia-Altieri is a transplant psychiatrist who also works with our team to help Veterans with their mental health needs.
Palliative Care Specialist
Dr. Leanne Jackson is a palliative care specialist. Palliative care is a type of care that focuses on the symptoms and burdens of disease. These specialists work alongside us to help make sure that your goals and preferences are met and that we address them. She and her team may discuss difficult topics with you and your family. You should feel free to talk about these issues or any other concerns with any member of our heart team.
Aarti Gajjar PT,DPT is an exercise physiologist who will be your physical therapist before and after your surgery. You will meet her in clinic where she will assess any needs you have for physical therapy and provide you with an “exercise prescription” if needed. She will follow you when you are in the hospital and work with you to regain your strength and independence as soon as possible. She will help determine whether you will need to go to an inpatient rehabilitation center following your surgery, or whether you can be directly discharged home.
Transplant/Heart Failure Dietician
Shelley Eitel MS, RD the transplant/heart failure dietician. She will meet with you as part of your evaluation and will follow along with you as part of your care team. Her input is important not only if we need to help you maintain a healthy weight, but also to make sure that you are getting the proper nutrients to help with wound healing and operative recovery.
Clinical Social Worker
Sheila Joseph LCSW, is the clinical social worker with our program. She will meet with you and your family to take a complete psychosocial history. The purpose of psychosocial assessment is to see if there are any areas of psychological/emotional support we can offer to you; or to determine if referral and linkage to community resources are needed throughout transplant.
The resources could include Medicare, Medicaid, Social Security Disability, patient assistance programs in addition to the VA benefits you receive. She can be an advocate for you in dealing with numerous agencies that could provide you with services pre - and post- transplant, working with your home VA and your primary care social worker. She will also facilitate the support group for all candidates and recipients and their families.
Clinical Pharmacist Practitioner
William Kuan, PharmD, BCPS, BCCP is a clinical pharmacist practitioner at the Michael E. DeBakey Houston Veterans Affairs Medical Center. He completed his PharmD degree at Rutgers University Ernest Mario School of Pharmacy, followed by his general pharmacy residency at New York Methodist Hospital and Cardiology pharmacy residency at Loma Linda University Health. Prior to joining the team at Michael E. DeBakey Houston Veterans Affairs Medical Center, he spent a little over 6 years at the University of Kentucky providing pharmacological expertise in the service with advanced heart failure, LVAD, and heart transplant patients. His clinical interests consist of heart failure pharmacotherapy, antibody mediated rejection, desensitization, and anticoagulation.
Program Support Administrator
Monique Burnette is our heart transplant program support administrator. She may be the first point of contact for you and your local doctors to coordinate services at MEDVAMC. She will schedule your workup tests, educational meetings with transplant team, and consultations with doctors. She will inform your upcoming appointments via phone/by mail. She will also contact other hospitals to request for your medical records, so the team has necessary clinical information for patient care.
Cardiovascular Intensive Care Unit Team
Dr. Mastian Chand and Dr. Javier Finkielman are critical care physicians who will help manage you while you are in the intensive care unit. This will be following your surgery, but may be before it as well. They work with closely with the transplant cardiologists and surgeons.
Andre’lyn Williams, PA and Michael Sheehan, NP are members of the surgical team who will follow you after your surgery in the intensive care unit and on the surgical floor. They may also see you in clinic and help with removal of surgical staples and drain.