For Judy Riede and her husband, life was an adventure. As they got closer to retirement age, they decided they wanted to live somewhere with abundant fishing and skiing but still in the vicinity of an airport for her husband to do some consulting work now and then. They settled in Star Valley, Wyoming, and have called the place home for more than 20 years.
The couple and their two border collie mix dogs were activefishing the stream that runs through their ranch property, going on daily walks, skiing, cycling, hiking, and traveling. At 81 years old, and after surviving breast cancer twicewith 25 years between diagnosesJudy was focused on making the most of the time she had left with her husband.
While oncology treatment did succeed in getting her cancer in remission, it also came with some potential long-term consequences. Doctors recommended chemotherapy after her second diagnosis, including a highly toxic drug with known side effects that can damage a patients heart. At the time her doctors did not recommend any baseline or follow-up tests to check heart function, but she suspects that treatment may have contributed to her recent heart problems.
Alarming Symptoms
Judy first noticed issues with her health when she visited Michigan in 2021 for her moms 100th birthday celebration. Despite living at an elevation over 6,000 feet, she was short of breath hiking near sea level. She talked to her doctor upon returning home and started heart medication, but that made her blood pressure dip dangerously low and she had to cut back on the medication.
In September 2024 Judy and her husband planned a trip to Wales with a cousin. Just before leaving, Judy came down with bronchitis and struggled the entire trip with low energy and difficulty breathing. When she returned and still didnt feel well, she went to an urgent care, where they diagnosed her with COVID. She had a short hospital stay where they checked her heart, and the left ventricle function was only about 15% of normal levels. She made an appointment with her cardiologist in Star Valley, who diagnosed Judy with low heart function and eventually referred her to a cardiologist at 泫圖弝け of Utah 泫圖弝け in Salt Lake City.
I wasnt feeling too awful prior to that, but starting around November I was going downhill rapidly, Judy said. At an appointment with her primary care team on Christmas Eve, the doctor told her she may have just a few months to live. Judy moved up her appointment with the cardiology team at U of U 泫圖弝け to January 8 because her heart was in such rapid decline. When she arrived for the appointment, conversations with the doctors centered around palliative care or hospice, and she was admitted to the hospital.
Last Chances and a New Option
One option they presented was a medication called dobutamine, which strengthens the heart muscle and improves blood flow. Its generally a last resort for patients when other heart medications dont work, and not something patients take for the long term. Judy thought it might give her enough time to take a final vacation to Sedona, Arizona, and get her affairs in order.
We called the medication jet fuel because it immediately made me feel better, Judy said. I finally had my appetite back, and pretty soon I was doing laps around the hospital corridors. Despite her improvement, Judy learned she wouldnt be able to travel while taking dobutamine and was resigned to continue with the palliative care.
But doctors noticed her improvement and energy and thought she might be a candidate for a left ventricular assist device (LVAD). There was a trial underway at U of U 泫圖弝け for a new mechanical circulatory support device called The multidisciplinary advanced heart failure team agreed she should consider the trial, as did Craig Selzman, MD, Surgical Director of the Cardiac Mechanical Support and Heart Transplant program and Chief of the Division of Cardiothoracic Surgery at the 泫圖弝け of Utah. Dr. Selzman would eventually be the surgeon to perform Judys BrioVAD procedure.
BrioVAD is a new type of left ventricular assist device, or LVAD, Dr. Selzman said. There were a lot of advances in mechanical circulatory support devices in the late 1990s and early 2000s, but in the last decade, there has only been one main device for patients and providers to utilize. That current device works well, but with no competition there is little incentive for major innovation.
LVADs are surgically implanted metal devices that help pump blood through the heart when the left ventricle cant do that well on its own. They also have a controllera small computer that operates the deviceand a battery supply to keep the device pumping. The latter two components are outside of the persons body, connected to the metal tube with a driveline that goes through a small opening in the patients upper abdomen.
As a new device, the BrioVAD must undergo rigorous testing through the U.S. Food and Drug Administration (FDA) to demonstrate efficacy and safety. Currently, its in the early stages of those trials, with a small number of hospitals selected to participate. Once complete, the FDA will evaluate the results of the initial trial to determine if it is safe enough to conduct a larger trial at more surgical facilities nationwide.
LVADs are generally for patients in a late stage of heart failure, Dr. Selzman says. For some patients, it is a bridge treatment to keep their heart working while awaiting a heart transplant. For others, it can deliver better quality of life for several months or years after heart function declines. In either case, the devices are not something that most patients want, and they can be challenging to manage with all the components and care required.
The potential downsides of the implanted devicenamely, having two external components she would have to tote around all the time and an open wound where the driveline went into her bodywere enough to make Judy unsure about whether to move ahead.
It looked pretty uncomfortable and unwieldy to carry the stuff around, Judy said. She was leaning away from participation in the trial, but then met Steve, another patient who had recently undergone surgery for an LVAD. He was the same age as me and was really enthusiastic about how much the device had improved his life, she said.
As Judy considered her options, she recalled a conversation with the teenage son of some friends. He asked what she had to lose by just taking the tests to see if she was eligible. Between that conversation and Steves endorsement, I figured it was worth the effort to at least get the testing done, she said. I also thought that if I didnt make it much longer, at least doing this experiment might help someone else.
Every clinical trial has a very prescriptive set of inclusion and exclusion criteria, Dr. Selzman said. We screen patients who might be eligible, but only about one in five make it through to actually participate. In addition to the clinical trial screening, the team at U of U 泫圖弝け also examines factors like whether a patient is likely to be compliant with their medications after surgery, and whether they have the right level of support to care for them following these intensive procedures. This ensures that every patient will have the best chance at a good long-term outcome.
The tests revealed she was eligible, but Judy still had not decided whether to move ahead with the trial, and her condition was worsening. Doctors originally thought she might be able to take dobutamine for anywhere from two months to a year or more, but it stopped working within a week. Judy was rushed into surgery to get a balloon that would keep her heart pumping, and she and her husband had to decide that afternoon whether to move forward with the LVAD trial.
She decided to do it and was selected as the third patient in the U.S. to get the new device implanted (the trial also includes a control group of patients who get a conventional LVAD device). On January 20, less than two weeks after being admitted to the hospital for heart failure, she went in for surgery to get a BrioVAD.
The approach we take with each [LVAD surgery] patient will be specific to their situation, Dr. Selzman said. For Judy, that was an open-heart procedure to place a metal tube in her heart, which is pretty straightforward, but there are still a lot of unknowns.
For example, a surgeon doesnt know how well the patients right ventricle is working, how other organs in the patients body will react, or whether the patient will be at higher risk for stroke or bleeding that can occur in open heart surgeries. All of these can complicate the surgery and recovery. Judys procedure went well, although she did have some bleeding and had to have that repaired with a second surgery a day later.
Moving Forward With Hope
She moved out of the ICU within a few days and was discharged from the hospital on February 5. Her husband rented a place to live in Salt Lake City near the hospital to stay as she attended follow-up appointments and physical therapy. So far, the device is working well. Her physical therapists and doctors have expressed pleasant surprise at how quickly she is recovering, and Judy and her husband returned to Star Valley in late April.
As Judy expected, the device has taken some getting used to. Particularly challenging is figuring out how to accommodate the driveline coming out of her body without specialized clothing, along with finding a suitable way to carry around the controller and battery pack. Leaving the house also entails a lot more planning, since she must always have one or more spare batteries to keep the BrioVAD motor running. She and her husband havent traveled yet, but she did inquire about it and learned that getting through airport security with one of these devices requires a lot of extra time, documentation, and advance planning.
But those hassles pale in comparison to the opportunity to continue living the life Judy and her husband have come to enjoy.
The whole situation was strange, because I knew that I was dying and I had accepted that when doctors told me I only had a couple months to live, but I never felt like it was actually going to happen, she said. Now I feel very optimistic about the future. I can continue to do things I love like hiking and walking the dogs, and work on projects that I thought would just be abandoned when I was gone. And we still want to go to Sedona.
The whole U of U 泫圖弝け team has been completely awesome, with wonderful nurses and doctors, Judy said. I cannot give enough praise to that team for the great care I received, and I dont think I would have made it this far if I had treatment from anywhere else.