MADDOW:
we begin tonight with unexpectedly major news about the health of former vice president
Dick Cheney
. An episode of acute
cardiovascular disease
last week required Mr.
Cheney
to undergo an advanced surgical procedure. Now, the nature of the
surgery
has revealed unequivocally the severity of Mr.
Cheney
`s
heart condition
. And the entire event occurred without the real-time public awareness to which we have become so accustomed when it comes to the health of major public figures. In a statement today, the
Cheney
family revealed that Mr.
Cheney
underwent
cardiac surgery
last week in a
northern Virginia
hospital to combat
congestive heart failure
.
Congestive heart failure
means the
heart
can`t pump enough
blood
to the body`s other organs. Mr.
Cheney
`s
surgery
installed a small pump, called a
left ventricular assist device
which by
battery power
helps the
heart
`s main pumping chamber pump
blood
through the body. Included in the
Cheney
family press release was a statement from the former vice president himself, which read in part, "I have dealt with
coronary artery disease
for decades. A few weeks ago, it became clear I was entering a new phase of the disease when I began experiencing increasing
congestive heart failure
. After a series of recent tests and discussions with my doctors, I decided to take advantage of one of the new technologies available and have a
left ventricular assist device
implanted.
The L
-vad is a small implantable pump that improves
heart
function and will enable me to resume an
active life
." Mr.
Cheney
has suffered
coronary disease
for more than 30 years. A minor
heart attack
as recently as February was his fifth since
1978
when he suffered his first at age 37. In late June, the former vice president was admitted to
George Washington University Hospital
in
Washington
after complaining of discomfort. That episode resulted in his receiving medication to treat a fluid buildup around his
heart
. But this latest episode is different. The installation of this
Lvad
, this
device
, it`s traditionally been a short to midterm treatment of
heart failure
, frequently used to sustain patients who require
heart
transplants. The
American Heart Association
`s website refers to this
device
as a bridge to transplant. That`s the way they put it. The
device
that Mr.
Cheney
received is being worn outside his body, like sort of a belly pack. His statement described the
surgery
as a success. He said that he is recuperating well.
NBC News
`s
Steve Handelsman
did additional reporting by speaking with a doctor involved with the former vice president`s care. That doctor told
NBC News
that
Dick Cheney
is doing well now, but that he was, quote, in
heart failure
before the
surgery
. The doctor describes Mr.
Cheney
as, quote, running on three cylinders. Now the doctor says he is running on eight.
Dick Cheney
is, of course, among the most significant and polarizing figures in modern
American politics
and policy. As always, we sincerely wish him good health tonight. To help us understand the former vice president`s current condition, Dr.
Alan Stewart
joins us now.
Dr. Stewart
is a
cardiac surgeon
and director of the
Aortic Surgery Program
at
New York Presbyterian Hospital
,
Columbia University Medical Center
.
Dr. Stewart
, thanks very much for being here.
DR. ALAN STEWART, HEART SURGEON:
Thank you for inviting me.
MADDOW:
I will guess that I got some of those basics, some of that explanation wrong. Did I get anything -- fuzz that at all?
STEWART:
Well, you had all the salient points right. A
left ventricular assist device
, this is an example of the
device
that Mr.
Cheney
has. It`s predominantly inside the body with the
battery pack
exiting through a small drive line that exits the belly. This
ventricular assist device
is quite small, as you can see, and it`s hooked up --
MADDOW:
Is this actual size?
STEWART:
That is actual size.
MADDOW:
Oh, my gosh, that doesn`t seem small.
STEWART:
It involves an inflow to the
device
, an impeller pump, which is a
rotary pump
that spins it about 8,000 to 10,000 rpms and an outflow to the body. It`s hooked up by coring a hole in the ventricle, shown here, which is a pumping chamber of the
heart
. This will be hooked up here. This pump would reside just at the top of the belly, and then would spin. It spins in a continuous manner to allow
blood
to be impelled into the aorta, which contains
blood
and which allows
blood
to be distributed to the rest of the body.
MADDOW:
So essentially a mechanical bypass to do the pumping motion that the
heart
in a healthy individual would do on its own?
STEWART:
Exactly.
MADDOW:
Okay. What are the implications for Mr.
Cheney
`s health to have this implanted? As far as I understand it, this is something that`s usually implanted on a short-term basis. Sounds like he`s intending on having it permanently in his body.
STEWART:
Well there are two options for a
ventricular assist device
. Bridge to transplant, which is a short-term
device
meaning that he would eventually get a transplant. And the reality is is that there is no indication for Mr.
Cheney
to have a transplant. The other option is that it can be something called destination therapy, meaning that this is his destination. This is his end result. He will have this
ventricular assist device
for the rest of his life.
MADDOW:
What does that mean for him, for the way he lives and his health?
STEWART:
You can have a pretty decent quality of life on a
ventricular assist device
. The devices are smaller now and they`re quite durable. This
device
could be expected to last for three to five years and then could even be changed out for another
device
.
MADDOW:
In terms of, when we were talking to you earlier about explaining what this means, one of the things you pointed out, which I think was -- it tells you an important point about how this works, is that Mr.
Cheney
won`t be expected to have, literally, a
pulse
.
STEWART:
A
pulse
. That`s true.
MADDOW:
He won`t have a
pulse
.
STEWART:
This is a continuous
ventricular assist device
, meaning that
blood
is impelled. It is not a pulsetile
device
. So if someone were to feel Mr.
Cheney
`s wrist, Mr.
Cheney
will have no
pulse
.
MADDOW:
Because it flows continuously like a garden hose instead of something that goes on and off. No
pulse
.
STEWART:
Exactly. The
normal heart
has an expansion and contraction, and that gives that bump bump, or two-beat
pulse
that we feel. It`s the valves closing. The valves will stay shut in his
heart
now and
blood
will flow in a continuous manner.
MADDOW:
Through that whirring motor that`s in the machine.
STEWART:
Correct.
MADDOW:
How common are devices like this and what does Mr.
Cheney
having one suggest to you about the seriousness of his condition?
STEWART:
Well, it means he`s at the end of his line as far as
medical care
. He had coronary
surgery
. He had percotanious stenting done. He had a pacemaker. He had medical management and failed all of those over
the course of time
. This was his last step. Either he would die of
congestive heart failure
or have a
mechanical device
inserted. It meant that he was quite ill at the time of his operation and didn`t have a long period of time to exist without a fatal event.
MADDOW:
It is shocking to hear the doctor describe him as being in
heart failure
at the time this was implanted. One last detail on this, it seems remarkable again for people who don`t know about these devices, like me, that this is worn -- part of this, the drive for this, as you say, is worn outside the body. Does Mr.
Cheney
have to wear this belly pack apparatus all the time now?
STEWART:
Absolutely. The
device
is powered by batteries, for six to eight hours outside to be untethered. And he`ll carry a number of battery packs, either in a handbag or in a harness which have become quite small and really not visible underneath the clothes. However, at nighttime, he`ll need to be hooked up into a power adapter into the wall.
MADDOW:
Wow. Without a
pulse
.
STEWART:
Without a
pulse
.
MADDOW:
The state of the technology is amazing. This is a strange way to learn it, and obviously, grave concern for Mr.
Cheney
`s health, but it`s fascinating.
Dr. Stewart
,
thank you very much
. I really appreciate your help with this.
STEWART:
Thank you.
MADDOW:
Dr.
Alan Stewart
is a
cardiac surgeon
, he`s the director of the
Aortic Surgery Program
at
New York Presbyterian Hospital
,
Columbia University Medical Center
. So
