Nick Draper, the 7-month-old who struggled to live after receiving a transplanted heart at UCLA Medical Center last week, is improving so fast that doctors plan to sew up his chest over the next two days, his surgeon said Wednesday.
Nick's improvement was balanced by news that the condition of his twin brother, Nate, who also needs a new heart, had worsened. Doctors at UCLA plan to move Nate into an intensive care unit as he awaits a transplant.
Last Thursday, just after Nick's new heart was transplanted during a long operation, it began struggling to beat normally. Fearing that he would die, doctors kept his chest open in an almond-shaped, 4-inch-long gash as they transferred him to a heart/lung bypass machine. Over the weekend, his new heart steadily grew stronger, and he was taken off the machine Tuesday. Except for brief moments, he has been sedated since the operation.
"Now he's improving so much we're looking at getting his chest closed," said Dr. Mark Plunkett, Nick's surgeon. "Closing the chest will be a real turning point. Once we have his chest closed, we can have him wake up."
Plunkett said he planned to begin pulling the ribs in Nick's chest together today. If the baby tolerates that, the surgeon intends to completely close the chest Friday.
Doctors are increasingly worried about Nate, who also suffers from dilated cardiomyopathy, a disease that skews the heart's architecture and causes it to barely pump. Over the last week, acid levels in Nate's blood rose and he grew fussier and less hungry, signs that his condition was worsening.
Dr. Juan Alejos, the UCLA cardiologist in charge of his care, said he planned to put Nate in an intensive care ward by this evening. Alejos said that if the boy's condition keeps declining, Nate might be put on a bypass machine. That would leave few options. Babies typically can't live longer than a few weeks on the machine, meaning that he would need a transplant within that time or he would probably die.
Doctors at UCLA have long said both boys would probably need new hearts by the time they begin to walk, because by then their bodies would need better circulation. Nick received a new heart first because shortly after birth, Nate was too sick to be on the transplant list. Once Nate got better, he was eligible for a transplant, but stayed behind his brother on the list.
Even if both boys get new hearts, uncertainty will remain. The body eventually attacks a transplanted heart, recognizing the organ as foreign and rejecting it. That could happen days, months or even several years after surgery. Some children with transplanted hearts suffer fatal heart attacks. About half of pediatric heart transplant patients live a decade before their hearts are rejected and they have to go back on the transplant list.