Baby Jesse’s New Heart Beating Steadily and Vital Signs Are Good
Baby Jesse, his new heart beating steadily and all his vital signs good, slept through most of Wednesday while doctors here issued a cautiously optimistic prognosis for the 17-day-old boy, recipient of their fifth infant-to-infant heart transplant in little more than six months.
Jesse Dean Sepulveda, the baby that Loma Linda University Medical Center initially rejected and then accepted as a transplant candidate after an outpouring of pressure from the media and the public, came through more than four hours of surgery in good condition, surgeon Leonard L. Bailey reported at a press conference Wednesday morning.
Bailey, who has performed all five infant heart transplants, said the boy was “warm and pink” and “looks better then when he went into the operating room.”
The news got better as the day wore on. Tired but happy, Jesse Sepulveda Sr., the 26-year-old air-conditioning and heating worker who less than 10 days ago was making funeral arrangements for his newborn son, told reporters just after noon that he saw his child minutes after the operation ended late Tuesday night and again early Wednesday morning.
“He looked far better than I expected and probably better than anybody expected,” Sepulveda said. “I was telling him how much I loved him when he opened his eyes.”
Dr. Bruce Branson, Loma Linda’s chief of surgery, said Wednesday afternoon that Baby Jesse’s vital signs were “secure and stable.”
There was no postoperative bleeding and Baby Jesse’s new heart was helping to clear his lungs of fluid, Branson added.
The transplant team’s immunologist, Sandra Nehlsen-Cannarella, said the crucial tissue match-up between Jesse and the donor heart also looked good.
“My feeling is that it is one of the best, if not the best, transplant match-ups we have done so far,” she said.
Nehlsen-Cannarella said all components of Jesse’s blood and the blood of the donor were compatible and that Jesse and the donor shared two of six antigens (substances on the surface of tissue that cause the recipient’s immune system to produce rejection antibodies), and partially shared a third.
“It’s a good indication that the future is fairly promising,” she said.
Baboon’s Heart
Baby Jesse’s transplant represents the latest surgical success for Bailey, who first brought the medical center to national prominence when he transplanted the heart of a baboon into an infant named Baby Fae, who died three weeks later.
Since November, Bailey has performed five infant-to-infant transplants, all on victims of hypoplastic left heart syndrome, a rare but invariably fatal birth defect. All of the patients are still surviving. In the handful of infant heart transplants done previously in the United States and England, the patients died shortly after surgery.
Though the postoperative news was good on Baby Jesse, Loma Linda doctors remained dogged by questions from the media on their controversial initial decision to reject Jesse because his young, unwed parents seemed to them incapable of providing crucial ongoing postoperative medical care. Only after the Sepulveda family’s priest and the Southern California Right to Life League took Jesse’s case to the public and after guardianship of the child was legally transferred to his paternal grandparents last week did Loma Linda accept him.
Barely an hour out of the operating room, Bailey found himself on the defensive yet again, saying he “would not change one iota” the selection committee’s criteria for a candidate. “It would be insane not to use reason and good judgment to select a family best-suited for this surgery,” he said.
Screening Process
More than 12 hours later, Branson found himself facing the same kind of questions.
He indicated that hospital officials would say little more about the selection process. “From the time of Hippocrates, some 3,000 years ago, physicians have been expected by their patients to keep their confidentiality,” Branson said. “That trust is as sacred as the confidentiality and sacredness of the confessional.”
(It is standard practice at all hospital transplant centers that each candidate for an organ transplant be carefully evaluated by a hospital committee. These evaluations typically take into account a number of social and psychological factors, including family relationships, that could affect the patient’s recovery.)
The transplant operation on Baby Jesse began at 6:25 p.m. Tuesday, less then 12 hours after the parents of a brain-dead Michigan baby, Frank Edward Clemenshaw Jr., who heard of Jesse’s plight through news reports, agreed to donate their boy’s heart to Jesse.
Anti-Rejection Drug
Jesse was treated with an anti-rejection drug and then wheeled into the operating room. By 9:30 p.m., the new heart was in place in Jesse’s chest, a hospital spokesman announced. For roughly 40 minutes, warm blood was pumped through Jesse, priming his new heart. By 9:55 p.m., the heart was working at the rate of 140 beats per minute, normal for an infant. Shortly before 11 p.m., the operation was over.
Baby Jesse’s parents, Sepulveda and Deana Binkley, 17, and their families were gathered in a nearby waiting room.
Just after the operation, Bailey entered and reported to the family that all had gone well. Shortly thereafter, two or three minutes past midnight, an exhausted Bailey, still dressed in his surgical gown, faced reporters and in a matter-of-fact, low-key way, reported “everything went smoothly” and “the new heart looks to be functioning well.”
He said Jesse will remain in the medical center’s neonatal intensive care unit for several days and on a respirator for two or three days.
Bailey said signs of rejection of the new heart could come anytime in the next three weeks but, after that period passes, Jesse may go home to his grandparents.
Responsibility then would pass to family members to make sure Jesse is given medication, is closely watched for signs of continued problems and is taken back to the medical center for outpatient treatment, Bailey said.
Neither the medical center nor Bailey will be paid for the experimental operation. Costs, Loma Linda Linda officials said, will be borne by the medical center. They are estimated at between $60,000 and $100,000.
Meanwhile, in Louisville, Ky., it was reported that the heart donation to Baby Jesse apparently bypassed another infant who has been waiting even longer.
The infant, identified only as 3-week-old Baby Calvin, is in critical condition at Kosair Children’s Hospital with hypoplastic left heart syndrome. Baby Calvin has been on the nationwide organ-donor network since May 30, which was before Baby Jesse was added.
The heart donation for Baby Jesse’s operation apparently was handled directly between hospitals, rather than through the nationwide organ-procurement network, where Baby Calvin was listed, said Nan Hamlyn, who coordinates the University of Louisville’s organ-procurement agency.
The Grand Rapids doctor who arranged to donate Baby Frank’s heart to Jesse told the Associated Press on Wednesday that Frank’s parents specifically asked that their infant’s heart be donated to Jesse.
