Laughing, grabbing his mother's hair and kicking his legs wildly - Chace Campsall is, in many ways, like any other 10-month-old. However, for all his precocious energy, trouble lies under the base of a pair of tubes protruding from his tiny belly. His heart is weak and two times too big.
A decade ago, it might have been a death sentence. But Chace, who suffers from a rare heart defect known as dilated cardiomyopathy, relies on a mechanical heart to live as he awaits a transplant. "If he didn't go on this [mechanical heart] he would be dead," his mother Christa Campsall, 37, says, sitting beside the purring blue machine that looks like a small shopping cart, attached to the tubes. "Without a second thought."
Introduced in Canada six years ago, the EXCOR pediatric ventricular assist device, or "Berlin Heart," has proven to be a game-changer, doctors say. The EXCOR device (it stands for extracorporeal, outside the body) allows children on the transplant list to play, eat and sleep normally for months on end as they wait for an organ from a small and shrinking pool of donors.
In a country as spread out and thinly populated as Canada, the rare procedure is only done regularly at two hospitals - Edmonton's Stollery Children's Hospital, where Chace, who hails from Victoria, has spent the past four months, and Toronto's Hospital for Sick Children.
Now a third hospital appears to want in.
The B.C. Children's Hospital has an extensive pediatric open-heart surgery program, performing about 170 operations a year. But, interested in performing pediatric heart transplants and installing Berlin Hearts, the Vancouver hospital has recruited Sanjiv Gandhi, one of the United States' top Berlin Heart experts, from the St. Louis Children's Hospital. He will start in July. (A hospital spokeswoman would only say there is "no immediate plan" for such an expansion.)
On the face of it, a third centre is a positive step. It would bring the procedure to another part of the country, so that heart-transplant patients and their families would not have to travel at great expense to one of the two pediatric hospitals that act as de facto regional hubs. (It would also provide an alternative to Toronto, a city that Western Canadians do not precisely warm to. "I can't imagine going to Toronto. That'd be crazy," says Alberta mother Jessica Seely, whose son is recovering from a heart transplant at the Stollery.)
However, there is only a small pool of talent in Canada who perform the Berlin procedures. If the B.C. hospital recruits from within Canada, that raises a question for parents whose children may require a transplant: Can that pool of international talent be divvied without diminishing the level of care?
"We have right now, in Toronto and Edmonton, two programs with extremely good results," says Holger Buchholz of Edmonton's Stollery, carefully. "It's the high-end stage of pediatric cardiology medicine. You need an extremely good team, a team of pros."
Toronto developed its program first, sending staff to Germany in 2004 for training. Scrappy, small-scale Stollery, part of the University of Alberta hospital, expanded aggressively into the technology soon after, poaching Sick Kids staff and hiring Dr. Buchholz, a cardiac surgeon, who had worked with the technology's rollout in its namesake city. In 2006, the Stollery became North America's first Berlin Heart training centre.
Stollery and Sick Kids have since divided (somewhat acrimoniously) the relatively small pool of high-level talent required for the advanced medical treatment, giving Canada two world-class centres for the technology.
"I hope, with a third program in Vancouver, we can keep results as good as they are," Dr. Buchholz says.
Anne Dipchand, the head of Sick Kids' heart transplant program, is confident the three can co-exist peacefully. "The bottom line is that it would be best for the patients and, if done with the appropriate resources and infrastructure, I have no doubt that Vancouver could have a solid heart failure and heart transplant program," she says.
The Berlin Effect