Michigan surgeons conduct first beating-heart transplants

Ken Miller, a resident of Ferndale, Michigan, received extraordinary news on his 58th birthday. He became the first person in Michigan, and one of the few in the United States, to undergo a beating-heart transplant. This groundbreaking procedure, performed by the transplant team at Henry Ford Hospital, promises better outcomes and increased access to donor hearts.

The transplant team at Henry Ford Hospital, led by cardiac and transplant surgeon Dr. Kyle Miletic, successfully implanted Miller's new heart while it was still beating. Just three weeks later, Dr. Miletic and his team completed another beating-heart transplant, believed to be the second in Michigan.

“I woke up on my 58th birthday to a new heart, a new kidney, and thanks to this team at Henry Ford, a new lease on life,” Miller said, expressing his gratitude for the double organ transplant. “I think it’s simply a miracle.”

“Beating-heart transplant is novel. The first one was performed less than a year ago,” explained Dr. Hassan Nemeh, Surgical Director of Thoracic Organ Transplant and Division Head of Cardiac Surgery at Henry Ford Health. He performed the second beating-heart transplant at Henry Ford Hospital in mid-June. “These two successful surgeries represent a significant advancement in organ transplantation for Henry Ford, the state, and the region, and it offers hope to so many patients awaiting life-saving procedures.”

The United States has performed only about 70 beating-heart transplants to date. With approximately 3,500 people currently awaiting a heart transplant, the demand for donor hearts is immense.

Traditionally, hearts are stopped, removed from the donor, and transported on ice to the transplant hospital. This method limits the time a heart can remain viable, restricting the distance it can travel and reducing the number of available organs.

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Technological advancements, sometimes referred to as “heart in a box,” now allow for the transportation of viable organs from further distances, increasing the availability of donor hearts. This technology keeps the heart pumping during transport.

“The heart in a box is like a mini heart and lung machine that we use for traditional open-heart surgery,” said Dr. Miletic. “Surgeons stop the heart at the donor hospital and put it on this machine. The machine restarts the heart and gives it all the blood and nutrients it needs to stay healthy. While it’s traveling to Henry Ford Hospital, the heart never loses its blood supply and never stops beating until you take it off the device.”

While the heart in a box allows for consistent blood flow, the heart typically stops twice—once during donation and again when it is removed from the machine for transplantation.

“Stopping the heart a second time weakens it, increasing the chances that the heart will need machine support—such as a balloon pump or ECMO—after transplant, which can lead to longer recovery times for the patient,” Dr. Miletic explained. “But if the heart only has to stop once, the muscle remains stronger, and outcomes for the patient are better.”

In 20% to 30% of cases where the donor heart is stopped and restarted twice, patients require machine support during recovery, leading to complications such as strokes, kidney, and liver damage. Avoiding these complications can improve long-term outcomes and simplify the recovery process.

In Miller's case, the team employed a technique that allowed the heart to continue beating when it was removed from the machine. “While still on the device, we placed a tube in the donor heart and connected it to the bypass machine that the recipient was already on,” Dr. Miletic said. “This tube provided the recipient’s blood to the heart the entire time we were sewing it into the patient. Because the heart was getting blood flow, it kept beating the whole time we performed the procedure. While this was more challenging than operating on a still, stopped heart, the heart was much stronger and more robust than we typically see after the traditional method.”

Miller didn't need any added support after surgery. He and his new heart are recovering well. “I live comfortably with my rescue dog, Chip, and I’m excited to go home and relax and get back to normal—to see my children and grandchildren, to sit and play my guitar again. I’m so grateful to these doctors to be able to say that,” Miller said.

Before his double transplant surgery on May 31, Miller had been at Henry Ford Hospital for several weeks, receiving mechanical support for his failing heart from a balloon pump while awaiting a heart transplant. He had been battling heart disease since 2013, which led to heart failure, kidney failure, and the need for a kidney transplant.

When the transplant team learned that a heart was en route to Detroit from several hundred miles away, Dr. Miletic identified Miller as a good candidate for a beating-heart transplant. “It’s more challenging because you’re sewing in moving tissue, but this patient was exceptionally suited for this transplant method,” Miletic said. “Because this patient’s heart was so damaged over the years, it had grown to twice normal size, providing more space for us to operate. This was also his first surgery. When patients have previously undergone open-heart surgery, subsequent operations can be complicated due to the presence of scar tissue. In this case, conditions were near perfect for us.”

Dr. Miletic was assisted by his partner, Dr. Dimitrious Apostolou, a specialist in cardiac surgery, and Dr. Rachel Diehl, a specialist in anesthesiology. Mary-Margaret Looby, the perfusionist, played a critical role by running the heart and lung machine during surgery and regulating and monitoring blood flow to the donor heart during implantation.

Miller, who had a heart attack in 2013, which forced him to retire from his job at a dairy in Livonia after 30 years, always held onto his faith despite being told by other physicians that not much could be done for him unless he received a new heart. “I knew I’d need a new heart one day. I never dreamed it would be this special,” Miller said. His family has established a fundraiser through Help Hope Live to help cover medical bills.

In the second beating-heart transplant performed at Henry Ford Hospital, the donor heart was transported from nearly 2,000 miles away and was outside the body for nearly seven hours due to travel time.

“Even though the box gives us more time to travel, it is not unlimited, and we have seen some issues with donor heart function when the heart is out of the body for so long,” Dr. Miletic said. “Therefore, I felt the additional protective effects of the beating-heart technique were even more important for this patient.”

The donor heart worked well immediately, and the patient is recovering at Henry Ford Hospital.

“It takes a team with extensive experience and a spirit of innovation to make a groundbreaking procedure like beating-heart transplant go off without a hitch,” said Dr. Marwan Abouljoud, director of Henry Ford’s Transplant Institute. “The success speaks not only to the technological skills of our surgeons but the strength of the team that makes Henry Ford’s leading-edge transplant program so successful.”

The beating-heart transplant procedure represents a significant leap forward in organ transplantation, offering new hope and better outcomes for patients like Ken Miller. As medical technology continues to advance, the possibilities for saving and improving lives expand, demonstrating the profound impact of innovative surgical techniques and collaborative medical teams.

Note: Materials provided above by The Brighter Side of News. Content may be edited for style and length.

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