How A Minimally Invasive Procedure Helped This Heart Failure Patient Get Her Life Back.
(Novant Health, Patrick Flanary) — For most of 2024, Karen Powell struggled to get out of bed.
Regular tasks like taking a shower and vacuuming the house sapped her strength and often left her breathless. The worst part was that Powell, a Wilmington grandmother of five, had experienced this before.
Back in 2013, when Powell was diagnosed with congestive heart failure — a progressive disease that affects about 7 million Americans — she spent a week in the hospital following a cardiac catheterization. With a pacemaker and heart medication, Powell’s symptoms eased for several years. But the familiar fatigue eventually returned.
“I was continuing to go downhill, and we had already tried adjusting medications and nothing was helping,” said Powell, 72. “I just felt terrible all the time. All I wanted to do was sleep.”
There is no cure for heart disease. But a heart device implant known as a Barostim has given candidates like Powell hope for immediate improvement. The minimally invasive procedure, approved by the Food and Drug Administration in 2019, is designed to target the patient’s neurohormonal pathway to significantly improve heart function, exercise capacity and quality of life.
While Barostim is not for everyone, candidates include patients whose medications fail to control Class II or III heart failure symptoms, like fatigue from climbing a flight of stairs.
A long-awaited solution
Barostim Baroreflex Activation Therapy works by electrically stimulating carotid baroreceptors, which increases baroreflex sensitivity and rebalances the autonomic nervous system. Combined with guideline-directed medical therapy, the Barostim implant – about the size of a standard pacemaker – improves the patient’s heart rate and blood flow.
“By stimulating the carotid baroreceptors, we are able to recalibrate the autonomic nervous system,” said cardiothoracic surgeon Dr. Jeko Madjarov of Novant Health Heart & Vascular Institute, one of the few surgeons in North Carolina who performs the surgery. “This widens the blood vessels to make it easier for the heart to work, and can improve the patient’s quality of life.”
Most Barostim patients have an existing defibrillator or pacemaker, which the implant complements. While Powell has no family history of heart problems, her condition was caused by viral myocarditis, which inflames the heart muscle and disrupts blood flow.
When Powell’s medications grew ineffective, her cardiologist, Dr. John Rommel of Novant Health Heart & Vascular Institute, recommended a heart transplant. But an evaluation in April 2024 ruled one out. Powell was not a candidate due to her age, Type 2 diabetes and single kidney. (She had one removed 20 years ago after developing a cyst.)
But while Powell was not fit for a heart transplant, she was eligible for Barostim implant surgery, which became available at Novant Health New Hanover Regional Medical Center in October 2024.
“I’m ready as soon as you can get me in,” Powell told Rommel. “I was willing to investigate every avenue I could for help.”
That November, Powell became one of the first Barostim patients at New Hanover Regional Medical Center. The procedure took less than an hour, and while patients often go home the same day, Powell spent the night at the hospital.
“Compared to when I walked in, I would say it’s almost like a miracle,” Powell said. “I just feel 100% better than I did before the procedure.”
Recovery and follow-up
After the implant is performed and the patient has had time to recover, they typically follow up within a couple of weeks to begin increasing Barostim therapy. This is done under medical supervision in the referring physician’s clinic.
One of the care team members present during these appointments is Donovan Harper, a representative for CVRx, which developed the Barostim technology.
“We want to give the patient adequate time to recover from surgery before making adjustments to increase their therapy,” Harper said. “We partner with the (health care) team to ensure that we’re making the appropriate adjustments to complement their standard of care.”
With Rommel present, Harper initially adjusts a patient’s electrical impulse dosage every couple of weeks to ensure that their activity levels and quality of life begin to improve. He checks the device’s battery twice a year.
Surgery and recovery require close coordination between the patient’s cardiologist, cardiothoracic surgeon and primary care physician, as well as nurse practitioners, physician assistants, pharmacists and more. The Novant Health Heart & Vascular Institute’s multidisciplinary approach makes this level of care possible.
“By building that trust with the patient over time, we can figure out the steps toward managing this complex disease,” Rommel said. “That’s what I think makes this job exciting, and to see Karen feeling so much better is incredibly rewarding.”
Recent blood work has shown improvement in Powell’s creatinine levels and kidney function. She says her strength is renewed and she now has the energy to do the little things many take for granted, like cooking a meal or taking a walk.
But most of all, she’s excited to travel again with her husband, Morris. In September, they plan to board a Disney cruise ship to Alaska, a vacation they had to put off last year.
“I am so appreciative of the Novant Health team helping people like me live a fuller life,” Powell said. “I just continue to feel better and better. It’s like a miracle has happened to me.”