Patients Waiting For a Heart Transplant Now Have Another Long-Term Life-Saving Option
Small battery-powered pump can often be a better option
They say big things come in small packages. And a tiny device that is eliminating the need for a heart transplant in some patients proves that. The LVAD, or left ventricular assist device, runs on batteries and only weighs one pound. Yet it can do up to 80 percent of the work for a damaged heart. Doctors once implanted it as a bridge to transplantation - meaning it helped strengthen patients and keep them alive long enough until a donor heart could become available. Now, doctors at The Nebraska Medical Center are the only local specialists certified to use the LVAD as destination therapy - a permanent, life-long option for patients suffering from end-stage heart failure.
"The ability to insert left ventricular assist devices for this disease is going to have more of an impact population-wise in the United States than heart transplantation has," said John Um, MD, cardiothoracic surgeon at The Nebraska Medical Center.
Dr. Um says the LVAD gives patients another, often better, option than having a transplant.
"Heart transplantation, while the gold standard for treating severe end-stage heart failure, is not the answer for many, if not most patients with severe end-stage heart failure."
For patients who receive the device, there is typically a dramatic improvement in their quality of life.
"Most people with heart failure are limited to what they can do," said Dr. Um. "Most of them get to the point where they can't even engage in activities of daily living. And now people can re-engage in life and do the things they were unable to do, typically for many years."
"They only have mild limitations with extreme activities," said Ioana Dumitru, MD, heart failure specialist at The Nebraska Medical Center. "But a lot of them can return to work, can return to doing their daily activities and their hobbies. They can go shopping; go to the movies. We had somebody that roofed their entire house. We currently have somebody out in the community that's farming full-time."
The device is implanted during open-heart surgery and connected to the heart via a tube that distributes blood to the body. It's powered by a small battery pack worn outside the body.
"The device is completely quiet," said Dr. Dumitru. "It doesn't interfere with your daily living activities. Overall the device weighs less than a pound. Most people won't feel it, and it's so small and can be so well-hidden, we actually had people get married with the device."
Doctors aren't sure how long the devices will last, because the technology is fairly new. But should the LVAD fail years down the road, another one can be implanted as a replacement.
"A lot of the younger patients have chosen not to pursue transplantation and continue to live on these devices," said Dr. Dumitru. "That's because of limited medications they have to take, less follow-up, fewer future invasive procedures and the ability to still receive the transplant at the back end if it's necessary. That gives them a higher chance of expanding their life expectancy."
In some cases, LVADs can even strengthen a patient's heart.
"A lot of the times what we're finding is people who were not candidates for transplant may become candidates for transplant," said Dr. Um.
"And in a certain number of people there may also be recovery." That recovery means some patients may no longer need the device or a transplant.
"The main benefit is that it provides patients and their families another choice on how to treat their cardiac condition," said Jorge Parodi, executive director of cardiovascular and pulmonary services at The Nebraska Medical Center. "With this designation, The Nebraska Medical Center now offers every possible option for our patients. Before, there was no other local option. They would've had to travel to have this device implanted if they weren't a heart transplant candidate."
Dr. Dumitru echoed those sentiments. "It opens the door to improved quality of life to a lot of local patients that otherwise would have no hope."