Mechanical Assist Device Provides Long-Term Option
Once used primarily as a bridge to transplant, the left ventricular assist device (LVAD) is emerging as a long-term option for many patients with end-stage heart failure. Traditionally, heart transplantation has been the gold standard of care for treating severe, end-stage heart failure. In many patients, however, transplantation is not a viable option due to advanced age or concurrent medical conditions. For these patients, the LVAD can be used as "destination therapy" for lifeline support. "The mechanical assist program is really changing and growing quickly due to new technology that is producing better devices that are more durable, last longer and are more effective," says Cardiovascular Surgeon John Um, MD, who specializes in thoracic transplantation and mechanical assist devices. "We may not be far from the day when mechanical hearts will replace human hearts."
With continued improvements in LVAD technology, it is becoming more common for some patients to choose to avoid heart transplantation completely in exchange for using the LVAD as a long-term therapy solution. The LVAD is also helping to fill a growing shortage of donor hearts nationwide.
The longest living patient on the current iteration of the LVAD is over six years. If needed, the LVAD can be removed and a new device can be implanted.
The mechanical circulatory support program at Nebraska Medicine recently received Disease Specific Certification for Ventricular Assist Devices from The Joint Commission. The first implantable mechanical assist device was implanted at Nebraska Medicine in 2004 and has grown under the direction of Dr. Um.
Candidates for the LVAD include:
- Very sick patients who might not otherwise survive while they wait for a donor heart to become available.
- Patients who are too sick to survive a heart transplant. (The LVAD buys them time to recover and become stronger for a transplant.)
- Young patients who need time to allow their hearts to recover. Some may recover well enough that they don’t need a transplant at all.
- People with medical problems that would interfere with immunosuppressant drugs.
Before a patient can become a candidate for a mechanical assist device, they must undergo an extensive evaluation process that involves a variety of testing and meeting with social workers and psychologists. If they do not qualify to be a donor heart transplant patient, they may then be considered for a mechanical assist device.
Primary benefits of the mechanical assist device include:
- Elimination of side effects caused by immunosuppressant drugs, one of the leading causes of secondary health issues in donor heart transplant patients.
- Fewer co-morbidities such as high blood pressure, high cholesterol, renal failure, infections and cancer.
Primary risks/challenges associated with mechanical assist devices include:
- The need to take anticoagulation medications.
- Increased risk for stroke.
- Risk of infection at the site where the electrical wires exit the body.