LVADs as Destination Therapy Rather Than Bridge-to-Transplant
McGowan Institute for Regenerative Medicine faculty member Robert Kormos, MD, director, Artificial Heart Program, co-director Heart Transplantation at the University of Pittsburgh Medical Center (UPMC), and medical director of Vital Engineering, and the team of professionals of the UPMC Artificial Heart Program provide long-term cardiac support for patients suffering from advanced-stage heart failure who are and are not eligible for transplantation.
Congestive heart failure (CHF) is a major chronic condition in the United States, marked by increasing prevalence, hospitalizations, and deaths. One type of CHF, called left-sided failure, is caused by a progressive failure of the left ventricle—the large, muscular chamber of the heart that pumps oxygen-rich blood out of the heart to the rest of the body. This form of CHF is often treated with medications and/or surgery, including a heart transplant. Patients who are too old or too ill to qualify for a heart transplant now may have another treatment option available to them.
A heart assist pump, approved by the US Food and Drug Administration (FDA), can be permanently implanted in patients who are not heart transplant candidates. The HeartMate is a left ventricular assist device (LVAD) that takes over the work of the left ventricle. The HeartMate II (pictured), a more compact device for smaller adults, is also FDA approved. This newer version is designed to be quieter, more comfortable, and more reliable than the older model. The technology for these devices was designed and developed by a team of specialists including Dr. Kormos and McGowan Institute for Regenerative Medicine affiliated faculty member James Antaki, PhD, associate professor in Biomedical Engineering at Carnegie Mellon University and adjunct professor in the University of Pittsburgh’s Departments of Surgery and Bioengineering.
An LVAD is a battery-powered pump that is placed in the upper abdomen. It draws blood from the left ventricle and sends that blood into the aorta thereby doing the work the weakened ventricle can no longer do.
LVADs extend life and improve the quality of life. Currently, Dr. Kormos said, 78 percent of destination therapy patients are alive at 1 year after implantation nationally, and at UPMC the survival rate is 76 percent. Numbers like that are encouraging more cardiologists to refer patients for possible LVAD implantation.
“It’s a technology that’s starting to get the attention of cardiologists,” Dr. Kormos said. “We’re encouraging people to send us those patients. … people with spirit who are active. We’re very well-positioned to help them.”
UPMC now has more than 40 patients living at home on heart pumps, close to 30 of them destination-therapy patients. Dr. Kormos said the number of heart-pump patients at home 3 years ago was much smaller.
“We’re sending about 30 a year [home], but I think it’s going to grow.”
Illustration: HeartMate II LVAD. – Thoratec, Inc.