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Spring 2010
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Advanced Technologies Offer a Bridge of Hope for Patients with Severe Heart Failure

04/01/2010

VS-Spring2010-HeartFailureCongestive heart failure is the most common diagnosis in hospitalized adult patients and affects nearly 5 million people in the United States. Patients with the most advanced and severe heart failure — some 50,000 in the U.S. — remain symptomatic despite optimal medical therapy and are unlikely to survive more than a year without additional treatment. Two possible interventions exist — heart transplantation or a ventricular assist device (VAD) — that can improve survival for these very advanced heart failure patients. With only about 2,000–2,500 heart transplants performed each year because of the limited availability of donor hearts, the advent of VADs “is a very exciting development to help address this great unmet need” and sustain lives that might otherwise be lost, says Gregg C. Fonarow, M.D., Ph.D., director of the Ahmanson-UCLA Cardiomyopathy Center.

What are ventricular assist devices, and who are they for?
These are devices for patients with advanced heart failure — people whose hearts have been irreversibly damaged and are no longer able to perform their pumping functions adequately despite optimal medical therapy. The devices are mechanical pumps that draw blood out from the left ventricle and into the rest of the body, producing up to 10 liters per minute of blood flow. They are battery-powered and surgically implanted, but require a highly specialized center such as UCLA to provide the surgeries and ongoing care.

In what circumstances would a VAD be used?
Most often, it serves as a bridge for a patient who is awaiting the availability of a donor heart — a way to keep him or her alive until the surgery can be performed. But VADs also are increasingly being used as a destination therapy in cases in which a patient is not, for a variety of reasons, a good candidate for transplantation.

How have these devices improved?
We’ve seen a remarkable evolution in the device design and technology. The biggest advance involves the newer, smaller devices that provide continuous flow, the most prominent of which is the HeartMate II. A recent study published in the New England Journal of Medicine compared this device to the first- and second-generation pulsatile flow devices, which are much larger and are dependent on valves and a pulsatile flow plunger-type mechanism. The newer HeartMate II device has recently been demonstrated to more than double the two-year survival rate for patients, with a lower rate of complications. That makes this a much more viable therapy for a patient in whom a heart transplant is not an option — to receive a ventricular assist device and be discharged from the hospital with a good functional capacity and quality of life.

VS-Spring2010-GreggFonarowMDHow does the quality of life for patients with these devices compare with that of patients who receive a new heart?
In many cases, it is equal to or better than getting a new heart, because patients after a transplant have to be on a number of medications to prevent rejection, and they need regular biopsies. The disadvantages, of course, relate to needing a battery pack and making sure the power for the device doesn’t run out. There are risks of serious infections or blood clots forming, and of the pumps failing, but these risks have been greatly reduced in the newer devices.

For patients who do undergo transplantation, how have things improved?
There have been advances in the immuno-suppressant drug regimen, as well as in the ability to monitor patients through a simple blood test to detect when the heart is being rejected. In addition, thanks to the pioneering work of Dr. Hillel Laks at UCLA, there is an expanded pool of donor hearts that are being safely used for transplants at UCLA and many other programs across the country. This includes hearts that were previously not used because of the age of the donor or because they were thought not to be a good match. These, along with advances in surgical and organ-preservation techniques, have improved the survival and quality of life in these patients.

To learn more about heart failure, go to:
www.transplants.ucla.edu/heartfailure





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