LVAD

Heart Transplant Patient Success Story

Dr. Vega, Emory Heart and VascularHerbert Grable was diagnosed in 2000 with congestive heart failure. When he was diagnosed, it came as a shock and he was scared. He didn’t know what caused his heart to fail and he didn’t know what heart failure treatments were available for him. He was very grateful to have the Emory Heart & Vascular Center near his home, as it offered a unique treatment for patients who are not candidates or can’t get a heart transplant right away – called Ventricular Assist Devices (VAD).

As we have discussed in previous blogs, a VAD is a mechanical device that is implanted in the heart. This pump takes over the function for the ventricle and circulates blood to the rest of the body. The goal of a VAD is to improve a patient’s survival and quality of life while they wait for a transplant (if they are a candidate for a transplant). The number of heart failure patients is tremendous, and with the number of transplants regulated per year at around 2,500 the VAD is another option for non-transplantable candidates as well.

After receiving the VAD, Herbert smiled and joked that he felt like himself again. His wife commented that the she got the “old Herbert back.” After eight months with the VAD, Herbert was again upgraded to the transplant list. One week later, he received the call  from Emory Transplant Center that a heart was available for him. Before transplant, Herbert was scared but he had faith in Emory and was determined that everything would work out. His wife was hopeful and optimistic that Herbert would be with her for many more years and would possibly see some grand kids one day.

Transplants are complex procedures. Emory transplant physicians are experts in their field and aware of all possible nuances that occur with each individual transplant patient. Should an unusual complication arise during a transplant experience, Emory has the skill to reach the most optimal outcome for a patient.

After Herbert received the heart transplant, he was able to live a normal lifestyle and do everything he always did before he was diagnosed with heart failure. He sums up his care “Emory is not just hospital, they care about the patient as well. I am so glad to have a place like Emory to treat me for this condition.”

For more information about heart transplant after the VAD procedure, watch this video:

About Dr. Vega

Dr. David Vega is a cardiothoracic surgeon at the Emory Heart & Vascular Center and the Director of Emory’s Heart Transplant program at Emory University Hospital. He implanted Georgia’s first dual pump ventricular assist device (VAD) in 1999 to serve as a bridge to heart transplantation, a procedure that initiated Emory’s ongoing national position at the forefront of the use of mechanical circulatory assist devices. In 2006, he implanted the state’s first VAD as a form of destination therapy for individuals who are ineligible for or are unwilling to undergo a heart transplant, and in 2007 he implanted an even smaller VAD for the same purpose that featured an automatic speed control mode designed to regulate pumping activity based on different levels of patient or cardiac activity.

Heart Transplant Patient Story: ‘I Feel Really Good’

A year and a half ago, Rachel Moore was readying to have her heart transplant at Emory. The surgery followed years of heart troubles, and Rachel spent two years with an LVAD as she awaited her transplant. Still, she was unsure if the heart transplant could really return her to good health. “My doctor told me, ‘After the transplant, you are going to feel so much better,’” Moore recalled recently during a phone chat. “It’s almost like I didn’t know what that meant.”

Now, 18 months later, Moore knows. “Before, when I was ill, I often wanted to just take a nap,” she said. “Now, when I’m up, I’m up all day and I exercise about five days a week for about an hour a day. I don’t feel winded or short of breath.” Moore, 45, visits Emory every three months for her check-up. Her medical team here checks her blood work and runs tests on her heart. If everything is running smoothly, she continues to take medication, and she returns in three months.

You can listen to Rachel Moore talk about how much better she feels since heart transplant surgery by clicking on the play button below:

“Sometimes I don’t know the right words to use, but I feel really good,” said Moore. “It’s almost like sometimes you have to remind yourself that there used to be something wrong. Like sometimes I’ll think to myself, ‘You had a heart transplant.’” For more information on Moore’s heart transplant and the effect it’s had on her life, visit her website at http://www.heart4rachel.org/ and watch this video:

Examining New LVAD Therapy Technology

In previous posts we’ve discussed how LVAD technology can serve as destination therapy for end-stage heart failure, or as a solution for transplant patients awaiting an available donor.  Today we’ll examine the latest cutting-edge LVAD technology available through our program at Emory University Hospital.

HeartMate II® LVAD; reprinted with permission from Thoratec Corporation

The Heartmate II is a smaller continuous flow LVAD that uses an internal motor to pump blood continuously into the ascending aorta. It provides up to 10 liters of cardiac ouput per minute, and due to its smaller size, it has a larger potential patient than previous generation LVADs.

The device is designed to provide greater mechanical reliability than previously available devices because it contains only one moving part—the internal rotor.

Our Emory VAD destination program has implanted over 25 Heartmate II devices to date.


HeartWare LVAD; reprinted with permission from HeartWare International

More recently, Heartware International (Framingham, MA) introduced the HeartWare LVAD system. This device uses a centrifugal pump to provide up to 10 liters of cardiac output per minute. The device is implanted above the diaphragm, directly adjacent to the heart, resulting in minimized surgery and recovery times.

The HeartWare LVAD is similar to the HeartMate II in that it contains only one moving part: the internal impeller. In addition, it has no mechanical bearings or points of contact between the impeller and the pump housing, which lowers the risk of device failure and other complications.

Emory University Hospital is one of approximately 30 registered ADVANCE trial sites for testing the safety and efficacy of the HeartWare LVAD. The trial is an integral step towards obtaining FDA approval for the bridge-to-transplant indication. (The HeartWare LVAD is already approved in Europe as a bridge to cardiac transplantation.)

In December of 2009, a study published in the New England Journal of Medicine revealed that continuous-flow LVADs significantly increase the chance of stroke-free survival and decrease the probability of device failure at the 2-year mark, as compared with a pulsatile-flow LVAD in patients with end-stage heart failure who were ineligible for transplantation.

It also revealed that patients who received the continuous flow device had an actuarial survival rate at two years of 58%, as compared to 24% for patients who received the pulsatile-flow device.

At Emory, we demonstrate our dedication to the advancement of heart failure therapy not only by staying on the forefront of technology, but also by treating our patients as family.

Do you have questions about our LVAD technology? If so, please feel free to let me know in the comments.

About J. David Vega, MD:

In 1999, Dr. Vega implanted Georgia’s first dual pump ventricular assist device (VAD) to serve as a bridge to heart transplantation, a procedure that initiated Emory’s ongoing national position at the forefront of the use of mechanical circulatory assist devices. In 2006, he implanted the state’s first VAD as a form of destination therapy for individuals who are ineligible for or are unwilling to undergo a heart transplant, and in 2007 he implanted an even smaller VAD for the same purpose that featured an automatic speed control mode designed to regulate pumping activity based on different levels of patient or cardiac activity.

A Special One-Year VAD Anniversary

William Shaw & Kris Wittersheim (VAD Coordinator)

In May of 2009, William Shaw, who has suffered from congestive heart failure for years, figured he had about two weeks left to live. Shaw, 72, had been in and out of the hospital for four months due to various heart-related troubles.

“I was just going down,” Mr. Shaw remembered during a recent visit to the Emory Transplant Center. “At the time, I was so weak that I couldn’t even sit up on the bed. If you sat me up, I’d fall over.”

But on May 22, 2009, Mr. Shaw underwent surgery and was implanted with a Ventricular Assist Device (VAD). The VAD procedure, discussed in detail here, is an emerging option for three types of heart failure patients: transplant candidates who are too sick to wait for a heart to become available, patients who may be heart transplant candidates but aren’t currently eligible for various reasons—such as obesity or smoking—and are getting sicker, and patients who aren’t transplant candidates due to other medical issues, or who (as in Mr. Shaw’s case) are elderly.

Simply put, the surgeons place a rotary pump under the heart (in the abdomen) to take over the function of the left side of the heart. This pump is dependent upon electricity—either batteries or AC power—at all times. The VAD does what the ailing heart can no longer do – it sends blood and oxygen to all areas of the body. Consequently, the VAD decreases heart failure symptoms, increases activity and drastically improves quality of life.

On May 18, 2010, almost one year after undergoing surgery, Mr. Shaw came in for his monthly checkup with me. So, how’s he doing? Not only is he now sitting up on his own, he’s enjoying life again. He took a hunting trip last November to South Dakota with his two sons, he works out three times a week, and he takes part in a number of retirement activities.

“My lifestyle has improved from one year ago,” Mr. Shaw said. “On a scale of 1-10, if 1 is the poorest and 10 is the best, I’ve gone from a 1 or 2 to a 7 or 8.”

In Mr. Shaw’s case, the VAD is destination therapy – meaning he’s not waiting for a heart transplant to make him better. The VAD is the cure.

Since receiving the procedure, Mr. Shaw has become a positive example for other heart transplant patients as they consider VAD surgery. He was even recently featured on a FOX 5 news report:

And when he visits Emory Clinic for his monthly check-ups, he spends time talking to other heart patients, and always asks if there is someone waiting in the hospital or being evaluated for a VAD that he may be able to talk to. His hope is to help them understand what they might be facing. His newfound independence, age, and story of recovery are an inspiration to others.

“When you’re my age, we all have things we have to work around,” Shaw said during his visit. “I’m just very thankful that it has worked out for me. They have taken care of me very well at Emory.”

Exploring VAD Therapy

In this video, I go into more detail about VAD therapy and show you an actual VAD device:

Ventricular Assist Devices: Hope for the Broken-Hearted

HeartMate II® LVAD; reprinted with permission from Thoratec Corporation

Many of you are aware of the benefits of heart transplant in patients with advanced heart failure; however, another form of therapy has been quietly emerging as a viable option for patients suffering from this condition.

A ventricular assist device (VAD) is a battery-operated mechanical pump that helps a weakened heart pump blood into the body. Essentially, it takes over the pumping action of the heart and drives blood into the aorta (the large artery that extends from the left ventricle of the heart and into the abdomen) and throughout the body. The device resides both inside and outside of the body, and is operated by an electric motor powered by a battery pack. The controller and batteries are typically worn over the shoulder or around the waist.

In most cases, VADs offer a short-term solution for patients awaiting a suitable donor for a heart transplant, particularly if their medical therapy has failed or if they’ve been hospitalized with end-stage heart failure. According to the United Network for Organ Sharing, over 2,900 Americans are currently awaiting a heart transplant (43 of which are in Georgia).

However, in some cases patients turn to VADs as an alternative to a heart transplant. We refer to this as ‘destination therapy’, meaning that the LVAD serves as a permanent solution for patients with advanced heart failure. Patients who are not heart transplant candidates but who have severe heart failure often pursue this course of treatment.

Ventricular Assist Devices support the left ventricle (LVAD), the right ventricle (RVAD) or both simultaneously (biventricular, or BiVAD). LVADs are used most commonly, and have been in existence for over twenty-five years.

A recent study comparing a new generation LVAD to an older model showed a marked improvement in survival at 2 years (58% vs 25%). In addition, patients reported an improved quality of life. As a result the FDA approved the Heartmate II as destination therapy for patients with end-stage heart failure.

Despite the severity of their illnesses, 70-80% of LVAD patients survive to transplantation.

There are several different types of LVADs, and I’ll go into more detail about specific devices and technology that the Emory Heart and Vascular Center utilizes in a later post. You’ll also hear from two very special patients who have been kind enough to share their stories with us.

Do you have any questions or thoughts about VAD technology or heart conditions in general? If so, please share them with me in the comments.

About Sonjoy Laskar, MD:

Dr. Laskar joined Emory Healthcare in 2005 and has devoted his career to providing direct care to patients with heart failure, heart transplantation and ventricular assist devices, as well as to teaching residents and fellows. He is an active researcher in the areas of echocardiography and ventricular assist devices as destination therapy, and is a member of the American College of Cardiology, Heart Failure Society of America and the International Society of Heart and Lung Transplantation.