Wednesday, September 22, 2010

Smaller LVADs may be solution for donor heart shortage

Left Ventricular Assist Devices (LVADs), were once used to help keep a patient alive only long enough to receive a donor heart. Now, doctors are using LVADs instead of donor hearts.

By Maureen McFadden

There's a shortage of donor hearts available. Right now, more than 3,000 people are waiting for a heart transplant, but only 2,200 will receive one. That leaves hundreds of people out of options and out of time.

However, heart pumps, once only used to keep patients alive long enough to get a donor heart, are now replacing hearts.

Cardiologist Maria Mountis' life is dedicated to helping hearts at the Cleveland Clinic, and also at home.

"He had a device put in because he was too sick to wait any longer for a transplant," said Dr. Mountis.

Doctor Mountis' dad suffered from heart failure. Since then, she's dedicated her life to helping others survive. She's experienced the evolution of treatment.

Dr. Mountis said, "You can really see a difference - less than a pound and close to four pounds with this particular device.”

LVADs, or left ventricular assist devices, were once only used to keep a patient alive long enough to get a donor heart. Now, this smaller LVAD can be used for patients who aren't eligible for a transplant.

If a patient were to use a new LVAD, "they would live with this device for the rest of their lives," said Dr. Mountis.

The old LVAD could only be used for a limited time. It's so big, most women and children couldn't carry the weight. A new study in the New England Journal of Nedicine reports a lower risk of stroke and clotting with the smaller device.

A “heart mate 2” is keeping Sylvia Coleman alive and walking today. Just a few years ago, she could barely stand up.

"I couldn't walk more than 10 feet. I felt like I had a ton on my chest,” said Coleman.

Four weeks after getting a new LVAD, Sylvia was trekking around the neighborhood. Four months after that, she was traveling around the world.

"She was gone for three months. We didn't have a call from her. Unbeknownst to me, she also went on a cruise while she was down there," said Dr. Mountis.

And Sylvia says the good times are just beginning.


BACKGROUND: According to the American Heart Association (AHA), a person needs a heart transplant when the heart can no longer work and a person is faced with death. People with long term heart failure or other heart injuries or those who have suffered coronary artery disease and multiple heart attacks are candidates for heart transplants.

In 2007, there were a total of 2,210 heart transplants, and there were 2,163 heart transplants performed in 2008. According to the AHA, in the United States alone, 72.4 percent of heart transplant recipients are male, 65.5 percent are white, and about 54.2 percent are 50 years of age or older. Statistics show the one-year survival rate as of June 5, 2009 was 88 percent for males and 77 percent for females. When looking at three-year survival rates, males had about a 79 percent survival rate while females had a 77 percent survival rate. When examining survival rates for five years after a heart transplant, men still had a higher survival rate than females, coming in with a 73 percent chance of survival. Females only had about a 67 percent chance of survival.

PROCEDURE AND POST-OP: During a heart transplant, doctors take out the diseased heart and replace it with a donor heart. During the procedure, a pump circulates blood throughout the body. Additionally, the surgeon connects the new heart to all the necessary blood vessels and uses a temporary wire to control the heart beats.

Like most other heart surgeries, heart transplant patients will need a cardiac rehabilitation program. Typically, the patient will remain in the hospital for one to two weeks after surgery for proper monitoring and checking of the new heart. Some risks include rejection of the donor heart, clogging of the arteries, bone loss, infection, and ulcers.

LVADs: Left Ventricular Assist Devices (LVADs), were once used to help keep a patient alive only long enough to receive a donor heart. Now, doctors are using LVADs instead of donor hearts. The AHA describes LVADs to be battery-operated, mechanical pumps that are surgically implanted. Furthermore, they maintain the heart pumping that the heart cannot do on its own. LVADs work through a tube that pulls blood located in the left ventricle into a pump. Next, the pump sends blood to the aorta. Since LVADs are portable, they are used for weeks or even months on end. LVADs allow patients to continue on with daily activities.

Cleveland Clinic Heart Institute
Cleveland, OH
(800) 659-7822

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