Implantable heart pump prolongs lives for heart patients

Left Ventricular Assist Devices (LVADs), once only considered a bridge to heart transplants for advanced heart failure patients, are now serving as a long-term therapy that is helping patients prolong their lives up to five years. Now being offered by the CardioVascular Institute at Beth Israel Deaconess Medical Center (BIDMC), LVADs are regarded as a "destination therapy."

BIDMC launched its LVAD program, becoming the first non-heart transplant hospital in Boston to provide such treatment, in response to the increase in heart failure patients as the baby-boom generation continues to age. Many LVAD patients are also candidates for heart transplants, according to surgical director Kamal R. Khabbaz, MD, but they are often on long wait lists, or poor health prevents them from undergoing heart transplantation.

Khabbaz, BIDMC chief of cardiac surgery, runs the LVAD program along with Robb D. Kociol, MD, a BIDMC cardiologist.

Kociol, associate director of BIDMC's Advanced Heart Failure Program and Medical Director of the LVAD program, says end-stage heart failure is a growing and debilitating condition that mostly afflicts the elderly when heart muscles become too weak to pump enough blood to the rest of the body. Symptoms include breathlessness, swelling, kidney failure, reduced mental functioning, and extreme fatigue.

"LVAD is an increasingly common, stand-alone therapy that improves quality of life and longevity for these patients, who are frequently in and out of hospitals," says Kociol. "But while LVADs improve symptoms, they can be challenging, since patients must depend on these devices around the clock."

LVADs consist of three components: a surgically implanted pump, an electronic controller, and batteries. The controller, which functions as a computer, and the batteries can be carried externally on a sling that fits over the shoulder or around the waist.

LVADs were first approved by the US Food & Drug Administration in 1994, but they have dramatically improved since then, according to Khabbaz. "Today, these devices are much more effective and longer lasting, and this has transformed them into a destination therapy for those with end-stage heart failure," he says.

The LVAD program features the HeartMate II heart pump, the first device of its kind to be approved by the US Food and Drug Administration for advanced heart failure. Manufactured by Thoratec Corp., it is smaller, quieter and more advanced than previous heart pumps.

"Despite our success with this program, the decision about whether to have an LVAD is a difficult one," adds Kociol. "There are inconveniences and risks associated with LVADs, but these devices are also a great gift ... they provide the gift of time and improved quality of life. I have patients who can now look forward to seeing their children get married and have babies. This is very gratifying."