Heart failure is an epidemic in the United States, with over 6 million patients suffering from some type of heart failure. While the majority of these patients will be treated medically or with traditional surgery, in some cases, these treatments will ultimately fail.
Although heart transplantation remains the gold standard for the treatment of end-stage heart failure, it is a limited commodity, with only about 2,500 transplants performed annually. Many patients with end-stage heart failure are not candidates for transplantation because of age, size and comorbidities. However, some of these can be safely and effectively treated with left ventricular assist device (LVAD) technology.
LVAD technology is currently offered both as a bridge to transplant and as destination therapy for those who will not qualify for transplant. In most cases, LVAD patients are completely disabled by their heart failure prior to the procedure. After implantation, most recipients are back to a normal quality of life, able to live independently, go back to work, and even engage in some sports.
“There is probably no surgery that a heart surgeon can perform that more dramatically improves the quantity and quality of life of a patient than LVAD implantation,” said Timothy George, MD, a cardiothoracic surgeon on the medical staff at Baylor Scott & White The Heart Hospital – Plano. “It truly is a life-saving and life-transforming therapy.”
In the landmark study evaluating the efficacy of LVAD implantation, patients treated with LVAD therapy were more than twice as likely to be alive at one year than those treated with medicine alone. Since that study, LVAD outcomes have continued to improve with expected 1 and 2-year survival rates of 80 and 70% respectively.
In recent years, LVAD technology and outcomes have continued to improve. Third generation LVAD devices are smaller, easier to implant and less prone to complications. Temporary mechanical support for both left- and right-sided heart failure is also becoming minimally invasive and, in most cases, completely percutaneous.
“I expect that within 10 years, these devices will be completely implantable without any connection to an external power source. Within 20 years, they will be placed without needing surgery at all and with outcomes superior to that of heart transplantation.” Dr. George said. “Heart transplantation is an incredibly effective treatment, but the number of available organs is totally inadequate to meet the demand of the current and growing heart failure burden. The future of heart failure treatment is LVAD therapy.”
Baylor Scott & White Heart – Plano is involved in evaluating these emerging technologies. As research continues, LVAD technology is being evaluated not only in those with severe heart failure symptoms but also as a therapy for those with less symptomatic heart failure.
“The ideal recipient population is really a moving target, so what I recommend is any patient with an ejection fraction less than 30 percent who has persistent heart failure symptoms or has been hospitalized even once for heart failure should see a heart failure specialist,” Dr. George said. “We would love to see these patients in the hospital or in the heart failure clinic.”
The Heart Failure Center at Baylor Scott & White Heart – Plano takes a comprehensive, multidisciplinary approach to treatment. Even for patients who do not need treatment using LVAD technology yet, the center’s team can work with referring physicians to determine the optimal time for that patient to be implanted with an LVAD device.
“As a medical community, we are still learning who benefits the most from LVAD technology,” Dr. George said. “We want to partner with referring physicians as early as possible to achieve quality outcomes for all of our patients.”
