Who benefits from a ventricular assist device?

Richard J. Shemin, MD
Thoracic Surgery (Cardiothoracic Vascular)
Patients that progress to severe heart failure that can no longer be managed with diuretics and other cardiac medications are on a downhill spiral to cardiogenic shock or low output syndrome. These patients are admitted to an intensive care unit and are treated with intravenous drugs to stimulate the heart muscle and may receive an intra aortic balloon pump. When this therapy fails and the patient is approved for a VAD either as a “bridge to transplantation” or for destination therapy when they are not transplant candidates.
Andrew J. Boyle, MD
Cardiology (Cardiovascular Disease)

There are two types of patients who get left ventricular assist devices. The first is someone we are trying to keep alive while he or she is waiting for a heart transplant.

The duration of time between implantation of left ventricular assist device and when a person gets a heart transplant varies based on a number of factors, the most common being weight and blood type. A more common the blood type means more people on the transplant list and a longer wait time. A rarer blood type means there are fewer people on the transplant list so the waiting time tends to be shorter.

The second type of patient is someone who is not a candidate for transplant, the main reason being age at the time of the implant. Patients ineligible for transplant may be a candidate for destination therapy, which means the goal is not to get to a new transplant but rather to improve quality of life and to improve survival with a left ventricular assist device.

Ventricular assist devices (VADs) are used to treat people 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. According to Gregg C. Fonarow, MD, PhD, director of the Ahmanson-UCLA Cardiomyopathy Center, 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 to provide the surgeries and ongoing care.

Dr. Fonarow explains that, in many cases, having a ventricular assist device is equal to or better than getting a new heart because people 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.

However, Dr. Fonarow says that, in some cases, people who receive the newest-generation VAD find that their quality of life has improved to the point that they no longer desire a new heart. However, a heart transplant still is the ideal therapy.

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