LVAD sizes 80mls, 60mls, 25mls, 10mls (5 under design)
RVAD sizes 10% smaller than left to reduce hyperperfusion of the lungs.
The Console can drive 2 VAD’s independently.
Allows long term support for patients with potential recovery or bridge to transplant.
Left Ventricular Assist Devices May Become Permanent Alternatives to Heart Transplants
Left ventricular assist devices (LVAD) may become a viable alternative to heart transplants, according to a recent report in the American Heart Association journal Circulation.
Left ventricular assist devices have typically been used by people with severe heart failure to take over the heart’s pumping action until a donor heart is available for heart transplantation. Researchers at Sharp Memorial Hospital in San Diego, California studied ten patients who had LVAD implanted as a bridge to transplantation. The researchers were comparing results of standard heart tests (including exercise and heart imaging studies) first after LVAD implantation and then again after heart transplantation.
Doctors have been interested in using LVAD as an alternative to heart transplant for a while, given the shortage of donor hearts available for transplantation. However, until now there had not been any physiologic studies to evaluate a patient’s ability to perform daily activities after having a LVAD implanted.
The researchers studied the patients on average at 46 days after LVAD placement for approximately one month. They found that the patients achieved maximum oxygen intake during exercise tests; this was the same level achieved for the same period after heart transplantation. In addition, they found that pulmonary capillary wedge pressure for LVAD beneficiaries were similar to those of heart transplant recipients.( Pulmonary capillary wedge pressure refers to the blood pressure in the lungs; higher levels reflect a worse condition of heart failure.)
The study demonstrated that for the period of time measured, LVAD recipients were at a similar functional capacity as heart transplant recipients. Unfortunately, all ten subjects eventually underwent transplantation so the researchers were not able to determine if their exercise capacity with LVAD would continue to improve in a similar manner to that of heart transplant recipients. However, the study’s authors note that additional research is underway that will compare long term LVAD survival when LVAD is used as a permanent alternative to heart transplant.
MAN TAKEN OFF HEART TRANSPLANT LIST AFTER HEART RECOVERS ON VENTRICULAR ASSIST DEVICE
Case is first for a patient with chronic heart disease, say University of Pittsburgh surgeons
PITTSBURGH, Aug. 15, 2000 –A patient with severe heart disease who had been placed on the national transplant waiting list was saved not by a heart transplant but by the device University of Pittsburgh Medical Center (UPMC) surgeons implanted to support his heart until a donor organ would be found. The device – a Thoratecâ LVAD (Left Ventricular Assist Device) System – was intended to serve as a “bridge to transplant,” but in this case – believed to be the first for a patient with ischemic heart disease – the device served as a bridge to his own heart’s recovery.
“This case demonstrates that patients with ischemic disease, or chronic heart disease, which accounts for about 60 percent of the transplant waiting list, can recover on an LVAD and not need a transplant. If put into wider practice, there would be fewer patients competing for the limited number of donor organs,” said Robert Kormos, M.D., associate professor of surgery in the division of cardiothoracic surgery at the University of Pittsburgh School of Medicine, and director of the Artificial Heart and Heart Transplant Program at UPMC.
The patient, 52-year-old David McCormick of Gary, W. Va., has a long history of heart disease, and recently experienced a severe heart attack for which he was hospitalized at a regional hospital. Physicians there had inserted a balloon pump as a stopgap measure and transferred him to UPMC Presbyterian for coronary artery bypass surgery, where surgeons are accustomed to such high-risk cases. But when during surgery there were additional complications and the patient could not be weaned from the heart/lung machine used during an open-heart procedure, cardiac surgeon Brack Hattler, M.D., had to consider other options for the patient. He was connected to another machine to take over the function of his lungs. And thinking that this patient was now destined for the transplant waiting list, Dr. Kormos was brought in to the operating room to implant the Thoratec LVAD, its purpose to provide the patient long-term support of the heart’s main pumping chamber until transplantation would be possible.
But a curious thing happened. About four weeks after the 11-hour surgery and the LVAD implant, Dr. Kormos noticed steady improvement in the patient. A series of specialized tests that determine if a heart will recover, developed and performed by UPMC cardiologist John Gorscan, M.D., confirmed Dr. Kormos’ and others’ suspicions: The patient’s heart was indeed getting better on the LVAD. Two weeks later, Dr. Kormos surgically removed the device and took Mr. McCormick off the transplant waiting list. Two weeks after that, he went home.
“The time to intervene is during the bypass procedure. If the patient can’t be weaned from the heart/lung machine, why not implant an LVAD with the idea that it could allow the heart to recover. Most would think ‘transplant list.’ But this represents a different way of thinking,” Dr. Kormos noted.
While there have been some cases reported of transplant candidates recovering on LVADs, including the Thoratec LVAD, these cases have been in patients with nonischemic disease, which is usually sudden onset in nature.
The UPMC’s Artificial Heart Transplant Program is considered one of the most active centers in the United States, having supported nearly 200 patients on assist devices since 1985 with a total support duration for these patients of 2,793 days, or more than 7.5 years of patient days. In addition to its clinical services, the center boasts an international reputation as a leading proving ground for new devices in the early stages of development or clinical phases of study. The Artificial Heart Program is part of the world-renowned transplant programs of the University of Pittsburgh, which have performed more than 10,000 transplants to date — more than any other center in the world.
Thoratec Laboratories Corporation (NASDAQ: THOR) is engaged in the research, development, manufacture and marketing of medical devices for circulatory support and vascular graft applications, all of which incorporate its proprietary biomaterial, Thoralonâ . Its VAD System is currently used by approximately 150 leading hospitals around the world and has helped treat more than 1,300 patients. The VAD System consists of one or two blood pumps, a drive console and cannulae that connect the pump to the heart and vessels. For additional information about Thoratec, visit the company’s website at http://www.thoratec.com
My near fatal experience
(Lvad Patient until a donor heart was found)
Well all those years ago when Dr Christian Barnard transplanted the first heart, yes and I can remember it, I never dreamt that I would require a transplant.
My family has more members who have had heart problems than those that don’t and that is both sides of my immediate family with all my grandparents, and four great uncles, two great aunts and two uncles. So when the doctor asked me is there any heart problems in your family, I could honestly say it would be easier to tell you who has not had problems.
I live in a little village called Pendeen in Cornwall and work as a Curator of an Art Gallery and Museum in Penzance, my name is Jonathan Holmes. I suffered my first heart attack in 1997, while on a working visit to Birmingham Art Gallery and guess what I had just had my fortieth birthday. Enough said about Life Begins at Forty ! I was rushed into the City Hospital in Birmingham with the paramedics saying its an asthma attack, lucky I had seen few heart attacks, I was given an ECG and then put in ITU over night. I spent 10 days in hospital before traveling back to Cornwall, stopping at a Travel lodge half way at Taunton to break the journey. In Cornwall I undertook exercise and rehabilitation classes and after two visits to the consultant and a good exercise test was pronounced fit and discharged and then left in the care of my GP. I was told that if I take it easy, relax and take the drugs prescribed well I should not suffer another heart attack. How wrong could they be! There were contributing factors I am an Insulin dependent diabetic with a family history of high cholesterol.
Having just started a temporary period of secondment at another Museum, I was exited in what the future had in store for me but it was just six weeks into the one year contract that disaster struck. It was September the 15th 1999, I drove to work it was a lovely sunny day and I had just got back from a camping holiday in the middle of nowhere in Dorset. Feeling relaxed I unlocked the Museum walked up to my office and guess what – my chest was getting tight and I had difficulty breathing. I had the presence of mind to walk down to the front door where my deputy was unloading his car. There being no hospital within twenty miles, he rushed me up to his health centre where they administered some drugs – which – well I can’t remember.
I was then sent to a smaller hospital rather than the main hospital in Cornwall, which is Treliske at Truro. I was rushed to the West Cornwall Hospital in Penzance which has a very small ITU for cardiac patients. I was there for a week and then discharged – but at that time I had so much fluid retention that I could hardly walk, my chest was making very interesting noises. I sounded like a boiling hot water tank. So why was I discharged it still makes me wonder. I was very fortunate in having a good friend who trained as a nurse and agreed to stay the night, he was so worried that he called the doctor three times during the night. I had two frusemide (diuretic) injections. But with no luck, this was a Friday, I was readmitted to the West Cornwall Hospital again and little was done until the Sunday when a young doctor was very unhappy with my condition. The next day I was transferred to the Treliske hospital by hi speed ambulance for special care in their HDU Cardiac Unit under the care of Dr Mourant.
I was not expected to live that night and had my breathing forced by machine and I urinated nearly 10 litres through the early part of that night. I remember coming round at one point and seeing all my family around my bed, not realising the seriousness of my situation. Looking back it was something akin to those Mafia films with being the Godfather. About a week later on the 5th October after much discussions between Treliske Hospital and Harefield, I was airlifted at about 6 pm, arriving at the helipad at Harefield Hospital about an hour and a half later. By that time I understand my condition had deteriorated again and it was touch and go whether they could even consider operating. My vital signs picked up during the night and I was rushed into theatre where they fitted an electric heart assist device called an LVAD for short which stands for Left Ventricular Assist Device.
Without this device I would not be here now. They use the device in two different ways
1. As a bridge to transplant. i.e. to wait until a suitable organ becomes available.
2. As a bridge to recovery i.e. sometimes the heart it has been found will mend it’s self in certain cases. But this was not the case with me.
The device is large, about the size of a large grapefruit and is fitted in the abdomen and is driven by a electric motor which pumps using a diaphragm . The pump is fed its power supply through a tube in the lower abdomen which has three main functions, to power the pump via batteries or a mains / battery unit. It also when connected to the power base unit, a unit that charges the batteries and allows the user not to use the batteries at night for example, can via a computer type screen give feedback on the flow of blood and other details.
If the worst happens and the electric motor stops, it can be operated by a hand pump but because of this it is necessary for the person fitted with the pump to have 24 hour supervision. This means you can not be left alone 24 hours a day. This proved the most difficult part for me as you had no privacy. When at home my mother even bought a baby alarm and carried it about so she could always here me. The large size of the pump, meant that for the first few months I found it very difficult to eat even small amounts would be returned so to speak, so small portions quite often were the order of the day. It was a good three months before I could eat a larger meal. I was in the hospital until the beginning of December when I moved with my friend into one of the flats that the hospital has in the village of Harefield especially for people who come from a distance. Living near Lands End, well you can’t get much further can you? Living with the LVAD can mean that you can have a near normal life, I mean near normal not normal. No disco dancing or gymnastics ! You need to learn your limitations but not to become a couch potato. Exercise being very important, being fit when a heart became available stood me in very good stead.
Well, Christmas went with a whimper and we were warned to be prepared for a problem on the stroke of midnight i.e. the millennium bug. Well Paul, my friend had the hand pump ready but when it got to 12.30 and the machine was still chuffing away, we cracked open a bottle of the bubbly stuff and had one glass each – Wow my first glass of the falling down juice since the beginning of September. Outside there were some wonderful fireworks from other peoples parties and the village do.
From the day I was back in the land of the conscious after the fitting of the LVAD and living, my main aim was to get back home to the land of pasties and clotted cream! This dream had given me something to live for, fight for and to work towards. But up until then you had to live within 50 miles of Harefield, so that you could get back to the hospital quickly. After a meeting in January with all the surgeons, doctors and specialist support staff, which was chaired by Professor Sir Magdi Yacoub, I was allowed home. Hurray ! the reasoning behind this was they could always fly me back if necessary something they would have to do if and when I would be called for transplant. One other factor was that I have a rare blood group AB+ so I might have to wait longer than the so called average.
I arrived home, traveling down with the specialist support staff, Dr Chris Bowles, LVAD Nurse Mandy Hipkin and Transplant co-ordinator Pam Baldock. The next few days were hectic with training sessions being run for the staff at the main hospital in Cornwall, Treliske, Truro and also for the District nurse teams and GP’s on the LVAD, Harefield’s work and for me on the regimes needed for the special dressings of the entry site for the drive line, which takes the power supply to the LVAD. All went well for around three months until my abdominal wound started to cause concern. I woke up one morning and did a good impression of the film Alien. The wound opened up in a small area and out spurted, yes I do mean spurted a thick liquid all over the floor, my legs and well I just don’t know how I did not panic. Something told me it was old blood and the district nurse confirmed it. I was brought back to Harefield where a small operation was undertaken to check it and clean it. Now at that time I came up on a Friday and was told that I could go home on the Monday, unfortunately they did not tell me which Monday and nearly four months later I was still there. There was an unknown infection which they decided to treat using a combination of IV and oral antibiotics. They scanned me and X rayed me in many different ways. At one point I thought that aliens had landed when I was told today you are going to have an nuclear “Infecton” scan ! It was fun having Beware Radioactive written on your door. These checks took place regularly until the final solution occurred.
It was a Sunday night, and I had a knock on my door at about midnight and Tracy the Transplant co-ordinator came in and told me that they had a heart and they wished to go ahead with the transplant later that night. At 4am I was taken down to the theatre and I understand that I was in there for around ten hours. My first recollection was waking up in the intensive care unit but which day that was I just can’t say.
I came out of the ITU on the Saturday afternoon and was placed back in the Transplant ward, which was already a sort of second home to me. Welcomed back by all the nurses it was great. The next few days various drips and drivers were disconnected and eventually I could get out of bed with some help, and was soon walking with the help of the physio’s down the corridor. My mother and sister came up from Cornwall and stayed as long as they could both having difficult family commitments.
I continued to improve daily and to eat more and more. Two of the major highlights were
1) Having a shower for the first time since the 14th September 1999.
2) Having a long, in fact very long soak in the bath and coming out resembling a wrinkled anaemic prune !
The other highlights were being able to be by myself when I wanted to be, walking around the hospital grounds and going to the Hospital League of Friends for one of their lovely cups of coffee, not quite the Ritz, but a very welcome bolthole off the ward. Lunch and tea meant that I could go over to the Canteen and at least choose what I wanted on the day I was eating it.
Another emotional moment was the first time I walked into the little village of Harefield and was able to potter in the shops, on the way back I stopped in at the Kings Arms where I had a coffee and read a magazine. I suddenly realised that this was the first place I went with Paul after the fitting of my LVAD. Should I confess here and say in fact before I had been officially discharged and had a wonderful roast Sunday lunch. I realised that I was here again, but by myself. I had my life back, something I will always thank the Organ donor and Harefield. I do not know what lies ahead but I plan to look after myself and enjoy life. Follow the rules, even if they seem stupid to some people. If I have to return to Harefield for any incidences of rejection or infection, well that’s life and I realise that soon I will be back again in sunny Cornwall, well that’s probably is a bit of an exaggeration as where I live the wind never seems to stop blowing off the Atlantic Ocean, bracing is not in it.
I have a lot to learn and it is still very early days but I hope to go back to work by Christmas 2000 and live a full and happy life. From my experiences I can only say
Just Don’t Give Up Hope
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