By Sam LaRose
For most people, a healthy heart is something that is easily taken for granted. Many do not have to worry about their placement on a waiting list or their compatibility with an available donor. For some individuals, however, the gift of a new heart is just what they need but is just too far out of reach. With only 2,000 hearts available for transplant within a given year in the United States and a waiting list that holds an average of 3,100 names on it per day [1], the math doesn’t add up in their favor.
Enter the LVAD.
What Is an LVAD?
LVAD stands for “Left-Ventricular Assist Device.” The LVAD’s purpose is simple: it pumps blood for the heart when the heart alone is unable to pump blood sufficiently.
“…there are tens of thousands of people every year who could potentially benefit from a heart transplant but realistically won’t get one. For these patients, an LVAD can be a lifesaving solution.”
In ideal circumstances, patients who need a heart transplant would be able to receive a transplant in a swift manner after their doctor confirmed that they needed one. The issue is that there simply are not enough hearts available, says Daniel Mulloy, MD.
“Heart transplant numbers have been pretty stable at about 2,000 heart transplants done in the United States per year for the last several decades. But there are tens of thousands of people every year who could potentially benefit from a heart transplant but realistically won’t get one. For these patients, an LVAD can be a lifesaving solution,” Dr. Mulloy points out.
Where LVADs help out, Dr. Mulloy explains, are situations where patients would not qualify for a heart transplant or do not have time to wait for one. These patients could be older than the typical transplant cut-off of 65-70, overweight or any of a number of other factors that would disqualify them for transplant. Or their hearts could be failing so severely that they would not survive while waiting for a transplant organ to become available. In the past there would be no option for these patients. Now placement of an LVAD can be a lifesaving operation that can preserve a good quality of life.
Doctors and other medical professionals have been attempting to create a heart pump since the 1960s with little success. Determination and hard work paid off when the first successful heart pump hit the market in 2001.
The LVAD is put in place via a sternotomy, which is a surgical procedure where a vertical inline incision is made through the sternum. The pump is connected to the appropriate portions of the heart and a wire, medically referred to as the “drive line,” exits the skin and is connected to a battery pack.
History of the HeartMate LVAD
“The HeartMate 3 LVAD is the newest and most exciting device that we have, and it was just approved for long-term support in October 2018. In recently completed trials it has shown the best survival rate, the lowest stroke risk and the lowest risk for pump thrombosis,” says Dr. Mulloy. Pump thrombosis is a blockage of blood flow through the pump usually caused by clot formation.
Despite just being approved in October 2018, Mission Hospital has already performed five HeartMate 3 implantations.
In 2009, the HeartMate 2 LVAD was approved and released to public hospitals. This enabled hospitals all over the country to practice the implementation of LVADs, as opposed to only specialized heart transplant centers. In the time since the HeartMate 2 was released, LVADs have become the gold standard for hospitals that do not perform heart transplants.
In terms of the overall success, the HeartMate 3 is proving to be a truly remarkable alternative to undergoing a transplant. In the recently completed randomized trial, 83 percent of HeartMate 3 recipients were alive two years after implantation of the pump. This compares favorably to heart transplants where about 85 percent of patients survive at least two years and is a significant improvement over the previous HeartMate 2 pump where 72 percent of patients survived at least two years. Without transplant or LVAD, only a small portion of these patients could survive even one year. With the limited availability of heart donations, the HeartMate 3 is the best alternative.
Despite just being approved in October 2018, Mission Hospital has already performed five HeartMate 3 implantations. All five of the patients who received HeartMate 3s have benefitted from the device. In total, Mission Hospital has performed 23 LVAD implantations.
Who Can Receive One?
Keep in mind that heart pumps such as the HeartMate 3 are typically prescribed for those who do not qualify for a heart transplant. Many younger patients diagnosed with end-stage heart failure would still be best suited with undergoing a transplant. However, if the patient is older than 70, is obese or a recent smoker then they would not qualify for a transplant.
Patients with acute heart failure also do not qualify for heart transplants, given that there simply would not be enough time given the extensive length of the heart transplant recipient list.
“We treat a great variety of patients, but the [most] typical candidates we are seeing here would be, say, someone who had a heart attack or bypass surgery ten years ago in their 50s… and then have had further progression of coronary artery disease and have a failing heart now,” Dr. Mulloy suggests. “Most of our patients have been in their 60s or 70s with failing hearts.”
We Want to Help Fix Broken Hearts
Mission Hospital does not currently offer heart transplants. However, what we do offer is a helping hand to assist you with regaining control over the health of your heart. With the HeartMate 3 and Mission Health doctors by your side, we can help you beat heart failure.
Daniel Mulloy, MD, is a cardiothoracic surgeon at Asheville Heart, an affiliate of Mission Health.