At his Baltimore-area home, Daniel Steele, 58, takes off his battery pack and plugs himself in. His left ventricular assist device -- a mechanical heart pump -- will keep his blood flowing strong as he sleeps. Steele, a former project manager for a utility, is now on disability with advanced heart failure. Since September 2013, the LVAD has helped keep him alive -- and feeling pretty good -- as he waits for aheart transplant.
In 2007, Laura Huber of Aberdeen, South Dakota, then 26, gave birth to her first child. Soon after delivery, unexpected symptoms began. Huber had developed a rare, pregnancy-related condition that led to heart failure. That May, she underwent open-heart surgery to get an LVAD. Eight years later, she's content to stay on a heart pump. For Huber, LVAD isn't a bridge to transplant -- it's a destination.
Transplant or Destination?
Dr. Rebecca Cogswell is an advanced heart failure cardiologist at the University of Minnesota Medical Center, which implants about 50 heart pumps a year, divided between patients on destination therapy -- for whom the heart pump is meant to be permanent -- and those awaiting transplant. LVADs buy time for those on the transplant list, Cogswell says. But "another avenue" for pump use is for people who aren't transplant candidates but could still benefit, such as those in their 70s or 80s.
Age over a center's cutoff is a major reason patients aren't eligible for transplant, says Dr. Ryan Tedford, a cardiologist at the Johns Hopkins Comprehensive Transplant Center in Baltimore. Cancer is another: Depending on type of malignancy, patients might have to wait at least five years for transplant. Similarly, heavier patients with a body mass index above cutoff might quality for an LVAD as destination therapy.
As with transplant, Tedford says, a heart pump is considered a last resort after all the right medications have been tried, guideline-directed medical therapy has been given -- and the hospitalized patient is still struggling and getting sicker.
A landmark study, which randomly assigned patients with advanced heart failure to receive either "optimal medical therapy" or an LVAD implant, found a "substantial improvement in survival" for patients on LVAD support.
In August 2013, Steele entered the hospital carrying about 30 pounds of fluid buildup in his belly and legs. A cardiac catheterization confirmed that his heart, already fitted with a defibrillator and apacemaker, was getting worse. Diagnosed a decade ago with heart failure, Steele knew that now he was "really going downhill." He couldn't climb a flight of stairs. When he came home from work each day, he had to lie down to take a nap. At night, he couldn't sleep. "I had to sit in my chair because of all the fluids," he says.
Steele sums up his dwindling options: "I could stay in the hospital and hope a heart became available, or I could go home and let it go the way it's supposed to go," as in, let nature take its course. "Or I could get a heart pump, an LVAD, which I decided to do." Soon Steele had surgery to implant the HeartWare LVAD. "It's been a lifesaver," he says, without hyperbole.
LVADs are the most common type of mechanical heart pump, used when the left ventricle -- one of the heart's four chambers -- is failing in its function: to pump oxygen-rich blood throughout the body.
Device parts include a tube placed in the left ventricle to draw blood into the pump. The pump, located in the upper abdomen, contains the rotor, which rapidly moves blood into the aorta. A second tube -- the drive line -- leads from the pump to outside the abdominal wall, where it attaches to the batteries and controller.
The LVAD requires specialized, high-voltage batteries. At night, people plug themselves into a power module at their bedside. It's a "revolutionary technology" Cogswell says, a far cry from when people used to "wait in hospitals on refrigerator-sized machines" until a donor heart became available.
When the possibility of an LVAD arises, Cogswell says patients should ask questions such as: "What's my survival if I go on the path of just medicines?" "Is there an option for transplant, or not?" and "What's the complication rate for the heart pump?"
Wait for Transplant
Steele says recovery from implantation surgery was "pretty rough" the first day or two. But in a couple of weeks, he started feeling better and eventually had so much energy that he could hardly sleep.
After discharge, support at home is a must, Cogswell says. Caregivers receive extensive training on the heart pump and how to manage it, and how to take care of the abdominal exit site. For several weeks, they need to stay nearby as patients recover, in case of rare events like passing out.
Steele, who says he receives "excellent" care from his wife, hasn't had any complications. The biggest drawback, he says, is having to carry the battery and controller along with him at all times. That's a minor annoyance, he adds -- the device has turned his life around.
For Steele, the LVAD is a bridge to transplant, but he realizes he might be standing on that bridge for a while. As a large man with the 'O' blood type, it could take many months for a matching heart to become available. "But eventually I would like to get one," he says.
After Laura Huber gave birth, a condition called peripartum cardiomyopathy put the new mother into heart failure. In and out of the ICU, Huber went through a battery of tests. Once doctors suspected she might need a heart device, she was flown to the specialty heart program at the University of Minnesota Medical Center.
On May 8, 2007, Huber was implanted with a Thoratec HeartMate II. Her husband C.J. and daughter Maddie were by her side throughout the hospitalization. Amazingly, Huber was back at work within three months -- as a physical therapist working in cardiac rehabilitation.
Last November, Huber's original LVAD was replaced due to wire malfunction. She hopes the replacement model, the same as her first, proves just as durable.
Potential for Complications
Because the LVAD only supports the left side of the heart, Tedford says, a patient who also has right ventricular failure could continue having symptoms after surgery -- possibly requiring a second type of device. Bleeding is a major complication. "About 30 percent of patients in the first year will have some kind of gastrointestinal bleeding," Tedford says. The increased risk of clotting found several years ago with LVADs appears to have tapered off, he says. Blood-thinning drugs are prescribed for patients on LVAD therapy, and their heart medications may change after implantation.
Infection of the drive line is another potential hazard. To prevent that, patients and caregivers learn proper technique for daily dressing changes. Patients are asked not to shower initially. Eventually, they're given a shower bag to protect their equipment.
For people living with heart pumps, power outages take on new meaning. There's 30 minutes of backup power built into the LVAD, Tedford says, along with alarms. For extended outages, as with storms, LVAD patients receive priority service from the power company. With delays, some of Tedford's patients have had to travel to a local hotel or mall to plug in.
People with LVADs can rock climb and ski and travel a good distance, but contact sports aren't recommended (no surprise). Water sports such as swimming and boating are also off limits. One practical issue is how to wear the LVAD gear. Steele had custom vests made for his LVAD components. On the job, Huber wears her batteries, secured by Velcro tabs, clipped to a strap hanging down her back. The controller fits in a pack around her waist.
Huber says she sometimes forgets she has the device. For daughter Maddie, she says, the LVAD is the norm: "She doesn't know Mom any other way." For other patients who might someday face her situation, Huber says, "You're living a life with an LVAD -- the LVAD doesn't need to be controlling your life."
Lisa Esposito is a Patient Advice reporter at U.S. News.
and if you DO - why cry like a baby and wonder why this or that isn't happening - when you know little about HF - even less about how the FDA operates and how CMS rimburses said investigation device. play the man
may make you feel better - me I don't buy what I think is junk. :)
ah somewhat - got caught up in the enthusiasm - but, I could afford it. Put aside about 600k kind of like gambling money - my quality of life at least from a economic standpoint is assurred along with say 50% of my kids.. just working for the right corp at the right time. But - now it's an education bought several companies sub .20 I've mentioned HLS and ATSG which has allowed be to almost triple by 600k funny money investing. HF really interest me personally and as it relates to others I know. my career allows me to talk with Cardiologist and Hospitals somewhat intelligently and for enjoyment. I think this little ole stock has legs with a lot of ups and downs before the 'fat lady sings'. It's not like HCA, HLS, THC but there is a real potential to see a 10 bagger in five or six years. if you can't stand the heat on a gamble like this - why do it... get out and buy HCA HLS THC unless the Supreme Court rules against Obama Care - all these stocks will be up at least 30% over the 18 months. I like this little ole C-Pulse in the next year or so there could be more 20% swings. why cry about it... I cant certainly handle the loss what 70 - 80k not a small amt - but note considered a core 'investment'. why are you in SSH? need the money in the next 6 mo don't do it. :)
have U spent more time addressing Bo's BB than talking with Cardiologist or staff - kick in a little conversation about HF. was back at BJC waiting with Pt friend in need of Kidney -- addressed some of the staff - once again. it's going to take some time and will be one of the tools. now sell some of those winners get another season ticket - and enjoy a little Aaron R football :) way back in thd day under grad worked the ole Danny Thomas Open then St Jude now FDX in Memphis. ole Arnold Chi Chi, Lee Trevino - they would talk to you as hit around. ah golf have a good weekend
what will he say.. He bought 5.00 - 5.10 but b4 he bought he sold o then he bought NO he ______ :) :)
sure beats a 1% MM for a year :)
ah Bigs gladly posted he thought he knew as he always does with all those 1,876.2 opinions - now if he will kindly cut and paste any that have unfolded as he predicted . whew we better turn the series around at 230 tomorrow will be at Blues game against SSH home team :)
U need to apply to the FDA and inform them of your JUNK! obviously over the past 20 years things have changed at the FDA modifications take place all the time. let's see you have submitted how many to the FDA vs say Kim / Medtronic and ah yes how many have you successfully navigated through the process and how well were you paid to accomplish. oops O and so you want to spend time yapping on a yahoo message bd. to bad so sad :)
are you another kid trying to make a quick buck? how hard is it to use your cell ask a few ?? own a car dr lic drive to a site - sit in a waiting room talk to a HF pt.. engage some staff small talk polite interested in HF how is that c-pulse etc etc would that be facts - be more beneficial that reading a message bd :)
I'd ask you --? do you know more about Wisc BB or the treatment of HF? and if it's HF where did you obtain your experience / training? :) if you don't like the c-pulse - where are the 'holes' have you ever actually seen a c-pulse?
We have developed new material to aid physicians in discussing the potential benefits of the C-Pulse System to their patients. These materials are currently going through centers institutional review board. In addition Dr. Bill Abraham has been instrumental in speaking with centers who had difficulty enrolling their first patients. After Dr. Abraham spoke with two of the three centers, how he positions C-Pulse therapy to patients, two of those three centers enrolled their first patient in the following month. So we are confident that we are making a lot of progress on increasing that enrollment rate up from that 20
Bigs all those shares between 5.00 - 5.10 may be underwater why didn't you do 4.00 - 4.10 my last 5,000 were under 4.00 :)
why? big boys own HCA and understand risk.. health care etc most on SSH are speculators far younger crowd trying to swing for the fences and hoping for a HR in a month. Not going to happen. or maybe just a few day traders trying to pick up a couple hundred dollars a day. your guess?
:) c-pulse not for every HF pt In a Trial you would like to exclude high risk patients - cherry pick - well if you say so.. it's a 'practice and those that 'practice' know with 100% certainty that 100% of all HF patients will die. c-pulse will delay that date for some improve the quality of life for some and to find that 'some' is the goal of the trial. cheers sell if you don't believe those shares will be bought by those that do
hospital U just don 't know what you talk about. are you just lonely . great ball game today you might want to listen to Elvis Are you lonesome tonight?
:) try to find some contentment somewhere - he a little BB might work - take in the Sox maybe the Mets
all over the Middle East.. good G man at least try to stay on some subject -- start a blog on your love for HF see if you gain any followers. maybe some will off this bd.. not me but maybe
get any positive attention about anything or opinion.. nonsense generates nothing eh!