Posts Tagged ‘ventricular-assist device’

James Fang discusses LVADs for End-Stage Heart Failure with WebMD

April 11, 2010

More than 5 million Americans have heart failure, a progressive and often lethal condition that weakens the heart and saps its pumping power. The mainstays of treatment — including drug therapy, lifestyle modification, and surgery to implant pacemakers or defibrillators — can be quite effective at managing symptoms of mild to moderate heart failure.

But what about the estimated 150,000 Americans who suffer from chronic, severe heart failure?

Doctors traditionally have had little to offer these patients in the way of lifesaving treatment, short of a heart transplant. But with only about 2,100 donor hearts available each year, the demand for hearts inevitably outweighs the supply. And some patients are simply too old to qualify for a transplant. For them, what’s the alternative?

There’s now an option that could change the outlook for many with severe heart failure: implantable mechanical pumps called left ventricular-assist devices (LVADs or sometimes simply VADs.)

These devices were once just used as a “bridge” — a temporary stopgap to keep heart failure patients alive until they could get a heart transplant. But now, they have become so effective that doctors use them as a treatment in themselves. LVADs are now an alternative to heart transplants, permanently augmenting the action of a heart’s main pumping chamber.

In addition, the continuous-flow LVAD was associated with fewer infections and a significantly lower rate of failure.

“The continuous-flow LVAD has changed the landscape of advanced heart failure,” says James C. Fang, MD, chief medical officer of the Harrington-McLaughlin Heart and Vascular Institute at University Hospitals Case Medical Center in Cleveland and the author of an editorial on LVADs that accompanied the study in the New England Journal of Medicine.

“In addition to being more durable, the new device is a lot smaller – about the size of a D battery. It’s also quiet. You can barely hear it. With the old devices, you could hear them coming down the street.”

Find the full article on CWRUmedicine.org

Dr James Fang discusses the VAD Approach

March 24, 2010

An alternative one-on-one, patient-oriented approach to  heart disease and heart failure

According to James C. Fang, MD, Medical Director, Advanced Heart Failure & Transplant Center and Professor, Case Western Reserve University Department of Medicine, “The mission of the Advanced Heart Failure & Transplant Center is to provide the latest and most effective therapies to patients in Northeast Ohio and surrounding regions in a personalized one-on-one, patient-centered approach.”

With a high level of expertise in treating heart failure, performing heart transplants, and implanting VADs (also known as heart pumps), the Center offers another sophisticated site in Ohio for patients to consider for their heart and vascular health. One of the most important services provided by the physicians at the Center is their ability to review a patient’s current medical and device therapies and then to provide other treatment options to improve their prognosis and quality of life. “At University Hospitals Case Medical Center, we offer many options and a very personalized approach. We are proud of the fact that we offer very individualized care,” says Dr. Fang. “Many patients don’t recognize that they are suffering needlessly.”

The VAD Option
Patients seen at the Center have refractory congestive heart failure and continue to be short of breath despite medications, device therapy (such as biventricular pacemakers) and heart surgery. These patients find that even doing simple activities like taking a shower or sitting in a chair are difficult. In addition, they cannot stay out of the hospital for very long – they are often regularly admitted for shortness of breath and fluid buildup in the legs. Such patients may be candidates for heart transplantation or a VAD.

VADs are sophisticated, miniaturized pumps that help the heart to provide sufficient blood flow throughout the patient’s body. “VADs are the newest form of a mechanical heart,” says Dr. Fang. A healthy heart can normally pump about 5 L of blood per minute around the body at rest. If, for example, a patient’s heart can pump only 1 L of blood per minute, the VAD will pump an additional 4 L, for a total of 5 L of blood per minute. “The heart pump helps,” notes Dr. Fang, “without entirely taking over the function of the heart.”

Typically, heart pumps are used temporarily while a patient awaits a heart transplant. Current first generation VADs, such as the Thoratec Heartmate XVE, are also used as a “destination” therapy – a permanent solution for heart failure. These devices can function for 12 to 18 months before they must be replaced. It is anticipated that a new, second generation of heart pumps, now undergoing investigational study, will increase the duration of ventricular assistance to two to four years. Nationwide about 2,500 heart transplant operations are performed annually and the Advanced Heart Failure & Transplant Center’s heart surgeons have collectively performed hundreds of heart transplants.

Learn more about VADs at CWRUmedicine.org