For patients who have been hospitalized 2-3 times for heart failure, surviving the next year is a coin toss. Left ventricular assist devices (LVADs) can help keep this population alive and improve quality of life. Internationally, the 1-year survival rate is 80%. Ours is 92% so far, and maintaining a 90% rate is an attainable goal.
Offering LVADs and other mechanical circulatory support devices is an essential part of comprehensive care as The University of Kansas Health System enhances its advanced heart failure and transplant services. It also gives patients in the region a second opinion close by. Having more than 1 local institution with this capability also increases overall visibility and challenges each hospital to maintain and improve quality and outcomes.
We have built a team of professionals who have experience with LVADs as part of established, high-volume institutions. This experience, combined with surgical skill, an excellent nursing team and dedicated palliative care experts, has enabled us to get patients back on their feet and living successfully. Our length of stay averages about 18 days, much better than the national average of 24 days.
HeartMate II® and HeartWare® devices available
We use 2 different devices – the HeartMate II LVAD and the HeartWare HVAD®.
The HeartMate II LVAD is a surgically implanted, rotary continuous-flow system that works in parallel with the native left ventricle. It's powered electrically through a percutaneous driveline. The HeartMate II was developed with the goal of providing several years of circulatory support for a broad range of advanced heart failure patients – as a destination therapy or bridge to transplant.
The HeartWare HVAD is a newer LVAD that fits totally within the pericardium. It is a smaller, centrifugal flow device, which we can implant less invasively, through a small thoracotomy and another small incision, avoiding a full sternotomy. This procedure can shorten length of stay and decrease blood loss and right ventricular dysfunction, allowing patients to return to daily life sooner.
Each device has benefits. Both are durable, safe and able to get patients out of heart failure so they can enjoy life. We may be more likely to recommend the HeartWare HVAD for very small people and those without other cardiac issues. But we also have to balance the risks: The HeartWare HVAD has a higher stroke rate in the long term, while the HeartMate II LVAD has a higher thrombosis rate. We have had success managing both with refined surgical techniques and careful control of blood pressure and anticoagulation.
Quality of life enhanced
Some patients fear an assist device will negatively affect their quality of life. To the contrary, our experience and data prove that patients have an objective increase in quality of life when they come out of heart failure supported by a device. Most can do 90% of what they could prior to receiving the device – sometimes even more.
Additionally, we are able to do these procedures with less intervention than ever before. We are experiencing so many advances that medical assistance may one day rival transplant for longevity and outcomes.
Transplant outcomes improved
Another common fear is the device will negatively affect the outcome of a future transplant. Our experience shows that some patients who receive a VAD prior to transplant see their heart failure symptoms abate, along with improvement in kidney, liver and respiratory function. They go into the transplant stronger and have better outcomes.