The treatment options for advanced heart failure include several short-term and long-term interventions and devices.
- Abbott-Thoratec Heartmate II
- Abbott-Thoratec Heartmate III is the newest LVAD available. It is a pump implanted in the left ventricle of the heart to help pump blood to the rest of the body.
- Extracorporeal membrane oxygenation (ECMO) is a temporary device that helps circulate blood for patients in cardiogenic shock.
- Impella (CP, 5.0, RP) is a catheter-based pump that provides temporary support of the left or right heart ventricle.
- Medtronic HeartWare is a small, silent LVAD which is used as a bridge to heart transplantation. It is currently in clinical trials for destination therapy in patients with end-stage heart failure.
- SynCardia total artificial heart is an artificial heart to use as a bridge to heart transplantation.
- Tandem heart is a small, external, short-term pump (VAD) that supports either the left or right side of the heart. It is used for short-term treatment or as a bridge to a longer-term device.
BENEFITS OF VAD
The overall goal of VAD implantation is improved health and quality of life. The VAD may not make all your symptoms go away, or directly fix the heart failure. However, patients see a marked improvement in symptoms of heart failure. In most cases, blood flow improves, you can expect to have more energy and decreased shortness of breath and fatigue.
Since successful VAD surgery helps deliver more oxygen-rich blood, you may feel well enough to resume many of the activities and hobbies. The improved blood flow may also prolong life. Research studies that have shown, on average, LVAD patients live longer than similar patients with advanced heart failure who are treated with medications alone.
THE DEVICE(S)
A VAD is a pump that assists a weakened heart to improve blood flow to the rest of your body. This most often involves assisting the heart with the placement of a left ventricular assist device (LVAD). There are several different types of artificial heart pump devices designed to meet the needs of individual patients:
- Left Ventricular Assist Device (LVAD) helps the left side of the heart pump blood to a large blood vessel called the aorta and to the rest of the body.
- Right Ventricular Assist Device (RVAD) helps the right side of the heart pump blood to the lungs.
- Bi-Ventricular Assist Device (BiVAD) helps both sides of the heart pump, by using both an LVAD and RVAD.
- Total Artificial Heart (TAH) replaces the heart and pumps blood both to the body and to the lungs. TAH is the only device that requires the removal of your own heart and replaces it with an artificial one. An LVAD or RVAD is placed in your own heart to pull blood out of your weakened heart and pump blood forward into the rest of your body.
Are VADs temporary or permanent?
VADs can be used as short and/or long-term therapies. Short-term devices (CentriMag) are used when patients are unstable and need help to pump the blood for a few days or weeks. Short-term devices are easier to put in and take out. This can be important for very sick patients who may not survive a more difficult surgery. Temporary support can be used to support one or both sides of the circulation.
Long-term devices (implantable VADs) are used for patients that need assistance for months or years. Long-term devices require a longer and more complicated surgery, but the device is more securely placed, so patients are able to leave the hospital and go on living a productive and meaningful life.
Some patients may receive a short-term device before getting a long-term device. Patients who are too sick and very high risk for a long-term LVAD, are given the option of a short-term LVAD temporarily.
Some patients may receive a short-term device before getting a long-term device. Patients who are too sick and very high risk for a long-term LVAD, are given the option of a short-term LVAD temporarily.
The short-term LVAD is also used as a bridge to heart transplantation. While recommending you for an LVAD, our medical team will evaluate your condition and recommend which option is best for you in your current condition.
- Bridge-To-Transplant (BTT) therapy is a treatment option for patients who get an LVAD in the advanced stages of heart failure who are awaiting heart transplantation.
- Destination Therapy (DT) is a permanent treatment option for patients who get an LVAD in the advanced stages of heart failure that are not eligible for heart transplantation. Some of these patients may become eligible for heart transplantation in the future.