Saving Hearts with LVADs: Cardiothoracic Surgeons Find Wider Use for Heart Device

Nearly 5 million Americans live with failing hearts, and that number keeps going up each year. In the past, the only option was heart transplants. But now, an implantable device may offer a permanent solution.

Like many grandparents, David Hodurski lives for the little ones and for the little moments. When doctors told him his heart was failing, every one counted.

"I couldn't walk from here to that wall prior to this without being totally exhausted," Hodurski says.

An implant gave Hodurski his life back. It's called a left-ventricular assist device -- also known as an LVAD. In the past, LVADs were only used on patients awaiting a heart transplant. But now, they may also benefit those who are not candidates for a transplant -- and could even double their survival rate.

Cardiothoracic surgeon Charles Klodell, of University of Florida in Gainesville, says, "Now, for the first time, for people who are appropriate candidates for this and maybe not for transplantation, we have something to offer them."

Surgeons place the device in the abdomen and connect it to the left ventricle. Once implanted, it takes blood out of the failing heart and pumps it into the body. That offers relief for patients with heart failure.

"Literally, in 24 hours, you'll walk by, and they'll tell you, 'I can't believe how much better I feel,' " Dr. Klodell says.

"[With the implant], I have no problem," Hodurski says. "I can get around. I just have to watch things like things that draw a lot of electricity."

Patients have to change their batteries about every three hours, but Hodurski says it's worth it. "You know, if I got to cart these around the rest of my life, that's still a small price to pay for the rest of my life." And he hopes researchers will continue to look for new options for the next generation of hearts.

Dr. Klodell says a heart transplant is still the preferred treatment if patients are candidates. About 100 centers in the United States offer LVADs as a permanent therapy. The device lasts about two years before having to be replaced. Dr. Klodell says the next generation of pumps may last five to six years.

When the heart no longer works properly, a person may be lucky enough to receive a heart transplant. Doctors replace the diseased heart with a normal organ from a donor who has died. The donor organ is removed, cooled and kept in a special solution as it is transported to the patient.

For the operation, the patient is hooked up to a heart-lung machine that pumps blood through the body, bypassing the heart and lungs. The breastbone is split in half and the patient's heart is removed, except for the back walls of the atria, the heart's upper chambers. These are connected to the backs of the atria on the new heart, which is then sewn in place. Once the blood vessels are re-connected, the heart may start beating on its own as it warms up, but sometimes an electric shock is needed to start it.

Once the transplant is complete, the patient must take several medications, usually for the rest of his or her life. The most vital to survival are called immunosuppressants: These keep the body's immune system from rejecting the new organ as foreign tissue. But the drugs have side effects: hypertension, fluid retention, tremors, and possible kidney damage. The weakened immune system may also be less able to fight off genuinely threatening invaders, leading to infection. So additional drugs may also be prescribed.

Transplants are risky procedures. The most common causes of death following a transplant are infection and organ rejection, but survival rates continue to improve. Today, survival rates are 84 percent after one year, 77 percent after three years, and about 50 percent after 10 years following the transplant surgery. As of 2002, the longest a person has survived after a heart transplant is 24 years.

SOURCE/RESOURCE:  www.sciencedaily.com on 5/1/05