To treat heart failure, initially, doctors recommend diet, exercise, lifestyle changes and treatment or control over underlying diseases that can contribute to heart failure (like high blood pressure or diabetes). Medications can diminish fluid build-up, relax blood vessels, reduce workload on the heart or help the heart beat stronger. When heart failure is severe and treatments don't help alleviate symptoms, patients may require a heart transplant. According to the United Network for Organ Sharing, 2,030 heart transplants were performed in 2007.
A left ventricular assist device is a mechanical heart pump. It isn't a replacement for the heart. Instead, a LVAD acts like an extra pump to help the heart provide enough blood flow for the body. Patients with heart failure who are waiting for a heart transplant may be candidates for a LVAD. The LVAD acts as a "bridge to transplant," easing the workload on the heart and providing temporary relief from symptoms until a new heart becomes available.
Permanent use of a LVAD is known as destination therapy. There are three main categories for whom LVAD may be considered as a permanent option. First, is the cancer patient. Cancer patients are unable to take immunosuppressive medications because the drugs reduce the activity of the immune system. Thus, the body would lose much of its natural ability to fight the cancer. Sinan Simsir, M.D., a Cardiothoracic Surgeon with Cedars-Sinai Medical Center says doctors typically wait about five years after treatment before considering a transplant for a cancer patient.
The second category of heart failure patients who may benefit from permanent LVAD treatment are those who have high levels of antibodies. These antibodies develop after exposure to foreign proteins (like from a previous transplant, pregnancy or blood donation). When a patient is exposed to those antibodies again in a new heart (or any other organ), there is a high risk the immune system will reject the donor organ. The greater the number of antibodies a patient has, the higher the risk of rejection.
The last group of patients who would most benefit from permanent LVAD therapy are those with immune suppressing diseases, like HIV/AIDS. These patients already have a weakened immune system and can't tolerate immune-suppressing medications needed after a transplant.
Dr. Simsir says patients who receive LVAD as a permanent therapy have a greatly improved quality of life. They are able to exercise, work and participate in social/family activities. One long-term study found 56 percent of LVAD patients were still alive at one year and 33 percent were alive at two years.