Surgeons at the Brigham and Women’s Hospital (BWH) Cardiovascular Center offer an innovative surgical option that can improve survival and quality-of-life for carefully selected patients with end-stage heart disease. Gregory Couper, MD, Director of the Heart Transplant and Circulatory Assist Program at BWH, says, “We are pleased to offer our patients the HeartMate XVE Left Ventricular Assist System, the only left ventricular assist device (LVAD) FDA-approved as destination therapy for advanced heart disease.”
Patient Selection
Appropriate candidates for LVAD destination therapy:
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Suffer from end-stage (NYHA Class III or IV) heart failure, despite optimal medical management;
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Are inotrope-dependent;
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Are not eligible for transplantation because of age or medical condition.
REMATCH
BWH was the only New England site for the landmark REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial, which compared outcomes for patients managed with LVAD plus medical therapy with outcomes for patients on optimal medical therapy alone. The trial demonstrated a better survival rate among the LVAD group, and most LVAD recipients improved two NYHA classes.
Living with an LVAD
The device consists of a pump implanted in the abdomen, inflow and outflow conduits, and a driveline that exits the body and attaches to an external battery pack. Patients fitted with an LVAD can participate in any activities they choose, with the exception of swimming. Dr. Couper says, “One of our patients improved so significantly on LVAD destination therapy that he became a candidate for transplantation and subsequently received a heart transplant.” Occasionally, a destination VAD patient will improve so much on therapy to become a suitable transplant candidate.
Next-Generation LVADs
Mechanical failure is the limiting factor on this, and indeed on all LVAD systems; pumps need to be replaced every two or three years. The next generation of LVADs, on the very near horizon, will have rotary action as compared with the pulsatile action of today’s LVADs and are anticipated to last at least five, and perhaps as many as 10 years.
Cardiac Pioneers
BWH cardiac surgeons have been pioneers in the clinical development of surgical options to treat heart failure. Twenty years ago they performed the first successful heart transplant in New England, and five years ago they performed the first LVAD implantation in New England intended as destination therapy. Today, BWH has one of the busiest cardiac transplantation and circulatory assist programs in New England. Dr. Couper says, “LVAD destination therapy is a welcome addition to our therapeutic armamentarium for patients with end-stage heart failure.”
This article appeared in BWH's Winter 2005 Cardiovascular Center Update.
The Cardiovascular Center at BWH
Delivering innovative insights and solutions to even the most complex disorders of the heart, vessels and circulatory system, The Cardiovascular Center leads the way in providing comprehensive care across the full spectrum of cardiovascular disease areas. Many of the innovative therapies and state-of-the-art technologies available at the Center have been developed by the experts of Brigham and Women’s Hospital. We are consistently ranked among the best hospitals in the country in just about every specialty, including cardiac surgery, cardiovascular medicine and vascular surgery.
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