Heart-Failure Treatment by Device
Technological breakthroughs are changing the course of heart-failure treatment -- but doubts remain about how many people will benefit in the near future.
Left Ventricular Assist Devices (LVADs)
In the past, people with end-stage heart failure had to rely on the hope of a transplant. Left ventricular assist devices (LVADs) were originally designed as "bridge" therapy, to help people with a weak left ventricle -- the main pumping heart pumping chamber -- survive while they waited for a heart transplant.
LVADs are implanted, pump-like devices that assist the weakened heart in circulating blood. While LVADs were originally attached to large control panels in hospitals, newer devices are smaller and contained, allowing patients to leave the hospital and go home with a small external device and battery pack. LVADs are generally used in people who are not eligible for heart transplants, usually because of age.
While transplants are a highly effective heart-failure treatment, the chances of getting one are limited by the availability of donors. Only about 2,500 people in the U.S. receive a heart transplant each year while many more remain on waiting lists; heart failure causes 50,000 deaths annually and contributes to another 250,000 deaths. A mechanical device like an LVAD that doesn't rely on donors could make a huge difference in heart-failure treatment.
Eric A. Rose, MD, chairman of the department of surgery at Columbia University College of Physicians and Surgeons and surgeon-in-chief at Columbia Presbyterian Medical Center, tested the effectiveness of the LVAD in people with end-stage heart failure -- 68 had LVADs implanted and 61 were given standard medical care. After two years, the LVADs were shown to be strikingly effective, reducing deaths by 47%.
Potentially, one of the most promising aspects of LVADs is that they may actually rest the heart, allowing it to recover; in such cases, the device can be removed.
"In a lot of ways, it's not unexpected," says John Watson, MD, who was a project officer for the LVAD study. "One of the original ways of treating heart failure was with bed rest, and some people recovered. It's like putting a bone in a cast, giving the heart time to heal."
However, Rose is cautious. "I think that the effect has been overrated," he says. "I've seen people who can have their LVADs removed successfully, but I've seen others who have had their hearts fail again afterwards. I think that success is the exception rather than the rule, and it all depends on the mechanism of heart failure in the first place."
Rose does believe that LVADs technology for heart-failure treatment will improve and become more widely used with time.
"I think that LVAD usage will be analogous to kidney dialysis," says Rose. "When dialysis was first introduced in the 1960s, it was only viewed as a bridge to kidney transplantation. But as the technology developed, it's gotten to the point where people can live on dialysis for decades."