More than 5 million Americans have heart failure, a progressive and often
lethal condition that weakens the heart and saps its pumping power. The
mainstays of treatment -- including drug therapy, lifestyle modification, and
surgery to implant pacemakers or defibrillators -- can be quite effective at
managing symptoms of mild to moderate heart failure.
But what about the estimated 150,000 Americans who suffer from chronic,
severe heart failure?
Drug therapy to lower blood pressure has been shown to reduce heart failure rates by 40%-60%.
Reducing blockages in the coronary arteries with anti-cholesterol drugs has been shown to reduce heart failure rates by 30%.
Early diagnosis and treatment of heart-valve abnormalities can prevent heart failure caused by chronic volume overload of the heart's left chamber.
Doctors traditionally have had little to offer these patients in the way of
lifesaving treatment, short of a heart transplant. But with only about 2,100
donor hearts available each year, the demand for hearts inevitably outweighs
the supply. And some patients are simply too old to qualify for a transplant.
For them, what's the alternative?
There's now an option that could change the outlook for many with severe
heart failure: implantable mechanical pumps called left ventricular-assist
devices (LVADs or sometimes simply VADs.)
These devices were once just used as a "bridge" -- a temporary stopgap to
keep heart failure patients alive until they could get a heart transplant. But
now, they have become so effective that doctors use them as a treatment in
themselves. LVADs are now an alternative to heart transplants, permanently
augmenting the action of a heart's main pumping chamber.
"With the new devices, there finally appears to be a real, practical
solution to advanced heart failure,” says Clyde W. Yancy, MD, president of the
American Heart Association, medical director of the Baylor Heart and Vascular
Institute at Baylor University Medical Center in Dallas, and a noted expert on
heart failure. “This has been a 40-year pursuit of a mechanism that can take
over for a heart that is failing. This is big news."
The Evolution of LVADs
LVADs have been around in some form since the 1960s, but have been used
primarily as a temporary treatment to give the patient's heart a chance to
improve or to keep the patient alive long enough for a donor heart to be
First-generation LVADs are limited by their considerable bulk and poor
durability. The large size increases the risk of implantation surgery and makes
the device unsuitable for smaller patients.
Recent research has demonstrated the superiority of the newer rotary, or
"continuous-flow," LVADs, which are smaller and more durable than their
Continuous-flow LVADs consist of a pump implanted in the abdominal wall
linked with tubes to the patient's aorta and left ventricle. A power cord
emerging through the abdominal skin leads to a control unit worn on the belt,
which, in turn, is attached to battery packs worn in a shoulder
One study of 200 patients with advanced heart failure showed that both the
older LVADs and the new continuous-flow LVADs improved exercise tolerance and
quality of life. That's significant, Yancy says, given that even people with
well-treated heart failure tend to have seriously impaired quality of