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    LVADs for End-Stage Heart Failure: An Alternative to Transplants

    Continuous-Flow LVADs

    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 harness.

    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 life.

    What's more, patients implanted with the new continuous-flow pump were twice as likely to live for at least two years following surgery, according to the report in the Dec. 3, 2009, issue of the New England Journal of Medicine. And they were four times as likely to survive for two years as patients on drug therapy alone.

    In addition, the continuous-flow LVAD was associated with fewer infections and a significantly lower rate of failure.

    "The continuous-flow LVAD has changed the landscape of advanced heart failure," says James C. Fang, MD, chief medical officer of the Harrington-McLaughlin Heart and Vascular Institute at University Hospitals Case Medical Center in Cleveland and the author of an editorial on LVADs that accompanied the study in the New England Journal of Medicine.

    "In addition to being more durable, the new device is a lot smaller -- about the size of a D battery. It's also quiet. You can barely hear it. With the old devices, you could hear them coming down the street."

    LVADs: Risks and Warnings

    Though LVADs offer new hope to many people with heart failure, it's important to understand the drawbacks. They don't work for everyone. They also pose an increased risk of stroke. Some people with LVADs need to take anticoagulants to lower the odds of stroke.

    And despite their successes, LVADs are still a new treatment. Yancy estimates that a few thousand people have received them so far. Hundreds more will get them this year. That's a small number compared to the tens of thousands who could potentially benefit. About 100 centers in the country have the expertise to implant them.

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