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