Quality of life is important to everyone but can be elusive for Central Texans who suffer from heart failure. American Heart Association statistics indicate about half a million people have heart failure and many die from it annually. Certainly a disease of old age and the result of cardiovascular disease, heart failure also can burden younger people who have congenital heart defects or develop cardiomyopathy, weakening of the heart muscle following a viral infection.
"Basically, their pump is failing," says Mim Luetje, RN, BSN, Ventricular Assist Device (VAD) and Heart Transplant Coordinator for the Seton Heart Specialty Care and Transplant Center (HSCTC). "Their body isn't getting enough blood, their daily activities are restricted, and they may feel fatigue. It really does change quality of life."
Mim described one patient, a younger man, who couldn't walk his kids to school just next door. Vacuuming the living room wore him out for the day. These are activities we all take for granted.
"We all expect to have a life and these patients progressively don't have a life," she adds. "It's especially difficult for those who have young children. Other components include feelings of depression, impotence, and helplessness about life."
The Seton Heart Specialty Care and Transplant Center operates as an umbrella that brings together physicians from multiple specialties that coordinate efforts to provide the best plan of care for the individual patient. That plan can include medication, exercise, diet management, surgery, and possible heart transplant. A primary tool in their arsenal is the Ventricular Assist Device (VAD), a mechanical pump that assists the heart in circulating blood in the body.
Ventricular Assist Device (VAD)
VADs can be used in two ways, either to help support a patient's failing heart while they await a heart transplant, called bridge to transplant, or as destination therapy, the final type of treatment to help improve quality of life for patients who are not candidates for heart transplant.
"The next big thing in heart care is device technology to support the failing heart," says William F. Kessler, MD of Cardiothoracic and Vascular Surgeons, medical director of the HSCTC's Mechanical Circulatory Assist Device program. "When I came to Austin eight years ago, I thought it would be several more years before heart transplant could be replaced. But it's coming to fruition now. There are ten new heart pumps in clinical trials. A patient who has poor quality of life because of heart failure now can have a pump that allows them to live as well as they can with twice the life expectancy and improved quality."
He cites an important study called REMATCH (Randomized Evaluation of Mechanical Assistance For the Treatment of Congestive Heart Failure) that followed the progress of two groups of heart failure patients. It demonstrated that the critically ill patients on VAD therapy lived longer and reported improvements in quality of life over their previous condition when compared to similar patients who received medication only.
Dr. Kessler describes a case of a 30-year-old mother who had a weakened heart after a viral autoimmune disease. He implanted a VAD, hoping to give the heart muscle a chance to recover. "About two weeks later, we took off the pump and her heart function came completely back to normal," he explains. "Now she has a normal life expectancy, which is important to someone with two young children."
"Right now, we diagnose about 40,000 patients each year in this country who have failing hearts. Worldwide, only 2,000 donor hearts become available for transplant. The only way we can keep up with the need is to improve these mechanical devices."
In 2002 the US Food and Drug Administration approved a device called the HeartMate® for use in patients who are not considered candidates for transplant. Instead of bridging them to transplant, it enables many of them to go home with an implanted pump that connects to household electricity or a battery-based power supply in a vest than can allow the person to be untethered for about an hour.
HeartMate® is one of three devices available at Seton's HSCTC. The others include the Abiomed and Thoratec systems. Seton became an early adopter of VAD technology, implanting its first Thoratec device in 1990. The HeartMate® supports only the left side of the heart. The Thoratec and Abiomed devices can support both sides of the heart. With the Thoratec device, the patient can go home using a "carry-on" suitcase-sized rolling power supply. A patient with the Abiomed in place must be in the intensive care unit until their heart recovers or they receive a heart transplant. Seton was one of the first three testers in the country to use the Abiomed device.
"One of our goals is to help patients make the best care choice for them," says Mim. "Not everyone can handle the need to be connected to a device all the time."
Dr. Kessler believes the technology will continue to improve. "Right now, the pumps have been reduced to about the size of a D-cell battery that can be implanted into a patient's chest. We have eliminated some of the lines that hook to the power source to make it simpler. This really is kind of space-age stuff. It's interesting and challenging, and you never get bored."
"Until people are threatened with heart bypass surgery, they don't get the message about self-care," he says. "It is particularly difficult in contemporary life with jobs and kids and busy schedules. But the most important thing you can do for yourself is preventive medicine - living life in moderation, not overeating, getting regular exercise and not smoking. If we could all do that well, there would be a dramatic decrease in coronary disease."
Advanced cardiovascular care such as heart transplant requires Medicare approval. Seton Medical Center Austin is the only Central Texas heart transplant center and one of only six facilities in Texas and 69 in the US approved by Medicare as destination therapy centers.
Find out more about heart failure and heart transplant in our Online Medical Encyclopedia.
William F. Kessler, M.D.
Originally from Houston, Dr. Kessler received his medical degree from Baylor College of Medicine in Houston and completed his General Surgery and Cardiothoracic Surgery residencies at the University of Texas Southwestern Medical Center in Dallas. Further training included a fellowship in Heart Transplantation at the University of California, Los Angeles. Dr. Kessler is a Fellow of the American College of Surgeons and a Diplomate of the American Board of Surgery and the American Board of Thoracic Surgery. He specializes in adult Cardiothoracic Surgery including heart transplantation, implantation and management of ventricular assist devices (VADs), valvular heart disease and all areas of Thoracic Surgery. Dr. Kessler has participated in numerous research studies and has authored various research articles in his specialty.
Mim Luetje, RN, BSN
Ms. Luetje was graduated from Barnes Hospital School of Nursing, then completed her BS in Nursing at UT-Austin. Before becoming a VAD coordinator, she was a Seton ICU nurse specializing in cardiovascular surgery patients, including teaching and mentoring nurses in the care of these patients.
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