Health Articles

LVADs can keep heart failure patients alive -- and off the transplant list.

By Kathleen Yount

There are two holy grails in solid-organ transplantation, says Robert D. Davis, MD.

One is unlimited survival of a transplanted organ once it finds its new home body. The other is unlimited access to donor organs.

The latter, in particular, was on the minds of researchers seeking ways to keep heart transplant candidates alive long enough to receive their new hearts.

Their solution was ventricular assist devices (VADs), surgically implanted medical pumps that take over most of the heart's circulatory duties. Originally used as a bridge to heart transplant, the devices functioned so well that they are now also used as a primary treatment (called destination therapy) for advanced heart failure patients not eligible for heart transplantation.

Five years ago, Duke became one of the first hospitals nationwide and the first in North Carolina to perform left VAD (or LVAD) implantation as a destination therapy, and since then it has become one of the highest-volume LVAD centers in the country.

As with lung transplants, research shows that the more LVADs an institution does, the more successful it is at them; one Duke patient is still doing well after more than four years with device support, says surgeon Carmelo Milano, MD.

Duke is now conducting clinical trials to test the next generation of heart-assisting devices: axial flow pumps, which may be more durable and longer-lasting than LVADs.

As the second-largest enroller in the current trial of these pumps, HeartMate II, Duke surgeons have implanted more than 50 axial flow pumps as destination therapies.

And, says Milano, an encouraging number of these patients were women. Sizewise, he explains, LVADs can be a hard fit in a female chest cavity. But because axial flow pumps are 80 percent smaller than LVADs, they can be accommodated more easily in a woman.