Cardiac implant keeps weak heart pumping

St. Louis Post-Dispatch (MCT) - When someone's heart is about to quit, they're usually told to wait for a transplant or wait to die. Lately, doctors have found other options.

"Transplant will never solve the public health dilemma which is posed by all these people with end-stage heart disease," said Dr. Edwin McGee, surgical director of heart transplantation at Northwestern Memorial Hospital in Chicago.

Because there aren't enough donor hearts to meet the demand, "cardiologists are recognizing that these people need some type of help or they're going to die," McGee said.

More and more, surgeons turn to cardiac implants to help weak hearts pump blood to the body. The newest versions of ventricular assist devices are smaller, quieter and more portable. Where once the devices were the size of a coffee maker, the latest versions have shrunk to the size of a D battery.

They're not the equivalent of artificial hearts, which actually replace the heart. The implants attach to the heart and serve as a booster pump to increase blood flow. They can help reduce the symptoms of heart failure, including fatigue, shortness of breath and pain.

Heart disease is the nation's No. 1 killer of men and women. Historically, patients with end-stage heart failure were made to feel comfortable but had few options for survival. Doctors estimate that one-third to one-half of people with end-stage heart failure could benefit from a cardiac implant.

'THAT'S NOT A LIFE'

Tom Nichols wanted to die. His kidneys collapsed, he carried 40 pounds of water weight and fluid seeped from his skin. With intense pain in his legs, he couldn't walk or even stand. He stayed in the hospital for three weeks at a time.

"Towards the end I couldn't even get out of bed, so that's not a life," Nichols said.

The St. Louis resident got a heart assist device in November 2007. Surgeons created a pocket under Nichols' rib cage and attached the implant to his ventricle in a four-hour surgery.

Because Nichols is not a candidate for a heart transplant, he will live with the implant indefinitely. Now 57, Nichols spent New Year's Eve in Las Vegas.

Nichols' limitations include not being allowed to swim and carrying a battery pack at all times.

"It's not the easiest thing, but you get used to it pretty quickly," he said. "It sure beats a dirt nap."

BUYING TIME FOR PATIENTS

Some health care analysts say the cost-effectiveness of the devices isn't proven. The devices are so new that doctors aren't sure how long they will last or how they will affect a patient's life span. The open-heart surgery and related initial costs of the implants can top $300,000. Complications can include infection, stroke, kidney or respiratory failure, bleeding, clotting and device malfunction.

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At Barnes-Jewish Hospital in St. Louis, the patient who has lived the longest with a newer heart implant got one 3-˝ years ago. Doctors there say they anticipate the devices lasting five to 10 years.

Heart transplant is still the gold standard of treatment for end-stage heart failure, but doctors believe the implants can improve the quality of life for patients as they wait for a transplant and for those who aren't candidates for transplants because of their age or other health problems.

"Many of these patients are literally almost dead when we get them on the table," said Dr. Nader Moazami, surgical director of cardiac transplantation at Barnes-Jewish Hospital. "We think it will buy a lot of time for these patients in order to find an appropriate heart."

The eligibility rules for heart transplants are strict, in part because there aren't enough hearts for everyone who might need one. About 80 people are on waiting lists for heart transplants in St. Louis. About 30 people here get new hearts each year.

Last year, surgeons at Barnes-Jewish implanted more heart-assist devices (31) than they performed heart transplants (24). At Northwestern, surgeons performed 27 of each in 2008.

About two-thirds of the patients who receive heart pump devices go on to receive transplants, and the other third will use the implants permanently. Moazami believes that as doctors' experience with the devices grows, more patients will receive them as an alternative to transplants.

CARRYING A BATTERY PACK

The devices require some dedication. The patient must be willing to wear a small 5- to 8-pound backpack and check in regularly with doctors. A half-inch thick tube exits the patient's body and connects to the controller and battery pack. The batteries last three to five hours at a time and can be charged by plugging the pack into a base unit.

Larry Bonds couldn't walk up a flight of stairs or pick up a grocery bag before getting a ventricular assist device in May. The device got him up and moving as he waited for a new heart that came in November.

Now, Bonds said, he likes knowing everything inside him is real, and working.

"I no longer have man-made equipment in me," said Bonds, 52, of Brentwood, Mo. "It is such a difference to feel normal again."

HEART INFO

Visit artificialheart.wustl.edu

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© 2009, St. Louis Post-Dispatch.