Mechanical pumps offer hope to patients not suited for heart transplants
March 12, 2012 4:00 PM
Robert and Dawna Perlick of Rochester with their three sons, from left, R.J., 8, Joseph, 5, and Tommy, 7. Robert Perlick, 40, was given an artificial heart pump in 2009 due to severe heart failure caused by a virus.
By Pohla Smith Pittsburgh Post-Gazette
Physicians gave Robert Perlick six months to live in 2009 because of congestive heart failure caused by a virus that attacked his heart.
In March 2011 William McChesney's heart was so weakened by an attack three years earlier that doctors said he was no more than a month away from death.
A transplant would have been the ideal solution for each man but wasn't possible even if heart matches weren't so hard to come by.
A review of Mr. McChesney's medical records showed a few cancer cells had been detected when the Bethel Park CPA, now 69, had a growth removed from his colon in 2009. His insurance company wanted him to be cancer-free for five years before he was listed for transplant.
Mr. Perlick, now 40, a disabled truck driver from Rochester, was 395 pounds -- too obese to meet transplant-list standards.
But help was available: Both men underwent surgery for implantation of LVADs, mechanical pumps that help send blood from the left ventricle, the lower left chamber of the heart, to the rest of the body.
The devices were implanted as destination therapy rather than bridge-to-transplant, which means the two men will have the devices at least for the foreseeable future.
Destination therapy is growing as an option for patients whose hearts are not going to recover and who probably are never going to be transplant candidates.
There also are RVADs, and when both lower chambers of the heart need assistance to pump effectively, both devices can be used together and referred to as BIVADs.
"The percentage of destination therapy patients is growing," said Stephen Bailey, surgical director of heart transplantation and mechanical circulatory support at Allegheny General Hospital. Right now, though, twice as many LVADs are implanted as bridge to transplant at Allegheny General, compared to destination therapy.
There also is a category called bridge to decision, in which for various reasons it is not yet clear whether a patient could be a candidate for a heart transplant.
But Mr. McChesney and Mr. Perlick are considered destination-therapy patients, said Robert Kormos, director of UPMC's artificial heart program and the surgeon who implanted their LVADs.
"They're destination-therapy unless they're obvious for transplant," he said, noting that both Mr. McChesney and Mr. Perlick hope their status will change to bridge-to-transplant. Mr. McChesney is counting how long it is since his cancer was detected, and Mr. Perlick has lost a great deal of weight.
"If something changes ... we would reassess them," Dr. Kormos said. He added, though, that other factors that would make a transplant inadvisable could also come up in the meantime.
But except for being unable to shower or bathe, swim, or run a vacuum, most LVAD patients live close to normal lives without transplants. Mr. Perlick plays catch with his three sons. Mr. McChesney resumed bowling until a leg infection got in the way.
Destination therapy patients are living a relatively long time with LVADs, too, even though Dr. Kormos and Dr. Bailey have implanted them in patients in their mid-to-late 70s.
UPMC has a patient, Anthony Wilson of Aliquippa, who marked his fifth anniversary with an LVAD over the Christmas holidays, and Allegheny General has a patient who is about four years out from implantation. Dr. Kormos said there are longer survivors than that across the nation.
What makes a patient a good LVAD candidate?
"It's a lot of things: A personal motivation to get better with a strong will to live. Someone who has a good support system with regards to family or community support," Dr. Bailey said. It is also key they be identified before they're so sick their organs are threatened with damage from heart failure, he added.
And when the LVAD patients eventually die, the two doctors said, it is not necessarily related to their mechanical pumps or heart disease.
"I think the things that kill people like that are the things that kill people of that age -- stroke, cancer," Dr. Kormos said.
"It's everything under the sun," Dr. Bailey said.
Certainly LVADs extend life, and the percentage is getting better.
Currently, Dr. Kormos said, 78 percent of destination therapy patients are alive at one year after implantation nationally, a number that is 76 percent at UPMC. "At two years out, 64 percent are still alive, compared to 55 percent at one year out in 2001."
At Allegheny General, the one-year survival rate is 85 percent and two-year survival 70 percent.
Numbers like that are encouraging more cardiologists to refer patients for possible VAD implantation.
"It's a technology that's starting to get the attention of cardiologists," Dr. Kormos said. "We're encouraging people to send us those patients. ... people with spirit who are active. We're very well-positioned to help them."
Dr. Kormos had a patient fly to Florida with his LVAD to golf. Another has resumed riding his horses. At Allegheny General, there's an 80-year-old patient three years out from surgery who travels around the country and just returned from a cruise.
UPMC now has more than 40 patients living at home on heart pumps, close to 30 of them destination-therapy patients. Dr. Kormos said the number of heart-pump patients at home three years ago was much smaller.
"We're sending about 30 a year [home], but I think it's going to grow."