U-M is one of only a few institutions worldwide with access to many investigational and FDA-approved mechanical circulatory support systems.
A Viable Alternative
LVAD therapy is now a long-term option for many end-stage heart failure patients
issue 20 | winter 2014
Over the past decade, ventricular assist devices (VADs) have become viable alternatives to heart transplants as the technology has continued to improve. Pumps are smaller and more durable and the batteries last longer. Patients who are referred to the University of Michigan Frankel Cardiovascular Center's Center for Circulatory Support benefit every day from these lifesaving devices.
Jerome Wilson, 62, was diagnosed with cardiomyopathy 20 years ago by his primary care physician. "I've been an athlete all my life," explains Wilson. "When I was 42, I started having difficulty walking up stairs because I would get tired. An echocardiogram revealed cardiomyopathy."
"The LVAD team has been wonderful, like another family."
Jerome Wilson, patient
Over time, his heart failure progressed, and traditional interventions including lifestyle modifications, drug therapies and a defibrillator no longer adequately improved his heart function. "That's when I was referred to the University of Michigan, and I met with Dr. Koelling, a cardiologist," says Wilson. "After several years of monitoring by both my local cardiologist and Dr. Koelling, last year they determined it was time to consider an LVAD."
After several years of medical management by Todd Michael Koelling, M.D., and his local cardiologist, Jerome Wilson's worsening cardiomyopathy warranted LVAD therapy.
A LEADING PROGRAM
For most left ventricular assist device (LVAD) patients, the procedure provides an opportunity to return to normalcy. They can usually exercise, work, travel and enjoy a better overall quality of life.
Since the late 1990s, the LVAD program at the Frankel CVC has implanted more than 580 long-term devices, making the program one of the largest and most experienced in the world. Frankel CVC's Center for Circulatory Support was one of the first centers to be awarded Disease-Specific Care Advanced Certification for Ventricular Assist Device Destination Therapy by The Joint Commission. The VAD program at the Frankel CVC is also one of the few programs worldwide with access to several investigational and FDA-approved LVADs.
WHEN TO REFER
It's important for a patient with advanced heart failure to be referred to a specialist at the earliest possible indication of worsening or severe heart failure. Physicians should evaluate functional limitations and indications of organ injury in patients with heart failure to determine if a referral for potential mechanical support is indicated.
Todd Michael Koelling, M.D., Francis D. Pagani, M.D., Ph.D., and Keith Aaronson, M.D., treat LVAD patients at the Center for Circulatory Support.
"If a patient with congestive heart failure (CHF) experiences worsening symptoms, so that their activites of daily life are affected or they have difficulty climbing stairs, it probably warrants a consultation," says Francis D. Pagani, M.D., Ph.D., surgical director, Adult Heart Transplantation, and director, Center for Circulatory Support. "The patient might benefit from other therapies we can offer other than medical treatment for their heart failure."
The other key is understanding the impact that heart failure has on organ function. "If there is evidence of kidney dysfunction, liver dysfunction or low serum sodium, then those are all markers that the patient should be referred for advanced therapies," says Pagani. "Once there is some organ failure, it cannot be reversed. So the earlier the referral, the better."
"When I was approved for the LVAD, it was music to my ears," says Wilson. "My procedure was done by Dr. Pagani, and I feel like the luckiest man in the world." Wilson's device was implanted in May 2013, and he returned home just 13 days after his procedure.
"We have a unique model program where patients who receive LVADs are strongly encouraged to follow up with their primary care physician and their referring cardiologist," explains Pagani. "To support the patient, our program schedules a VAD coordinator to accompany the patient for their first return appointment with the referring cardiologist.
"The coordinator provides instructions and education to the staff and the referring physician about the care requirements, and creates an individualized care plan for the patient," continues Pagani. "This allows the patient to receive follow-up care in their own community, with appropriate support from the specialist at U-M."
U-M LVAD survival rates are higher than the national average at both 1-year and 2-year measures.
"My recovery was pretty fast because I'm in good shape overall," says Wilson. "These days, I am able to stack firewood and work out at the gym. The LVAD team has been wonderful, like another family, and I talk with them frequently. I feel like I've had the best care any person could have."