Monday, July 11, 2011
PHOENIX — A number of patients in the Valley with severe congestive heart failure are experiencing a new lease on life, thanks to the constantly evolving world of mechanical innovations that can significantly assist the intricate function of the human heart.
They are cardiac patients at Mayo Clinic in Arizona, and they are recipients of ventricular assist devices and artificial hearts that offer hope for a better quality of life. For some, it is the hope of a heart transplant. For others, a VAD can be lifelong cardiac therapy.
VADs are surgically implanted into patients when their heart is too weak to pump blood on its own. Once the device is implanted in the abdomen and attached to the left, right or both ventricles of the heart, the system is powered by wires leading to external batteries carried in a portable pack. At home, the system uses electricity when not battery-powered. The result for the patient? Easier breathing, less fatigue and improved organ function. Importantly, many patients are able to leave the hospital and enjoy increased mobility, resuming normal activities, often including travel.
Statistics about Mayo's mechanical support device programs:
Mayo is also unique in that an emergency transport system (often referred to as the SWAT team approach) is deployed when community hospitals in the Phoenix area call, requesting Mayo's cardiac medical or surgical teams to evaluate a patient in cardiac distress. Often the patient can be transported to Mayo for continuing care.
The Joint Commission, in its most recent evaluation of Mayo's VAD program, gave high marks to the program. Certification for all services was granted, and the reviewer called the program, "excellence in motion." The reviewer added, "Mayo's program is the poster child for VAD programs nationally," and said if she ever required a VAD, she would come to Mayo Clinic in Arizona.
Mayo Clinic has a stable of 11 types of mechanical assist devices to support and improve the function of the heart in patients in what is called "crash and burn" condition — the highest at risk of dying from multiple organ failure.
VADs are used as a bridge-to-transplant, for when the heart function improves enough to withstand heart transplant, or as "destination" therapy, for lifetime use if patients are not eligible for a transplant. Sometimes a VAD is implanted until a decision can be made about the next treatment option, or until the heart recovers enough that the VAD can be removed.
When a 32-year-old Phoenix man with no prior history of heart disease suddenly went into heart failure because of a rare condition that affects young people, a team from Mayo Clinic was dispatched to a Valley hospital to provide specialized care. The patient was outfitted with both a left and a right VAD — one for each side of his heart.
His VADs were implanted as "bridge-to-transplant," and eight months later, he received a new heart.
A Sun City, Ariz., patient, at age 71, had been told he was "out of options" by his doctor when he experienced severe heart failure — and that his age and other medical conditions precluded him from being listed for a heart transplant. But once he came to Mayo and was implanted with a left ventricular assist device, his life was greatly enhanced. He now plays golf, sings in a choir and drives. He refers to the day he received his heart device as his "second birthday."
Mayo Clinic's VAD program is directed by Francisco Arabia, M.D., cardiothoracic and transplant surgeon and surgical director of the Heart Transplant and VAD program. Implantation of a VAD does not end with the surgery and discharge of the patient to await a heart or live with the device for the duration of life.
Importantly, a team of some 75 professionals plays a role each time a patient is transplanted with a new heart. VAD experts, including Linda Staley, nurse practitioner, coordinator, heads up training programs about how the VAD functions, the role of the patient, the role of the family caregivers — and the role of first responders in the neighborhoods where VAD patients reside. Staley and others visit the homes of VAD patients to make sure the batteries and equipment are set up properly. Even the local electric utility company is notified about what to do in the event of a power failure.
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