What do you do if your heart is failing? You could try to get a transplant, but there aren’t enough donor hearts to go around and sadly many people die before they get one. But something called a left ventricular assist device (LVAD) is helping bridge the gap between heart failure and transplant. The LVAD pumps blood through the body when the heart no longer can, and can be a lifeline until a donor heart becomes available.
In this episode of San Diego Health, host Susan Taylor talks with Darla Calvet and Scripps heart failure specialist J. Thomas Heywood, MD. Calvet began experiencing congestive heart failure when she was just 39 years old. Dr. Heywood, who is also medical director of the Advanced Heart Failure and Mechanical Circulatory Support Program at Scripps Health, talks about what led to Calvet’s diagnosis and the steps taken over the years to control the condition that was causing her heart to pump abnormally.
Upon returning from a business trip, Calvet noticed swelling in her ankles. A trip to the emergency room led to the diagnosis of congestive heart failure, which causes water retention in the legs and lungs. She was first implanted with a pacemaker and prescribed medication, which helped for a time. But then her heart really began to give out. She was close to death and was placed in a medically induced coma. Doctors then implanted an LVAD, which held her over for 14 months until a donor heart became available. After undergoing a transplant, Calvet, now 54, lifts weights, cross-trains and swims. She’s also training for the Transplant Games of America. Heart failure is a treatable illness and Calvet is living proof.
Learn more about heart failure and the LVAD.
The LVAD is a battery-operated, mechanical pump-type device that is surgically implanted in the chest and helps maintain the pumping ability of a heart that can’t effectively work on its own. It is not an artificial heart; instead, it assists the heart in doing its job. In Darla’s case, the LVAD was a stepping stone while she waited for the permanent solution: a heart transplant.
Dr. Heywood: Congestive heart failure means there's something wrong with the heart so it doesn't pump like it should or it fills abnormally. Pressures in the heart elevate and that's when you get swelling. Because that pressure gets transmitted to the legs and to the lungs, you retain water in the legs or the lungs, you get short of breath and swelling occurs.
Dr. Heywood: It can be congenital or it can be genetic. Heart failure can run in families. It can be from high blood pressure. It can be from a heart attack. Too much alcohol or other drugs can cause it. You can just get a common virus and it can cause heart failure.
Dr. Heywood: A heart attack happens when one of your arteries closes. Part of your heart muscle dies because of the closure of that vessel, whereas with heart failure it can happen with normal arteries or it can happen after an artery closes. Heart failure means that the heart is just not functioning well and so you retain fluid and get short of breath.
Dr. Heywood: Unfortunately not. Typically older people get it. But certainly younger people can get it too.
Dr. Heywood: In Darla's case we were working her up for a heart transplant. We wanted her to just go directly to a heart transplant, but she became so sick that she almost died. She came very close to death. So, it became impossible to wait for a heart transplant. So what the LVAD did was to bridge her. It allowed her to recover, get off the breathing machine and get off the pumps that were supporting her and then recover. She had this for about 14 months and then got a heart transplant.
Dr. Heywood: Now the other group of people that get LVADs are people that for one reason or another can't get a heart transplant. Maybe you've had cancer…or you have other medical conditions. Actually, we put in more LVADs each year than we do heart transplants.
Unfortunately there's only about 2,200 or 2,300 heart donors a year but there are 50,000 people that need a heart transplant or an LVAD. So the LVAD is for the people (who have to wait or) who we just can't get a heart for.
Dr. Heywood: You can play tennis. You can play golf. You can play baseball...You can't take a bath. You can take a shower. You can't go swimming.
We are working on getting them smaller. We're trying to make the batteries smaller and smaller all the time.There will be a fully implanted LVAD at some time. I think within 10 years. Everything will be inside. It will be wirelessly charged. It will charge up at night when you're asleep. You might wear external batteries part of the day but probably you could go four or five hours. So that will be a major breakthrough. But we're still working on that.
Dr. Heywood: They can live years. The pumps are very robust now. There have been patients who have lived 10 years with an LVAD.
We want to make sure that when we put one in that people have a good life expectancy afterward… We fully expect people to live for years with the device or until they get a heart transplant. But if we know they're not going to get a heart transplant, they can still live for years.
Dr. Heywood: You have to be pretty sick to have an LVAD. But we don't want you to be too sick because you can get past the point of no return where you're so sick that even the LVAD can't help you. We always hope to see patients before that.
So I would say if you've been hospitalized twice for heart failure or you needed IV meds to make your heart pump stronger in the hospital that's a warning sign. Or when your doctor has to start stopping your medications because your blood pressure is too low or your kidney functions are getting worse, those are all warning signs.
With heart failure we should be able to control your symptoms. If we can't control your symptoms that's a warning sign, too.