Emory Heart team implants 500th life-saving left ventricular assist device
On July 29, a team from Emory’s Cardiac and Vascular Center completed the implantation of its 500th durable continuous flow left ventricular assist device (LVAD), confirming Emory Healthcare’s status as a national leader in the procedure that saves lives.
This year alone, surgeons on Emory’s Advanced Heart Failure team had implanted nearly 60 devices by August, a number that has been growing ever since. Currently, Emory Healthcare is the premier LVAD implant center in the United States.
First used in the 1960s, the ventricular assist device – which has since undergone significant evolution, particularly over the past 20 years – provides mechanical circulatory support by pumping blood from the ventricles, or lower chambers of the heart, to the rest of the body. . Since the device is almost always placed on the left side of the heart, the device is often referred to as LVAD rather than VAD.
When a patient’s heart is in end-stage heart failure but is not eligible for a transplant, or it’s taking too long to get a transplant, an LVAD offers a course of action alternative that often makes the difference between life and death.
This recent milestone signals an increased ability to continue to deliver the consistent, comprehensive quality care that has long drawn heart failure patients to Emory from across the Southeast. Kris Wittersheim, coordinator of ventricular assist devices at Emory University Hospital, says it’s not unusual for them to see patients from southern Georgia towns like Savannah or Valdosta or neighboring states of Carolina. South, Alabama and Tennessee.
The pace, volume and quality of these procedures are also a testament to how technological innovations and critical additions to the surgical team have rapidly accelerated the number of heart failure patients who can receive life-saving surgery.
Cardiothoracic surgeon Tamer Attia, MD, PhD, says the process of first determining that an LVAD is the best option for the patient requires a collaborative effort across a wide variety of specialties and skill sets. This multidisciplinary team of 30-40 healthcare professionals includes surgeons, transplant cardiologists, VAD coordinators, pharmacists, nutritionists, social workers, infectious disease experts and palliative care specialists – all to assess the best course of action for an extremely ill patient.
Depending on the severity of the patient’s situation, the operation, which can take 5 to 7 hours, may take place a few days after being admitted to hospital with symptoms of heart failure. As with any surgery, there are risks, such as the potential for stroke or infections. But around 90% of patients are alive a year later and most are doing well, Attia says – and without the procedure the chances of survival are often slim.
After the surgery is successfully completed, the next six weeks require the patient to have a committed family member or friend to care for them 24/7. Therefore, designated caretakers also undergo extensive training with the Emory team on caring for their loved ones.
Getting back on your feet afterwards can take time. In general, most patients stay in the hospital for two to three weeks from the day of surgery. Faster recovery can take at least three months, but often longer. Most patients with LVAD can be hospitalized for some time, so there’s a period of reacclimatization to “normal life,” says Lakshmi Sridharan, MD, heart failure and transplant cardiologist at Emory’s Heart and Vascular Center.
Sridharan has counseled many patients before, during and after the LVAD procedure. Sometimes the pre-consultation process can be a tricky process. While the patient certainly knows this is something that will help keep them from dying, they may not yet fully understand what the device does or how it works. The medical team must therefore take extra care to explain in detail how it will become an important part of their life in the future.
After all, this piece of gear – on a practical level – can change how you look, feel, and move. Essentially, they’re high-tech machines that emerge below the ribs and above the navel and need to be plugged in at night to keep you alive.
“I always tell my patients that it takes a long time to heal from open heart surgery and it takes time to question yourself,” Sridharan said. “It changes a lot — you can’t swim anymore; you can no longer be submerged in water. You have to carry the weight (about 7 pounds). It’s a lot. We reassure them and let them know that it may take some time to adjust.
Some patients asked Sridharan if they could ever dress nicely to go out again. Fortunately, progress has been made in creating a sense of normalcy for LVAD recipients on a daily basis. Some innovations designed specifically for LVAD patients include a vest that goes under clothing or a carrier that looks like a purse.
Due to the comprehensive and intense journey required of their patients, the Advanced Heart Failure team often develops close relationships with those they have helped. Sridharan recalls finding ways for a patient to see his dog in the hospital “because that’s what he needs to be mentally strong enough to have the operation.” She’s also been in situations where they found a way for a patient to wave through a window to their family during the pandemic, a time when absolutely nothing was slowing down in the VAD center.
“We say we are advanced heart failure doctors, but in some ways we become their primary care, friends and family. When it comes to a life or death situation, they are the most vulnerable,” Sridharan said. “It’s so important to understand their support structure, who they rely on, what their coping mechanisms are, and to talk to them on their terms.”