Two lefts make it right: Cardiac experts find novel approach to treat heart failure

October 20, 2015, University of California - San Diego

A teenage girl faced with sudden rapid heart deterioration, a man in the prime years of his life suffering from debilitating heart failure and a former NFL athlete crippled by end-stage heart failure were all successfully treated with a surgical approach pioneered by cardiac experts at University of California, San Diego School of Medicine.

The work, recently published in The Annals of Thoracic Surgery, demonstrated significant benefits of implanting a left ventricular assist device (LVAD) in the right atrium to provide better through the lungs, giving complete biventricular circulatory support and fully replacing the 's function.

An LVAD is a small mechanical pump traditionally placed inside the left ventricle - one of four chambers of the heart, located in the lower left of the organ - to help restore blood flow throughout the body. Unlike an artificial heart, the LVAD doesn't replace the heart, but it can mean the difference between life and death for a person waiting for a transplant or suffering from advanced .

"An LVAD relieves symptoms, such as being constantly tired or short of breath in patients with advanced heart disease," said Victor Pretorius, MBchB, lead author of the report and surgical director of cardiac transplant and mechanical circulatory support at UC San Diego Health. "The caveat is that the LVAD still depends on the right side of the patient's heart to function optimally, and right ventricle failure is a common condition after an LVAD implantation, leaving some patients only partially treated. It is difficult to predict and increases mortality."

Pretorius said biventricular support is required for up to 30 percent of LVAD recipients. Currently, no durable, long-term right ventricular assist device (RVAD) has received Food and Drug Administration approval, and placing an LVAD in the right ventricle, for which it was not designed, may jeopardize the device and heart function.

"An alternative strategy would be to remove the heart completely and replace it with a total artificial heart, but this strategy does not allow for the failing heart to potentially recover, and there is the risk of the device malfunctioning," said Pretorius. "All three patients involved in the study were in desperate need of right-sided circulatory support. Our team placed an additional HeartWare HVAD, the smallest available LVAD, in the right atrium, the upper chamber of the heart, to provide right heart support."

The right atrium is considered a more ideal chamber for placing a mechanical pump to support right-sided circulation. The absence of valve structures ensures unobstructed blood flow into the pump, and the location next to the right lung makes accommodation for the pump's motor in the chest cavity more feasible.

An LVAD is composed of a computer controller, a power pack and a reserve power pack that remain outside the body and are recharged at night. Patients with the innovative BiVAD approach have to carry a duplicate set for each pump, but Pretorius said this is generally well tolerated.

Two of three patients in the study received successful heart transplants after receiving right-sided circulatory support, and the third patient remains in good condition with both LVADs still implanted.

"There is no standard of care for patients with biventricular failure, so using two LVADs to address this critical need gives patients another treatment option and hope," said Eric Adler, MD, co-auther of the report and director of cardiac transplant and at UC San Diego Health.

Seven at UC San Diego Health have been treated using this strategy. Pretorius and Adler added that more data is needed to evaluate the efficacy of this approach as a long-term solution.

Explore further: Successful implant of next-generation heart device marks Canadian first

Related Stories

Successful implant of next-generation heart device marks Canadian first

November 10, 2014
A surgical team at the Peter Munk Cardiac Centre led by internationally-acclaimed cardiovascular surgeon, Dr. Vivek Rao, has successfully implanted a novel mechanical device, the HeartMate IIITM, into a patient with advanced ...

New patient guidelines for heart devices

April 17, 2011
A series of new guidelines for cardiac specialists has been developed to determine when heart failure patients should receive a mechanical heart-pumping device.

Heart study aims to identify at-risk patients after pump implant

September 24, 2013
Emory researchers are exploring the use of echocardiography, an established non-invasive method to view the heart without radiation, to help identify patients at risk for right ventricular heart failure after implantation ...

LVADs may lead to declines in health, cognitive thinking in some heart failure patients

April 29, 2015
Left ventricular assist devices (LVADs) are life-prolonging devices for many patients with advanced heart failure but they also may leave some patients in poor health or with declines in brain function, according to two studies ...

Long-lasting mechanical heart implanted for the first time in Canada in heart-failure patient

October 12, 2010
In a Canadian first, the Peter Munk Cardiac Centre used a new kind of left ventricular assist device (LVAD) to treat a patient with advanced heart failure. The new device is longer lasting than older generation LVADs and ...

Non-cardiac surgery: Safe for patients with heart device

April 15, 2011
Non-cardiac surgery can be performed safely in patients with a heart device typically implanted into patients waiting for a transplant, according to a study at Henry Ford Hospital in Detroit.

Recommended for you

Surgical adhesions can be treated, prevented in mice

November 28, 2018
A cellular culprit—as well as a possible treatment—for a common, sometimes life-threating post-surgical complication has been identified by researchers at the Stanford University School of Medicine.

Cost and weight-loss potential matter most to bariatric surgery patients

November 28, 2018
A JAMA Surgery study found that patients are likely to base their weight loss surgery choice on expected out-of-pocket costs, and how much weight they can lose—not risk of complications or recovery time.

Treating spinal pain with replacement discs made of 'engineered living tissue' moves closer to reality

November 21, 2018
For the first time, bioengineered spinal discs were successfully implanted and provided long-term function in the largest animal model ever evaluated for tissue-engineered disc replacement. A new Penn Medicine study published ...

Screening for colorectal cancer spares male patients from intense treatments

November 21, 2018
While screening for colorectal cancer does not reduce mortality, it does reduce the need for chemotherapy and emergency surgeries among male patients, according to a recent Finnish study.

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.