Advances in Treating End-Stage Heart Failure: VADs, ECMO &
Total Artificial Heart
From the Director of NewYork Presbyterian's Mechanical Circulatory Support Program
New Options for End-Stage Heart Failure
The HeartMate ® II LVAD is a next-generation implantable device intended for a broad range of advanced-stage heart failure patients. HeartMate® II is FDA-approved for both bridge-to-transplantation, and as destination therapy for patients ineligible for transplant.
About 5.8 million people in the United States suffer from heart failure and nearly 700,000 new cases are diagnosed each year.
Heart failure usually develops slowly over time and some loss in pumping capacity is natural as people age. With end-stage heart failure, however, that loss becomes life threatening and is no longer manageable through medical therapies.
Previously, heart transplantation was the only hope for those with end stage heart failure. Now, with VADs (Ventricular Assist Devices), ECMO (machines providing short-term heart and lung support) and the Total Artificial Heart, patients have a wider range of options.
Premier Center for Heart Transplantation and LVADs
Founded over a quarter of a century ago, the heart transplant program at NewYork-Presbyterian Hospital/Columbia University Medical Center has long been the top cardiac transplant program in the US, performing the highest number of these surgeries.
To overcome long waiting lists for donor organs and other limitations, our surgeons have spearheaded an international effort to develop devices that provide mechanical support for failing hearts.
The Mechanical Circulatory Support Program, led by Yoshifumi Naka, MD, PhD, was founded at NewYork-Presbyterian/Columbia in 1990 to provide a bridge-to-transplantationsupporting patients' lives until suitable donor hearts became available. Today, we also offer mechanical assist devices as a destination therapy thus helping end-stage heart failure patients considered eligible for transplant.
New Generation VADS: HeartMate® and HeartWare®
Currently, the most common type of cardiac assist device is a left ventricular assist device (LVAD). We currently implant 60 to 80 LVADS each year, including the HeartMate® II, and the HeartWare® VAD, a third-generation device only available through clinical trials. We also employ another 50 short-term devices annually, including the CentriMag® VAD and ECMO (extracorporeal membrane oxygenation).
Among the First to Transplant the SynCardia Total Artificial Heart
Early in 2011, our surgeons transplanted their first Syncardia Total Artificial Heart. While VADs augment the failing heart, the Total Artificial Heart takes over the pumping action completely and the patient is no longer hampered by any diseases or abnormalities of the native heart.
Better Outcomes, Quality of Life with a Multidisciplinary Approach
Daily multidisciplinary rounds are a unique feature of our program providing the highest level of communication among many different medical experts. Surgeons and cardiologists specializing in heart failure participate along with ICU intensivists, pharmacists, VAD nurses and nurse practitioners. As the patient progresses, nutritionists, physical therapists and social workers join the team.
This approach allows us to significantly improve both the quality and continuity of care our patients receive. We are happy to report that this also results in better outcomes and improved quality of life.
Our team educates patients and their caregivers in how to maintain their devices and provides long-term follow-up care.
In the Forefront of Surgeon Training
NYPH/Columbia regularly conducts training for surgeons establishing new ventricular assist programs. We have successfully trained over 900 medical professionals, 80 surgeons, and 135 centers worldwide in LVAD implantation.
Mechanical Circulatory Assist Devices: Leaders in Research & Clinical Trials
NYPH/Columbia has developed multiple research programs in physiology, immunology, vascular biology, hematology, cellular and molecular biology, focusing on the effect of long-term implantable devices. In particular, we are investigating devices that are smaller, quieter, and more portable, fully implantable, or capable of providing biventricular support.
Other studies are advancing our use of the Total Artificial Heart and ECMO. to extend both survival and quality of life for those with end stage heart failure.
Yoshifumi Naka, MD, PhD
Director, The Mechanical Circulatory Support Program and Heart Transplantation
NewYork Presbyterian Hospital/Columbia University Medical Center