Better heart pumps a lasting fix for some

Staff WriterJuly 31, 2010 

Truman Fallaw, a retired banker from Columbia, S.C., and former Vice President Dick Cheney have two things in common.

Both are being kept alive by mechanical pumps surgically implanted in their hearts. And both can partially attribute their survival to the work of researchers in the Triangle.

"I would not have survived without my device," said Fallaw, who will turn 75 next week. "I thank God for each day that I have."

For more than 10 years, Duke University researchers have been among the nation's leaders in developing the pump therapy, called left ventricular assist device (LVAD). Doctors at Duke Medical Center implanted more than 100 in the last decade.

Sometimes called a "bridge to transplant," LVADs are often temporary fixes for those with serious heart failure who actually need fully functioning new hearts.

Now, the Duke researchers are among those pioneering the use of newer devices for a permanent pumping solution. The devices could replace transplants for people like Cheney and Fallow for whom a full-blown transplant could be impractical, medically risky - or both.

Cheney, 69, received a pump this month at a hospital in Virginia after five heart attacks since the age of 37. In Fallaw's case, the surgery at Duke was necessary after a virus invaded his heart, causing so much damage Fallaw could hardly make it down his driveway without stopping two or three times to catch his breath.

History of the LVAD

For decades, the mechanical pumps have been saving lives of people with severe heart failure.

The first pump was tried in Texas in 1963. But within days, the pump was discontinued and the patient died.

Since then, survival rates improved as scientists developed pumps designed to mimic real hearts. In these devices, the patient's blood is sucked into the pump and then pushed back out into the body.

Yet these pumps were "big, noisy, and unreliable," said Dr. Joseph Rogers, a medical director in cardiology at Duke.

Within the past several years, there has been a major shift in approach. The body, it was discovered, may not actually need a pulse.

In response to the realization came the development of the so-called continuous flow pumps. With tiny rotating propellers that continuously move blood, the pumps are smaller and require fewer moving parts. Although the older pumps tend to wear out within 12 to 18 months, Rogers said, the newer ones last more than five years.

Longer survival

In 2009, a landmark study by Rogers and colleagues, published in the New England Journal of Medicine, tracked 200 patients and found that second-generation devices significantly improved the likelihood of survival two years after implantation compared to the older pumps. For the older pump, the one- and two-year survival rates were 55 percent and 24 percent. For the new model, the rates were 68 percent and 58 percent, respectively.

The findings spurred the FDA to approve the HeartMate II brand of new pump as a long-term therapy in January 2010. Experts say the cost is roughly $80,000.

Avoiding transplants

The technology has the potential to reduce the need for heart transplants - difficult surgery fraught with complexities.

Donors are scarce, with about 2,200 surgeries in the U.S. each year for 3,200 patients on the waiting list. A recipient's position on the list is based on such factors as the severity of heart disease and the likelihood the surgery will be successful. Younger patients typically have a better shot.

The surgery entails cracking open the rib cage, which invites bleeding and infection. The recipient's body is also at risk of rejecting the n ew heart. After the procedure, some patients stay on drugs to suppress the immune system, which can trigger cancer.

"We want to shift the LVAD population away from the moribund," Rogers said. "And by that, I mean giving patients the device sooner - and to less sick people - to help people survive with it."

Better quality of life

Those who have gotten the LVAD often report feeling vastly better.

Fallaw, for instance, can now walk, travel and spend time with his five grandchildren without losing his breath within seconds.

He also volunteers at his local hospital to help patients about to go through the procedure.

"I tell them, 'You're a member of the zipper club now,'" he said. "I've been where they were, and I got better. I encourage them and their family members."

Still, Rogers emphasizes there's much work to be done on the LVAD to make it more convenient for patients' everyday lives.

The pump, implanted just beneath the heart, remains connected to a computer controller and battery that the patient must carry at all times. A cord runs from the implanted pump, through the skin and to the crucial computer system, which is often carried on a belt or harness.

"The weakest link is the power cord coming out of patients' bodies," he said. "If we could implant the device without having an electrical cord come out through the skin - well, that would be the holy grail."

ilanay@nando.com or 919-829-4881

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