Ask an Expert: Artificial devices used in heart care

Q: What can you tell me about mechanical heart assist devices? Are these devices a practical option for treating heart failure?

Answer from Jacob Abraham, M.D., cardiologist and medical director of Providence St. Vincent’s Center for Advanced Heart Disease:

Yes, mechanical heart devices, also known as ventricular assist devices (VADs), are increasingly used as a long-term treatment for some patients whose heart failure does not improve with standard therapies. These surgically implanted pumps help a weak heart pump blood.

VADs have been shown to be of benefit when used for two common situations.

The first situation is when a patient needs a heart transplant, but is too sick to wait for a donor organ to become available–a period that can sometimes be as long as six months. In the past, many people died during that waiting period. A VAD can now be used quite successfully to “bridge” the patient until a donor heart is available.

The second situation is a patient with advanced heart failure who is not a candidate for heart transplantation due to age or other medical illness (such as kidney disease, diabetes or pulmonary hypertension). A VAD can be implanted for long-term, permanent support of the patient (“destination therapy”).

In recent years, clinical trials have shown that the latest generation of VADs can drastically improve survival and quality-of-life when used as both a bridge-to-transplant and as destination therapy.

Even the current generation of VADs has short-comings, however. Patients must take blood-thinners to prevent blood clots from forming in the pump, yet such medication may also increase the risks of bleeding. A tube containing electrical wires, or driveline, is tunneled underneath the skin of the abdomen and exits through the skin to connect to a small computer (controller) that is worn around the waist. This exit site can be prone to infection and must be kept clean. Patients must be connected to a power source at all times, either with wearable batteries or directly to a wall power source.

Despite these limitations, VADs are a revolutionary therapy for some patients with heart failure. Only a careful evaluation at a specialized center such as Providence’s Center for Advanced Heart Disease can determine whether a patient could benefit from this type of technology.

Continued advances in technology are making VADs even smaller and easier to implant. In the near future, completely implanted devices without any external parts could make this therapy even better for patients.