Pump Implants May Rejuvenate Heart Failure Patients
TUESDAY, April 18, 2017 -- Implanted pumps may be more than a "bridge" to a heart transplant -- they might also restore healthy heart function for some heart failure patients, a new British study suggests.
As the researchers explained, these battery-operated left ventricular assist devices (LVADs) are often used to support patients with severe heart failure while they await a heart transplant.
But this new clinical trial is the first to show that an LVAD, combined with medication, can restore heart function completely, researchers said.
"We talk about these devices as a bridge-to-transplant, something which can keep a patient alive until a heart is available for transplantation," said study lead author Djordje Jakovljevic.
"However, we knew that sometimes patients recover to such an extent that they no longer need a heart transplant," noted Jakovljevic, a senior research fellow in cardiovascular aging and heart failure at Newcastle University.
"For the first time, what we have shown is that heart function is restored in some patients -- to the extent that they are just like someone healthy who has never had heart disease. In effect, these devices can be a bridge to full recovery in some patients," he said in a university news release.
With heart failure, the heart can't pump enough blood throughout the body. Sometimes, the heart can't fill with enough blood, and other times it can't pump blood out with enough force. Certain people have both problems, according to the U.S. National Heart, Lung, and Blood Institute.
The new trial included 58 men with heart failure who underwent assessments of their heart fitness. Of those patients, 16 men had received an LVAD and then had it removed because they had significant recovery of heart function.
The average length of time patients had an LVAD was 396 days, but that ranged between 22 days and 638 days among individual patients.
Another 18 patients still had an LVAD, and 24 were waiting for a heart transplant.
Of the patients who had their LVAD removed, 38 percent had heart function equivalent to that of a healthy man of the same age, the researchers reported.
"We can consider these pumps as a tool which can lead to a patient recovering, rather than as a device which keeps people alive until a heart transplant is available," Jakovljevic said.
Two American cardiologists said the results were encouraging.
"As part of the currently aging population of the United States, the number of patients with heart failure is continuing to steadily increase, yet there remains a relative shortage of donor hearts -- there simply aren't enough donor hearts available each year for each person who may benefit from transplantation," said Dr. S. Jacob Scheinerman. He's chair of cardiovascular and thoracic surgery at Lenox Hill Hospital in New York City.
He believes that "other treatment options need to be considered," and for some patients, a LVAD may be adequate.
Dr. Scott Schubach directs thoracic and cardiovascular surgery at NYU Winthrop Hospital, in Mineola, N.Y. He agreed that "the results of the study are particularly exciting for the future."
"As these assistive devices are improved, it will mean one more tool for treating patients with heart failure," Schubach said.
According to Jakovljevic's team, future research will aim to identify markers that might help doctors determine which patients may fully recover with LVADs, and when removing the devices won't raise the risk of heart failure returning.
"In most cases, the device reverses the symptoms of heart failure so that patients feel less short of breath and with less fatigue. In a smaller proportion of patients there is actually an improvement in heart function so that the pump can be disconnected or explanted," noted study co-author Dr. Stephan Schueler. He is a consultant cardiac surgeon at Newcastle Upon Tyne Hospitals NHS Foundation Trust in England.
The findings were published recently in the Journal of the American College of Cardiology.
The U.S. National Heart, Lung, and Blood Institute has more on heart failure.
Posted: April 2017
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