DALLAS, Nov. 14 – Heart pumps can significantly extend the
lives of end-stage heart failure patients who are not candidates
for heart transplants, researchers reported at the American
Heart Association’s Scientific Sessions 2005.
Left ventricular assist devices (LVADs), or mechanical
cardiac pumps, are among the newest treatment options for
congestive heart failure, which occurs when the heart can no
longer pump enough blood to the body’s organs. Traditionally,
doctors treat these patients with medications that strengthen
the heart’s pumping ability or, when symptoms are
life-threatening, with heart transplantation. LVADs perform the
mechanical work of the heart when medications fail. They’re
implanted in the abdomen and attached to the left ventricle and
the main blood vessel carrying blood from the heart to the body.
A tube connects the pump to an external controller and power
supply that are worn outside the body.
“We wanted to assess the impact of the Novacor LVAD in the
treatment of patients with end-stage heart failure, who were not
candidates for transplantation,” said Joseph G. Rogers, M.D.,
lead author of the study and associate professor of medicine and
medical director of the Cardiac Transplant and Mechanical
Circulatory Support Program at Duke University School of
Medicine in Durham, N.C.
Researchers studied 55 patients with the worst possible heart
failure symptoms, including shortness of breath and fluid
buildup in the body, who required intravenous medications to
stay alive. In the non-randomized study, 18 patients were given
intravenous medications, while 37 received an LVAD. Patients at
the start of the study had an average 14 percent ejection
fraction (EF), the measure of heart contractility. Normal EF is
between 55 percent and 60 percent.
The researchers studied the patients for the remainder of
their lives. They found that those with end-stage heart failure
who were treated with only medications had a remarkably poor
prognosis.
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“The average survival was three months in the medication therapy
arm of the trial,” Rogers said. “Patients with the LVAD had a
significant improvement in survival. The LVAD reduced the risk
of death by 50 percent at six and 12 months and extended the
average life span from 3.1 months to more than 10 months.”
“The pumps functioned well,” Rogers said.
“At the time the abstract was written, we had nearly 30
cumulative years of support and there were two patients on the
device for more than three years,” he said. “No patient had
catastrophic pump failure, defined as death, or the need for
emergency pump replacement.”
Researchers said this study provides additional support for
the notion that mechanical heart technologies can extend life.
The findings also point out the real challenges that doctors and
their heart failure patients face.
“We need to refine patient selection for these pumps and work
to minimize the complications associated with mechanical heart
technology,” Rogers said. “Further, we need to continue to focus
on new strategies for treating end-stage heart failure, which
has a survival rate so low that it rivals any cancer.”
WorldHeart funded the study.
Co-authors are Richard Pierson III, M.D., Ph.D.; Javed
Butler, M.D.; Alan Gass, M.D.; Steven L. Lansman, M.D., Ph.D.;
Peer M. Portner, Ph.D.; and Michael K. Pasque, M.D.
Sources
American Heart Association - Scientific Sessions - 2005
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