VADs As Bridge To Transplantation
When used as a bridge-to-transplantation, ventricular assist devices (VADs) support heart failure patients who are too sick to wait for a donor heart to become available. The VAD allows the heart and other body systems to rest, heal, and grow stronger before the stress of transplant surgery. On average, patients remain on a LVAD (left ventricular assist device) for two to six months prior to transplantation. Many patients can return home during that time with more functional capacity than they had before this surgery to address congestive heart failure.
FDA-approved implantable devices that are approved for use in bridge-to-transplantation include:
- Thoratec HeartMate® II
- Thoratec HeartMate I® (originally known as Thoratec XVE)
- Thoratec® VAD (PVAD, IVAD)
NewYork-Presbyterian's Mechanical Circulatory Assist Device Program is currently investigating two VADs that show extreme promise in clinical trials, the HeartWare® VAD, and the Terumo DuraHeart™ as well as a Total Artificial Heart developed by Syncardia West.
The HeartWare® VAD, a Ventricular Assist Support System is a miniature assist device currently available as a bridge-to-transplant through clinical trials.
On October 2, 2011 HeartWare presented new data at the 25th annual meeting of European Association for CardioThoracic Surgery in Lisbon, Portugal. The 241 patients enrolled in either the pivotal ADVANCE trial or CAP (Continued Access Protocol) demonstrated a 180-day survival of 93 percent. Consistent with previous reports, researchers found high survival rates for patients through the six-month endpoint, and particularly low rates of bleeding and infection.
The Terumo DuraHeart™ LVAD is a third generation device with no bearings that is designed to work at slower speeds, reduce wear on the mechanism, and prevent blood cell breakage. It is currently under investigation for bridge-to-transplant use. Read more about its pioneering use at NYPH:
- Next-Generation Mechanical Heart Pump Trial Begins For People Awaiting Transplants
- First Heart Patients Implanted With Next-Generation Mechanical Heart Pump
The Syncardia Total Artificial Heart (TAH) is now approved as a bridge to transplant for those with end-stage heart failure affecting both ventricles. To date, there have been more than 950 implants of the Total Artificial Heart both in the U.S. and Europe, accounting for more than 230 additional years of life for this patient group. Similar to a heart transplant, the Total Artificial Heart replaces both failing heart ventricles and the four heart valves. In July, 2011, NewYork-Presbyterian surgeons Yoshifumi Naka and Hiroo Takayama, implanted their first TAH.