Will Heart Failure Be Optional in the Near Future?

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Topics include: Treatment

In the U.S., heart disease remains the leading cause of death for both men and women. Through technological advances—many of them non-invasive—patients with serious heart conditions are now able to live long lives and return to the same quality of life they previously had. Dr. Liviu Klein, director of the Mechanical Circulatory Support and Heart Failure Device Program, at UCSF Heart and Vascular Center, talks about a new generation of devices changing how we once thought of the disease. Learn why Dr. Klein says, “In the next 5 years, death from heart failure will be optional.”

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Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Well, unfortunately, there are thousands of people in the U.S., and, of course, around the world whose heart does not pump efficiently, just doesn't pump as well.  These people may huff and puff trying to go up stairs or even sometimes doing much more than get out of bed.  That's called heart failure—heart just is not pumping efficiently. 

So what do you do?  Well, people take medications, and in many cases those can help to some degree.  Of course, on the other end, you can have a heart transplant. But there are not that many donated organs, and not everybody is a candidate for heart transplant.  Well, fortunately, technology has been filling the gap, and it's been filling the gap in an increasingly elegant way, if you will, to help more people. 

And with us to help us understand that is the director of the Mechanical Circulatory Support and Heart Failure Device program at the UCSF Heart and Vascular Center, and that's Dr. Liviu Klein.  Dr. Klein, welcome to Patient Power. 

We have very good medications and electrical therapies, such as pacemakers or resynchronization therapy, which can improve quality of life and survival in most people.  

So, obviously, trying to replace the left ventricle with a pump that takes over its action has been our desire for probably 50 or 60 years, and that's how the left ventricular assist devices came into play. 

Unfortunately, we don't have enough organs for everyone to transplant, so older individuals or individuals who have some other co?morbidities who are not candidates for transplantation will rely on these assist devices for the rest of their life, and we call that destination therapy.  Currently, we're probably implanting around 3,000 ventricular assist devices every year, and over half are actually in patients that will be on these devices sort of for the rest of their life. 

Of course, these are electrical devices so they need to be powered. So there is a wire connector, which is about like your phone cord in thickness that comes through the skin, and it's connected on the outside with something called a controller, which is basically the brain chip of the LVAD.  And side by side of the controller you actually have batteries, which can allow eight to 10 to 12 hours of freedom for these patients.  

The thing that they can absolutely not do is bathe or swim because it's an electrical device, so in contact with the water it will produce a short circuit.  When they do shower, they have a special kit they put around the device to avoid water.  Other than that, they actually have a normal lifespan and normal activity. 

The first?generation devices used to have a very high infection rate.  About 40 percent of them will get infected within a year.  Now we actually have less than 10 percent of patients getting infections. 

In fact, one of the devices that we have we currently implant through a mini thoracotomy, so a small incision on the left side between the ribs rather than full open sternotomy.  And the newer generation will be implanted similar to a valve through a transapical incision.  So that's one development that we think we're going to be there in clinical trials within a year. 

The second big development is actually to internalize everything, so have the batteries and the power source inside the chest or inside the abdomen, and I think the device companies are working with very smart physicists how to do that.  We think we're within five years of actually that happening.  We already have animal models that are very successful, and we're probably going to go into clinical trials for a fully implantable LVAD within the next two or three years. 

Dr. Liviu Klein, thank you so much for being with us on Patient Power. 

I'm Andrew Schorr.  Thank you for joining us.  Remember, knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.


Page last updated on June 7, 2014