Ventricular Assist Device (VAD) Program
Heart failure is a condition in which the heart is not strong enough to pump enough blood to meet your body's needs. It is classified from Class 1 (mild symptoms controlled with medication) to Class 4 (severe symptoms despite maximal medical treatment). Heart transplantation is the gold standard treatment for Class 4 heart failure, but is limited because of a shortage of donors and concomitant patient features such as significant kidney disease or history of cancer. The left ventricular assist device (LVAD) was developed initially as a "bridge" to help patients accepted for transplant survive until they received a new heart. Now, appropriate patients with Class 3 or 4 heart failure, who are ineligible for a transplant, can be supported indefinitely by the newly developed LVAD called HeartMate II.
What Is the Ventricular Assist Device (VAD) Program?
The multidisciplinary ventricular assist device (VAD) program of the Stony Brook Heart Institute is the first and only VAD program of its kind on Long Island. Our VAD program provides "destination therapy" using the latest VAD technology to treat eligible patients with advanced heart failure, and give them a new lease on life. This program has been accredited by the Joint Commission, which further distinguishes it and the quality of care we provide here at Stony Brook.
The left ventricular assist device (LVAD) called HeartMate II — a new generation of "artificial heart" technology approved by the FDA in 2010 — is a surgically implanted, battery-powered pump that helps the left ventricle pump adequate amounts of blood to the body.
The LVAD is implanted in your upper abdomen and connected to a power supply located outside your body. Blood is sent through a tube in your left ventricle into the LVAD, which pumps the blood through another tube into your aorta and throughout your body.
An LVAD can be implanted in people who are candidates for a heart transplant as a "bridge" to transplant. Some patients may experience improved heart function while the LVAD is in place, which may make the transplant unnecessary. In patients who are ineligible for a heart transplant, the LVAD can be destination therapy; that is, the LVAD is implanted permanently. Click here for more information about LVAD destination therapy.
Earning National Accreditation
In March 2011, our VAD program received national accreditation from the Joint Commission after an intensive two-day review by a team of Joint Commission surveyors. The inspection of the program occurred Feb. 28 and March 1. The program's "certification of distinction" is for a two-year period, with a performance review at the end of the first year.
"Accreditation is a seal of approval that signals to our patients that they are in a quality program and are in capable hands when they come to Stony Brook," said Todd K. Rosengart, MD, professor and chairman of surgery at Stony Brook Medicine.
"This is an outstanding achievement reflecting on a total team commitment to providing quality care to patients requiring ventricular assist devices for destination therapy," said Margaret Duffy, MS, RN, NEA-BC, associate director of nursing for cardiac services at Stony Brook Medicine.
Arthur Plowden, 42, of Amityville, calls himself "half man, half amazing." He invented the phrase a few weeks after he became the first patient ever at a Long Island hospital to receive VAD destination therapy. With Plowden are members of the SBU Heart Institute team, from left: Hal Skopicki, MD, Director, Heart Failure Program; Kathleen Newton, RN; Allison McLarty, MD, cardiothoracic surgeon, and Karen Garland-Smrek, RN.
Destination therapy uses VAD technology as the final treatment option for select patients whose hearts require mechanical assistance to pump blood. Once used as a temporary device for heart failure patients awaiting transplants, new VAD technology now helps more patients extend and improve their quality of life.
To achieve accreditation, VAD programs are evaluated on standards in the Joint Commission's Disease-Specific Care Certification Manual. Programs must demonstrate conformity with clinical practice guidelines or evidence-based practices. They are also required to collect and analyze data on at least four performance measures related to clinical practice guidelines until more standardized performance measures are identified.
Accredited programs must also:
- Provide VAD destination therapy to an adult population;
- Have facilities with the infrastructure to support VAD placement, including adequate staffing and facilities to perform and recover patients after cardiac surgery;
- Be an active continuous member of a national, audited registry for mechanically-assisted circulatory support devices that requires submission of health data on ventricular assist device destination therapy patients from the date of implantation throughout the remainder of their lives; and,
- Include a board-certified cardiac surgeon who has placed 10 VADs in the last 36 months with current activity in the last 12 months.
Providing Destination Therapy
Allison J. McLarty, MD, associate professor of surgery, leads Stony Brook's program in destination therapy, which provides an alternative to heart transplant. She is now treating a growing number of patients who have congestive heart failure with implantation of the HeartMate II.
In April 2010, Dr. McLarty accomplished the first permanent LVAD implantation on Long Island, making headlines for her success with this important new advance in patient care.
The HeartMate II, which had just been approved by the FDA as a permanent implant, consists of a surgically implanted pump attached to an external power source that can be portable and worn on a shoulder strap or belt. The pump takes over the work of the heart's left chamber that's become severely weakened as a result of congestive heart failure.
Unlike earlier LVADs that were designed for temporary use, the HeartMate II is for permanent use. This LVAD engineering represents a new generation of "artificial heart" technology that provides end-stage heart failure patients with access to an important new treatment option.
Studies show a significant improvement in quality of life with the HeartMate II compared to conventional medical treatment.
Dr. McLarty co-directs Stony Brook's VAD program with cardiologist Hal Skopicki, MD, assistant professor of medicine, who serves as medical director.
VAD News Stories
Questions from patients about LVAD:
- What is an LVAD?
- Why do I need an LVAD?
- What happens if choose not to have an LVAD?
- Will I still need medication for my heart after LVAD surgery?
- What is the hospital stay after LVAD surgery like?
- Will I be able to shower?
- Will I be able to go to work?
- What activities can I not do?
- How long does the LVAD last?
- How long do the batteries last?
- Can I still get a heart transplant after I receive an LVAD?
- What are the complications of living with an LVAD?
- What happens if the device malfunctions?
- Can I travel with an LVAD?
- Who can I call for answers to questions or for advice?
Q: What is an LVAD?
A: An LVAD — Left Ventricular Assist Device — is a surgically implanted, electrically (battery) powered pump that helps a failing heart's left ventricle pump adequate amounts of blood to the body.
Q: Why do I need an LVAD?
A: Heart failure, where the heart is not strong enough to pump blood for your body's needs, is classified from Class 1 (mild) to 4 (severe). Heart transplantation is the gold standard treatment for Class 4 heart failure. If you are waiting for a heart transplant or are ineligible for transplant and are doing poorly with maximal medical therapy, an LVAD can be lifesaving and improve your quality of life.
Q: What happens if choose not to have an LVAD?
A: Your doctors will continue to optimize your medications. However, the mortality of Class 4 heart failure, especially if you have been hospitalized multiple times for exacerbations, approaches 50%.
Q: Will I still need medication for my heart after LVAD surgery?
A: Yes. The device helps the left side of your heart. Medications are needed to help optimize function of the right side of the heart and to help remodeling of the heart. A small percentage of patients experience recovery of heart function with this strategy.
Q: What is the hospital stay after LVAD surgery like?
A: Most often, patients stay in the Cardiac Surgical Intensive Care Unit for about 1 week after surgery, and then in our Step Down Unit for 1 to 2 weeks. Discharge timing depends on physical recovery after surgery and familiarity with care of the LVAD.
Q: Will I be able to shower?
A: Yes. A shower kit is provided. We will teach you how to use it and practice in the hospital before you go home.
Q: Will I be able to go to work?
A: Yes, depending on the kind of work you do. There are some physical restrictions that your physician will discuss with you. But barring these, once you have recovered from surgery, you should be able to return to work.
Q: What activities can I not do?
A: Physical activity involving heavy contact that might cause bruising around the device is inadvisable. Also, you may not submerge in water (as in swimming).
Q: How long does the LVAD last?
A: The longest device has been in a patient for about 7 years. Testing by the manufacturers suggests that the LVAD should provide support for at least 10 years.
Q: How long do the batteries last?
A: Currently, the batteries last for 14 hours.
Q: Can I still get a heart transplant after I receive an LVAD?
A: If you are evaluated and deemed appropriate for a heart transplant, then you may receive an LVAD as a "bridge to transplant." Once a heart is available (waiting times may be as long as 1 to 2 years), you may then receive your transplant. Some patients are initially deemed ineligible for a transplant and receive an LVAD as an alternative, for what is called "destination therapy." This LVAD use may improve your overall condition, where you may now be reassessed and found to be a candidate for heart transplant.
Q: What are the complications of living with an LVAD?
A: Complications include wound infection of the driveline and bleeding. These may be minimized by working closely with your healthcare team.
Q: What happens if the device malfunctions?
A: There are multiple alarms on the device to indicate that a problem is brewing. Notify your LVAD coordinator immediately if there is such a problem.
Q: Can I travel with an LVAD?
A: Yes. Many patients travel by land, air, and sea with their LVAD. You must take all your equipment with you (not packed away in cargo). Your route and destination should include areas with a LVAD program in the event of an emergency.
Q: Who can I call for answers to questions or for advice?
A: Our LVAD coordinators are available 24 hours a day, 7 days a week. For ANY concerns, call our VAD phone at 631-617-2541.
Questions from physicians about LVAD:
- What are the indications for referral for LVAD implantation?
- What is the timeline after referral?
- What do I look for in my LVAD patients during their office visit?
- What kind of routine post-operative testing should I do for my LVAD patient?
- How does Stony Brook's LVAD program interface with heart transplant programs?
- What devices do you implant?
- How do I make a referral?
- How do I contact the LVAD service with urgent concerns?
Q: What are the indications for referral for LVAD implantation?
A: The indications for referral for LVAD implantation are as follows:
- Two or more hospitalizations for heart failure in the past six months
- Intolerance of heart failure medications
- No benefit from cardiac resynchronization via a biventricular pacemaker
- On, or being considered for, inotropic support
- Class 4 heart failure and ineligibility for transplant
- Cardiac cachexia
Q: What is the timeline after referral?
A: When we first see a patient referred for LVAD implantation, a comprehensive review is initiated. Multiple baseline tests are obtained, and patients are evaluated by all specialty services including renal, gastroenterology, pulmonary, psychiatry, nutrition, and social services, in order to ensure there are no contraindications to implant. A decision is made regarding implant as a "bridge to transplant" (BTT) versus "destination therapy" (DT). For outpatients, this process may take weeks to months. For patients who are unstable or clinically deteriorating, the process is fast tracked. Some patients require inotropic support or an intra-aortic balloon pump (IABP) prior to VAD implantation.
Q: What do I look for in my LVAD patients during their office visit?
A: Patients are seen initially weekly, then monthly, in our LVAD outpatient clinic. However, we ask that they also follow up with you. During the office visit with you,
- When obtaining vital signs, remember your patient may not have a palpable pulse; mean blood pressure (BP) may be obtained with a Doppler. Goal mean arterial pressure (MAP) ranges from 65 to 85.
- Patients can develop aortic insufficiency with long-term VAD support, so onset of a new diastolic murmur would be a concern, and should prompt an echocardiogram and communication with our VAD team.
- Gastrointestinal bleed can also occur in up to 15-20% of patients on long-term VAD support. Reports of tarry stools or signs of anemia would be a concern, and should prompt communication with our VAD team.
Our VAD coordinators are available at all times. Please call 631-617-2541 with questions or concerns.
Q: What kind of routine post-operative testing should I do for my LVAD patient?
A: A baseline EKG and echocardiogram are performed prior to the patient's discharge from the hospital. These should be repeated annually, or if clinically indicated. In addition, at Stony Brook, we perform the "6-minute walk test" at several intervals postoperatively to assess functionality and quality of life. Patients with an automatic implanted cardiac defibrillator (AICD) should have their device interrogated at regular intervals.
Q: How does Stony Brook's LVAD program interface with heart transplant programs?
A: We have excellent relationships with three of the New York-based transplant programs: Columbia University, Montefiore Medical Center, and Mount Sinai Medical Center. Our "bridge to transplant" patients have been evaluated and are listed for transplant at all three centers. As of January 2013, two of our patients have received heart transplants at Montefiore, and they are doing well.
Q: What devices do you implant?
A: We implant the HeartMate II LVAD, manufactured by Thoratec. This was the first FDA approved device for both "bridge to transplant" (BTT) and "destination therapy" (DT).
Heartware is a new smaller continuous-flow LVAD approved by the FDA in October 2012 for BTT. We will begin offering this pump to appropriate patients as the company rolls out support to implant centers.
Q: How do I make a referral?
Q: How do I contact the LVAD service with urgent concerns?
A: The LVAD phone is staffed 24 hours a day, 7 days a week, and we are happy to take your calls at any time. The LVAD phone number is 631-617-2541.
At the Stony Brook Heart Institute, we provide a full range of heart failure treatments aimed at helping patients to achieve and maintain the best quality of life possible, and keeping them out of the hospital. For patients with advanced heart failure, one option may be an implanted left ventricular assist device (LVAD), called the HeartMate II. Our LVAD program — the first and only program on Long Island that provides "destination therapy" — received national accreditation in 2011 from the Joint Commission. This video presents information about the HeartMate II.
- Heart Hope - Heart Hope is a network of healthcare professionals dedicated to advancing the treatment of heart failure. Its mission is to communicate a message of hope and empowerment to heart failure patients, families, and caregivers. It also offers a lot of information about heart failure and LVAD treatment.
- MyLVAD - This website is a resource for LVAD patients and for their loved ones. For recipients, it provides information through social connectivity, written content, and webinars that are intended help maximize their quality of life. For caregivers and loved ones, it provides the resources and support necessary to help them adjust not only to their loved one's needs, but also to their own.
- Thoratec - This is the website of the manufacturer of the HeartMate 2 LVAD used at Stony Brook, and it provides a wealth of information for medical professionals as well as for patients and caregivers.
Stony Brook Medicine
Nicolls Road and Health Sciences Drive intersection
Stony Brook, NY 11794