Yashoda Hospital created history by implanting HM III for the first in South India
Implantation of Left Ventricular Assist Device (LVAD), a lifesaving surgery for end-stage heart device was done at Yashoda Hospitals, Malakpet, Hyderabad for the first time in the Telugu states. The Heart Mate III is the latest advanced device in Mechanical Assist Devices.
LVAD was originally developed to support sick hearts temporarily so that either the heart recovers or go for heart transplantation once a suitable donor heart is available. With technological improvements in the design of VADs, they are now being used for more patients even for long-term support with improved survival and decreased incidence of complications.
Any patients with chronic heart diseases finally end-up in Heart Failure. There are about 23 million worldwide affected with Heart failure. Only 50% survive at the end of 5 years and 10% at 10 Years. In India, reports say there are 3 crore heart patients, out of which close to 45 lakh patients are in Heart Failure.
Heart failure is a condition which impairs the ability of the ventricle to fill or pump blood effectively. This can happen following heart attacks, valve diseases, long standing high blood pressure, irregular heartbeats, viral infections, alcohol, chemotherapy etc.
Heart failure patients can be managed with standard medical management for a long time. Some of them will be benefitted by surgeries like CABG, Valve repairs, Placements of ICD, CRT etc. But eventually they end-up in an advanced Heart failure, requiring frequent hospitalizations, and need for ICU care. The only life-saving procedure for them has been Heart Transplantation. The shortage of available donor heart, majority of patients die before a donor heart is available. This is where the LVAD is useful for those waiting for transplantation. The patients who are not fit for heart transplantation either due to advanced age or due to other comorbidities, LVAD is the only method to save them.
VAD is a mechanical pump that unloads the failing heart and pumps into circulation so that the cardiac output improves and adequate blood flow reaches the organs. If it is used to support the left Ventricle, it is called LVAD and RVAD if it supports the right ventricle. If both ventricles fail, they need Bi Ventricular Assist Devices / Total Artificial Heart.
Implantation of VAD requires open heart surgery, and the device has three components. The inflow cannula is connected to the apex of the ventricle (LV) and the outflow cannula is connected to the ascending aorta or pulmonary artery. The pumping chamber is placed inside the pericardial cavity next to the heart with an electric drive line coming out of the abdominal wall, which will be connected to the controller. The controller is worn by the patient on the body in belt and it will be connected to portable batteries or a power module.
Indications of VAD
Bridge to Transplantation: Patients who are eligible for heart transplantation. Majority die during the waiting period as they are too sick to wait till a donor heart is available. LVAD helps them survive this period.
Bridge to Recovery: Patients who are very sick due to severe acute Heart failure secondary to viral infections, postcardiotomy shock, myocardial infarction and peripartum cardiomyopathy and requiring support only for a period ranging from days to weeks. Once they recover, the VAD is removed.
Destination Therapy:Used for patients not suitable for heart transplantation. Advanced age, comorbidities and other contra indications for heart transplantation. An LVAD as a DT therapy should be offered to those Heart failure patients with life expectancy of lower than 50% at 1 year.
HEART MATE III
Heart mate III LVAD is an advanced version of LVAD offering high efficiency and durability.
This is an improved version of the successful Heart Mate II Device.
HM III works as centrifugal pump with flow rate from 2 to 10 Liters per Minute.
Works with fully magnetically levitated technology to create a frictionless and non-contact rotor with wider gaps limiting damage to blood cells.
It has a pump with inlet and outlet conduits and a modular drive line. The controller is compact with prioritized visual alarms with clear actionable instructions. It has a backup battery.
HM III has software in both the internal pump and the controller. Unlike other continuous flow pumps it can add an artificial pulse. Battery consumption is less and hence the batteries last for longer period.
Assess patient’s support system, psychosocial status, and compliance.
The patient, family and caregivers should be trained how to operate and take care of LVAD system.
Patient selection remains one of the most important and challenging matters in clinical practice.
As devices and perioperative management continue to improve, VAD therapy will be a suitable option in less severely ill Heart failure patients.
It is likely that long-term mechanical circulatory support will approach the survival benefit of Heart Transplant and become a viable alternative for patients with advanced Heart Failure.
This technology is currently used only in dedicated centers.