Assist for Congestive Heart Failure

At his Baltimore-area home, Daniel Steele, 58, takes off his battery pack and plugs himself in. His left ventricular assist device -- a mechanical heart pump -- will keep his blood flowing strong as he sleeps. Steele, a former project manager for a utility, is now on disability with advanced heart failure. Since September 2013, the LVAD has helped keep him alive -- and feeling pretty good -- as he waits for a heart transplant.

In 2007, Laura Huber of Aberdeen, South Dakota, then 26, gave birth to her first child. Soon after delivery, unexpected symptoms began. Huber had developed a rare, pregnancy-related condition that led to heart failure. That May, she underwent open-heart surgery to get an LVAD. Eight years later, she's content to stay on a heart pump. For Huber, LVAD isn't a bridge to transplant -- it's a destination.

Transplant or Destination?

Dr. Rebecca Cogswell is an advanced heart failure cardiologist at the University of Minnesota Medical Center, which implants about 50 heart pumps a year, divided between patients on destination therapy -- for whom the heart pump is meant to be permanent -- and those awaiting transplant. LVADs buy time for those on the transplant list, Cogswell says. But "another avenue" for pump use is for people who aren't transplant candidates but could still benefit, such as those in their 70s or 80s.

Age over a center's cutoff is a major reason patients aren't eligible for transplant, says Dr. Ryan Tedford, a cardiologist at the Johns Hopkins Comprehensive Transplant Center in Baltimore. Cancer is another: Depending on type of malignancy, patients might have to wait at least five years for transplant. Similarly, heavier patients with a body mass index above cutoff might quality for an LVAD as destination therapy.

As with transplant, Tedford says, a heart pump is considered a last resort after all the right medications have been tried, guideline-directed medical therapy has been given -- and the hospitalized patient is still struggling and getting sicker.

A landmark study, which randomly assigned patients with advanced heart failure to receive either "optimal medical therapy" or an LVAD implant, found a "substantial improvement in survival" for patients on LVAD support.

Choosing

In August 2013, Steele entered the hospital carrying about 30 pounds of fluid buildup in his belly and legs. A cardiac catheterization confirmed that his heart, already fitted with a defibrillator and a pacemaker, was getting worse. Diagnosed a decade ago with heart failure, Steele knew that now he was "really going downhill." He couldn't climb a flight of stairs. When he came home from work each day, he had to lie down to take a nap. At night, he couldn't sleep. "I had to sit in my chair because of all the fluids," he says.

Steele sums up his dwindling options: "I could stay in the hospital and hope a heart became available, or I could go home and let it go the way it's supposed to go," as in, let nature take its course. "Or I could get a heart pump, an LVAD, which I decided to do." Soon Steele had surgery to implant the HeartWare LVAD. "It's been a lifesaver," he says, without hyperbole.

The Pump

LVADs are the most common type of mechanical heart pump, used when the left ventricle -- one of the heart's four chambers -- is failing in its function: to pump oxygen-rich blood throughout the body.

Device parts include a tube placed in the left ventricle to draw blood into the pump. The pump, located in the upper abdomen, contains the rotor, which rapidly moves blood into the aorta. A second tube -- the drive line -- leads from the pump to outside the abdominal wall, where it attaches to the batteries and controller.

The LVAD requires specialized, high-voltage batteries. At night, people plug themselves into a power module at their bedside. It's a "revolutionary technology" Cogswell says, a far cry from when people used to "wait in hospitals on refrigerator-sized machines" until a donor heart became available.

When the possibility of an LVAD arises, Cogswell says patients should ask questions such as: "What's my survival if I go on the path of just medicines?" "Is there an option for transplant, or not?" and "What's the complication rate for the heart pump?"

Wait for Transplant

Steele says recovery from implantation surgery was "pretty rough" the first day or two. But in a couple of weeks, he started feeling better and eventually had so much energy that he could hardly sleep.

After discharge, support at home is a must, Cogswell says. Caregivers receive extensive training on the heart pump and how to manage it, and how to take care of the abdominal exit site. For several weeks, they need to stay nearby as patients recover, in case of rare events like passing out.

Steele, who says he receives "excellent" care from his wife, hasn't had any complications. The biggest drawback, he says, is having to carry the battery and controller along with him at all times. That's a minor annoyance, he adds -- the device has turned his life around.

For Steele, the LVAD is a bridge to transplant, but he realizes he might be standing on that bridge for a while. As a large man with the 'O' blood type, it could take many months for a matching heart to become available. "But eventually I would like to get one," he says.

Going Strong

After Laura Huber gave birth, a condition called peripartum cardiomyopathy put the new mother into heart failure. In and out of the ICU, Huber went through a battery of tests. Once doctors suspected she might need a heart device, she was flown to the specialty heart program at the University of Minnesota Medical Center.

On May 8, 2007, Huber was implanted with a Thoratec HeartMate II. Her husband C.J. and daughter Maddie were by her side throughout the hospitalization. Amazingly, Huber was back at work within three months -- as a physical therapist working in cardiac rehabilitation.

Last November, Huber's original LVAD was replaced due to wire malfunction. She hopes the replacement model, the same as her first, proves just as durable.

Potential for Complications

Because the LVAD only supports the left side of the heart, Tedford says, a patient who also has right ventricular failure could continue having symptoms after surgery -- possibly requiring a second type of device. Bleeding is a major complication. "About 30 percent of patients in the first year will have some kind of gastrointestinal bleeding," Tedford says. The increased risk of clotting found several years ago with LVADs appears to have tapered off, he says. Blood-thinning drugs are prescribed for patients on LVAD therapy, and their heart medications may change after implantation.

Infection of the drive line is another potential hazard. To prevent that, patients and caregivers learn proper technique for daily dressing changes. Patients are asked not to shower initially. Eventually, they're given a shower bag to protect their equipment.

LVAD Lifestyle

For people living with heart pumps, power outages take on new meaning. There's 30 minutes of backup power built into the LVAD, Tedford says, along with alarms. For extended outages, as with storms, LVAD patients receive priority service from the power company. With delays, some of Tedford's patients have had to travel to a local hotel or mall to plug in.

People with LVADs can rock climb and ski and travel a good distance, but contact sports aren't recommended (no surprise). Water sports such as swimming and boating are also off limits. One practical issue is how to wear the LVAD gear. Steele had custom vests made for his LVAD components. On the job, Huber wears her batteries, secured by Velcro tabs, clipped to a strap hanging down her back. The controller fits in a pack around her waist.

Huber says she sometimes forgets she has the device. For daughter Maddie, she says, the LVAD is the norm: "She doesn't know Mom any other way." For other patients who might someday face her situation, Huber says, "You're living a life with an LVAD -- the LVAD doesn't need to be controlling your life."

Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.