Drs. Ashish Haryani and William E. Stansfield discuss LVAD implanted into 60-year-old male with severe end-stage heart failure and history of cancer and stroke.
Okay. My name is Dr Ashish Pariani. I am the medical director of the L VAD, or left ventricular Assist Device Program here at Amita Health For patients with heart failure from the time of diagnosis, about 50% of patients are alive after five years. Thea Media Health Program encompasses the broad spectrum of heart failure care from the initial diagnosis through somebody who needs something like a left ventricular assist device program. This is unique, especially in our region. There are no centers around us who can provide such a comprehensive evaluation as well as a comprehensive care for each of our heart failure patients. We have, ah, slightly better understanding slash ability to identify patients who are at higher risk for further complications so that we're able to identify these patients earlier for them to proceed onto other options such as an L VAD, or heart transplant. As a heart failure specialist, I think my first job is to make sure that patients are on the appropriate guideline directed medical therapy and those air maximized to their patients ability the purpose of the program. It is truly to make patients healthier, more accountable for their care and also give them or stability in their heart failure diagnosis. So we provide both, you know, emotional support, family support, social support so that they're educated on what exactly is happening. So in the end, the patient work with us so that their care is more successful. There care is more timely, and they truly feel better. The Amita Health Heart Function Program involves comprehensive care. This includes routine nurse check ins. This includes telephone check ins as well. This also can upgraded to more advanced things like a device placement, such as a primary artery sensor that allows us to manage you from home, is well. This has helped us reduce readmissions for heart failure as well. Azaz keep people live longer in certain situations prior to getting them to a left ventricular assist device or heart transplant. If we're able to really utilize the tools that we have early on, we can either prolong their time without it or actually prevent it from occurring. It's not unusual that when a patient gets referred for higher level of care that their primary physician or cardiologists tends to lose touch with that patient with the media health. I believe this differs from other institutions, and I want to make sure that the physicians that refer patients to us, they will always remain a critical partner and the decision making throughout the longevity of that patient. My name is Dr William Stansfield. I'm a cardiothoracic surgeon. I work here to meet a health with Dr Harry Anne and the rest of the heart failure team for any patient. We want to choose the therapy that is gonna be the best for that patient. Some patients cannot tolerate a heart transplant for a variety of reasons. For example, they can't tolerate immuno suppression or they have other co morbidity is that would mean that a transplant would have excessively high communications for these patients. I believe that the L VAD is an outstanding alternative. It gives them the advantage of increased cardiac output, and it can help them feel better and dramatically improve the quality of their lives without exposing them to the risks of immuno suppression that accompany heart transplant. The main benefit that patients derive from Anel VOD is improving their cardiac output. So of course, if a patient's Onley problem is that they have low cardiac output, then that would be the ideal patient for an Al Abad. However, very few of the patients that we see actually fall into that category. Many of the patients have injuries to other organ systems as a result of chronic low flow toe all of their organs. However, with the L VOD, we believe that this technology, by improving the blood flow to things like their kidney and their intestines and their liver, it can actually improve the functioning of those organs in many cases. And that's one of the main values of the L VAD as we use it today. I met Mr Mateusiak approximately two years ago. He was referred to me from the electro physiologist. The electro physiologist had tried to put in a special type of pacemaker and that pacemaker occasionally can regenerate the heart function. Unfortunately, his case, the heart function, had not improved, so he was sent to me in order to maximize his therapies With close monitoring, he was able to go about two years without needing the device. During that two years, he was stable. He was walking several miles. Initially, he had visited Mount Fiji with his son in Japan. He was able to climb a few 1000 ft. But what we noticed about six months prior to his device placement, he was starting to have a few subtle hints that things were changing. He was hospitalized a few times. He couldn't even get around his house anymore. And that was this telling signal that it was time that we sort of upgrade his level of care and start discussing this left ventricular assist device or transplant in more detail for me, he represented really the ideal L VAD candidate left ventricular assist. Device therapy is similar to a conventional open heart surgery. We access the heart by dividing the breastbone, and we put the patient on a heart lung machine to support the patient. We place the ventricular assist device into the left ventricle through a core in the apex of the left ventricle. And then we bring the outflow graft around to the ascending aorta, and we had asked mostly to the ascending aorta. We then activate the device. We wean the patient from bypass Justus. If we were doing a regular heart surgery and we bring out the drive line for the device from the patient's perspective, l VAD surgery is much like a conventional heart procedure. They're going to go to sleep. They're gonna have an incision on their chest. The difference is that they're gonna have a drive line coming out that will power the device. This type of pump takes a lot of energy, much more than a pacemaker or defibrillator where the patients battery could be small enough that it could be implanted For this type of pump. The patients have toe have this drive line that connects to an external battery, which they can wear on their waist. When it's convenient. They can also plug into the wall and they can plug into a controller, which gives them information about how the pump is performing when the battery is getting low and other things that they need to know or communicate with us. I meet with boys. I'm a nurse practitioner in the Advanced Heart Failure and Bad program at Amita Health. I am clinically involved in the management and care of our patients in the inpatient setting and in the outpatient setting. Education is very important to a patient success, but also important for their caregiver to understand the role that they were going to play in their management of the bed itself. We spend hours, um, usually meeting with patients and family, discussing what a bad looks like, what it does, but also how to take care of it. When I first met Mr Mateusiak, he was admitted for acute heart failure by Dr Hourani. He wasn't in good shape. He was pretty sick. He had lost a lot of weight and he also was very symptomatic. So when I met him, we started talking about that implantation as his next step. We did a lot of education about what the implantation would look like, what life after surgery would look like. Life with a bad and also his goals of what activities he wanted to resume. From the moment we met him, we could tell that he was going to do well. He was very enthusiastic and eager to go forward with E l VAD procedure. He had read a lot about it. His family was fully supportive. We felt like this was a nine ideal set up for him to have a good outcome. He had an uneventful operation which we like, and he had a very smooth and steady recovery he benefited dramatically from having an increased cardiac output with Dale that one of the reasons for a patient to come to media foreign al VOD is because we're a local provider. This makes it easier for the patient to be seen and follow up. It makes it easier for us to stay in close communication with the patient, and those things make it easier for us to help ensure that the patient has good outcomes here. To meet a health, we have two options for ventricular assist devices that we can place in patients. One is called the Hardware H Bad. This device is a little bit smaller, and it's a little bit easier to put into a patient that has a smaller heart or smaller ventricle. We also have ah, newer device. There was more recently approved heart made three has Thea Vantage that it adds an artificial pulse into the normally continuous output of the left ventricular assist device. We believe that this artificial pulse can help reduce some complications related to thrombosis and stroke. So when we evaluated Mr Mateusiak, he had a remote history of stroke with no sick wala, and we felt that device with a lower stroke risk would be better for him. I had used the heart made three in my previous job, and other surgeons in our group also had experience with the heart made three. We therefore decided that from a surgical standpoint that we had the expertise required and we just needed to get the rest of the team up to speed to ensure the safest possible outcomes for Mr Mateusiak. In order to prepare for Mr Mateusiak surgery, our team helped train about 60 people in a short window of time, but also had this equipment flown over that would be ready for a surgery to truly exemplify the team nature of this. Everyone from the nursing staff on the floors to Edith Boys are bad coordinator to the O. R staff are surgeons are anesthesiologists are profusion ist everyone truly came together to make this happen. For Mr Mateusiak, the reason that I went into heart failure as a subspecialty of cardiothoracic surgery is because of the huge difference that this makes in the quality of people's lives. We take the sickest patients and we essentially have the opportunity to make them normal. This is incredibly rewarding from a physician and care standpoint. Our patient recently left clinic telling us that every time he leaves the appointment, he leaves with a smile on his face. And that, I think, truly exemplifies the care that we can provide as a team here to meet a health. It is Thebe best feeling in the world to be able to help somebody enough that they can get their life back. We just saw bike riding right outside our hospital.