LVAD: Ernie Werner
By July of 2014, 67-year-old Ernie Werner was facing the final phase of end-stage congestive heart failure. His weakening heart was causing his kidneys and liver to fail. His cognitive function was starting to decline. He couldn’t walk more than a few steps without hyperventilating. He barely had the energy to get up to use the restroom, let alone spend time with friends and family. After living with heart failure for nearly ten years, and despite a robust medication regimen, multiple heart procedures, and a team of top notch doctors, it was clear Mr. Werner was losing this battle. Without advanced surgical intervention, Mr. Werner would likely only live for a few months.
But today, thanks to the cardiac doctors and surgeons at St. Luke’s Hospital, and a surgically implanted pump called a Left Ventricular Assist Device (LVAD), Mr. Werner is alive and well, and enjoying activities he never thought he’d be able to do again.
Not only is this surgical procedure available at St. Luke’s, but thanks to an expert cardiac team, the facility also enjoys the best outcomes in the region. Survival rates, post-operative recovery time, and patient satisfaction for those implanted with an LVAD at St. Luke’s all exceed national averages, and many of the patients whom have received the implant are now advocates for others facing similar circumstances.
“All of us that have worked hard in the LVAD program at St. Luke’s are incredibly proud of the success we’ve had,” Dr. David Allen, Medical Director of the Heart Failure and LVAD programs at St. Luke’s, said. “We’re giving people an option when they’ve been told they had no options. We’re giving them a second chance on life, to live a longer and more productive life. Our success rates have been incredible for a new program, and I think that speaks volumes to how we’ve not only prepared ourselves as physicians and LVAD coordinators, but also to how we’ve taught and educated the nurses, physical therapists, and the surrounding community — all of which are integral to the success of this program.”
The surgeons, doctors, and coordinators in the St. Luke’s LVAD program come from excellent training and are dedicated to bettering the lives of those in the community. Because of this expert level of care, St. Luke’s now offers this “big city University” procedure locally, and with fantastic results. Patients in the Lehigh Valley no longer need to travel far distances to obtain the best possible outcomes.
Heart failure is aptly named, as in the most basic of terms it is simply a weakening of the heart. The condition is not reversible, and over time the heart continues to weaken, its ability to meet the body’s needs becoming increasingly diminished. Once a patient is in the throes of end-stage heart failure, the heart is virtually unable to carry on its primary functions without surgical intervention. In turn, the rest of the body tries to make up for the lack of heart function by diverting oxygen-rich blood from other organ systems such as the kidneys, liver, and brain.
When a patient is in the earlier stages of heart failure, cardiac specialists treat the affliction with prescription medications, monitored cardiac rehabilitation, and lifestyle changes such as exercise and healthy eating habits. This treatment regimen can often slow the progression to a point where many patients live happy and relatively healthy lives for many years. But when a patient reaches the end-stage of heart failure, medications and lifestyle changes are no longer effective, and more invasive procedures must be considered to prevent the heart — and the rest of the body — from completely shutting down. At this point in heart failure, a patient is looking at either a heart transplant, or the aforementioned LVAD.
Further complicating matters for those suffering from end-stage heart failure is that many are not eligible for a transplant, either due to age or significant physical issues that could prohibit post-transplantation recovery. “In these scenarios we can utilize an LVAD for what is called ‘Destination Therapy’ or a ‘Bridge to Life’ procedure,” Dr. Allen said. “We implant the LVAD to extend the patient’s life from a few months to two, three, or even more years. And it’s important to note that with this type of procedure, we’re not only extending the patient’s life, but we are also greatly improving the quality of that patient’s life.”
The LVAD works to support the heart by literally taking over most of the heart’s function. The device acts as a pump and is placed in a surgically created “pocket” near the upper part of the belly, where it is then attached to the heart. When blood leaves the heart, it is pumped into the LVAD, and then back to the aorta of the heart, and then carried to the rest of the body. In effect, the LVAD, which is smaller than the palm of one’s hand and battery operated, is taking over the entire function of the left side of the heart.
Dr. Allen explains that while getting a new heart to replace a failing one is ideal, the waiting list for a heart transplant can be prohibitively long. “There simply aren’t enough hearts to fulfill the need of every patient on the transplant list, and a patient’s heart will continue to decline while awaiting a transplant, leading to total failure of the heart and even death,” Dr. Allen said. “So what can we do for these patients to get them through? In these scenarios an LVAD is traditionally used as a ‘Bridge to Transplant,’ meaning we implant the LVAD to support the heart, and then the patient can get a transplant at a later point, whether it’s a year, two years or longer.”
While Mr. Werner did not meet all the criteria for a transplant, the team of highly skilled cardiac surgeons and doctors at St. Luke’s determined he would be a good candidate for an LVAD as “Destination Therapy.” There was one catch, though — Mr. Werner would be the very first patient to receive an LVAD at St. Luke’s. But that didn’t deter him from jumping at the chance to live a longer, more fruitful life. “I told them, ‘That’s okay. I don’t care if I’m the first or not, just fix me up,’” Mr. Werner said. “Because really, if I’d have to run down to Philly every week, it would be a huge pain. I was in a very bad situation, and if the heart team from St. Luke’s said this was my best option, well I had complete trust in them. They’ve been great to me this whole time.”
As Dr. Jose Amortegui, Cardiac Surgeon at St. Luke’s, explains, the outlook for patients with end-stage heart failure is dire without a transplant or an LVAD implant. “Once a patient reaches this point, we know that the chances for survival of two years is just about 5%,” Dr. Amortegui said. “But with the LVAD procedure, survival rate for two years ranges from 30% to 80%. The difference is like day and night.”
St. Luke’s Cardiac Surgeon Dr. J. Raymond Fitzpatrick explains that the LVAD pumps currently used at St. Luke’s are considered state-of-the-art, resulting in the best possible outcomes as well as allowing for more patients to qualify for the procedure. “The first generation devices were much larger, they had a lot of moving parts, and they really only lasted one to two years,” Dr. Fitzpatrick said. “The device we’re using now — the HeartMate2 — lasts much longer and fits in a smaller package. The incision is a little smaller, and more people can qualify for it than with the first generation devices. With the older models, younger patients and petite adults didn’t qualify. Now the technology can be applied to almost anyone, and we’re adding years to people’s lives.”
While it’s great the LVAD can add years to a patient’s life, it’s the vast improvement in the patient’s quality of life that’s truly remarkable. Since the LVAD is basically taking over the heart’s function, many of the symptoms of heart failure dissipate. Symptoms such as shortness or breath, fatigue, and kidney failure are mitigated, and patients are able to once again enjoy activities they hadn’t been able to partake in for years. Because the battery for the device is about the size of a large cell phone, patients are not bed ridden or stuck at home; they can carry the battery in a small bag or on a belt and be able to go out and live their lives again.
Nearly two years after having the LVAD procedure, Mr. Werner has a new lease on life. He’s now able to partake in old hobbies he thought were completely in his past, such as regularly hitting the gym and going on hunting trips with his friends. But perhaps most importantly, he’s able to join his loving wife of 44 years on daily outings, whether it’s a quick trip to the mall or enjoying a nice stroll down the street.
For Mr. Werner, these activities and the quality time spent with his friends and family are all thanks to the cardiac team at St. Luke’s and cutting edge medical technology. “It was a great experience for me,” Mr. Werner said when reflecting on the post-procedure outcome. “When I got out of surgery, everybody was there to help. The doctors, surgeons, nurses, the physical and occupational therapists — they all helped to get me going again, and they all truly cared for me.”