UR Medicine cardiac surgeons recently introduced a new approach to care for people with congestive heart failure.
Strong Memorial Hospital is the first in the country to perform a minimally invasive surgery to implant the newest heart pump, which provides patients more time with loved ones and to wait for a new heart.
The HeartMate 3 LVAD is the next-generation left ventricular assist device for advanced congestive heart failure. The device supplements the pumping action of a weakened heart. It is approved for use as a bridge-to-transplant, which means the pump will support heart function for patients waiting for a heart transplant. Strong is upstate New York’s only center approved to use LVADs.
“This is a significant advance for patients who can receive this lifesaving device without weeks or months of recovery,” said Igor Gosev, heart transplant surgeon.
Gosev recently worked with cardiac surgeon Peter Knight and anesthesiologist Laurent Glance to place the one-pound device near the base of the heart of a Southern Tier man.
Surgeons traditionally implanted heart pumps through a large opening in the sternum — the breastbone — similar to open-heart surgery. It is a successful technique, though recovery can be long and there is risk of infection and scar tissue growth.
“It has been our goal to use a minimally invasive approach with the LVAD, because this new device is smaller and the placement on the heart is optimal,” Knight said.
Knight leads the minimally invasive cardiac surgery program. He has advanced techniques over the last two decades, and is nationally recognized for his innovation and leadership in the field.
Surgeons made two, 3-inch incisions — one under the heart and another below the collarbone on the right side — to implant the pump. Some surgeons in Europe use a similar technique. The device, made by Abbott, was approved by the Food and Drug Administration in August 2017, and UR Medicine surgeons started planning to perform the alternate method.
“This is a great example of teamwork and dedication to providing the best care for our patients,” said Sunil Prasad, cardiac surgery chief. “In this procedure, Dr. Knight, who has performed hundreds of minimally invasive heart surgeries, and Dr. Gosev, who has implanted hundreds of LVADs, came together to use this minimally invasive approach, and our patients have done extremely well.”
The heart and vascular team has implanted LVADs for nearly 20 years, having participated early clinical studies that led to their standard use for heart failure. To date, the team has provided LVADs to more than 500 people, some of whom have traveled from northern New York, Albany, Buffalo, the Southern Tier and Pennsylvania for care.
Using minimally invasive techniques, patients often experience less pain and blood loss, lower risk of complications, shorter hospital stay, improved quality of life and heart function. Especially important for heart failure patients is the ability to return home with their loved ones as they await heart transplantation. Some people face months of hospitalization waiting for a matching donor heart.
The team, which includes cardiac surgeon Bryan Barrus, performed the surgery for five people in the past three weeks.
Corning guitarist Loren Vinal first recognized signs of heart trouble last summer when climbing stairs and walking was difficult. Physicians initially treated him for a virus and then a lung disorder, because heart failure is rarely considered the cause of breathing difficulties for someone his age.
His symptoms worsened during a trip to Nashville, Tennessee, for a performance and vacation.
“I didn’t feel right, and I couldn’t breathe,” Vinal said.
Doctors at Vanderbilt University Medical Center diagnosed cardiomyopathy, a weakened heart and elevated risk of sudden cardiac death. While hospitalized, Vinal suffered a heart attack — another indication that his heart was deteriorating.
Vanderbilt doctors fitted him with a Lifevest, an external defibrillator, which tracked his heart rhythm and delivered a therapeutic shock to restore a safe and steady heartbeat. They encouraged him to seek care at Strong Memorial when he returned home.
“After 13 days in the hospital, I finally flew back to Corning,” Vinal said. “But just a day later, I couldn’t breathe again.”
Cardiologists John Rich and Ravi Akula, of Arnot Ogden Medical Center in Elmira, transferred him to Strong, whose cardiologists work with Arnot Ogden physicians to provide complex heart care.
Leway Chen, medical director of the advance heart failure program, said medications and close monitoring by the heart failure team weren’t effective for Vinal.
“He needed a new heart, and we placed him on the waiting list,” Chen said. “Initially we thought he could withstand the wait for a new heart, but we detected changes in his heart and had to shift our plans and put in the heart pump.”
Vinal said he was frightened by the rapid decline of his heart health the week before receiving the HeartMate 3 LVAD.
“At first the doctors thought my heart could last six months, and then it was a month and then a week,” he said. “On a Friday, the doctors said they were worried I wouldn’t make it through the weekend. That was hard to take, but I have to say the whole team did everything they could to make me comfortable.”
Jeffrey Alexis, medical director of the VAD and artificial heart program, said that scenario is common for patients in heart failure. The transition from the use of effective medications to needing a heart pump can be quick.
“The benefit for Mr. Vinal is that minimally invasive surgery wasn’t as much trauma to his body as the open approach,” Alexis said. “We know that the sicker you are going into this surgery, the sicker you are coming out. Once the LVAD is in place, people start to feel better because their blood flow improves and they start having more energy through the long recovery. Now that we are able to place the pump without opening their chest, it’s a real plus for our patients.”
Vinal recovered quickly, leaving the cardiac intensive care unit just two days after surgery. He went home two weeks later. Most patients who receive an LVAD are hospitalized three weeks or more after surgery.
More than 5.7 million people in the U.S. suffer from heart failure, and approximately 915,000 new patients are diagnosed annually. For congestive heart failure patients who can no longer rely on earlier stage treatment options, an LVAD can help their weakened heart pump blood through the body and provide crucial support as patients await further treatment, including heart transplants.
“Heart failure is a crippling and costly disease, which is why it’s important to be able to offer these patients a technology that gives them the opportunity to return to a better quality of life,” Alexis said.
Congestive heart failure treatment options are limited to LVAD and/or heart transplantation. LVADs extend survival, and can be used as the destination therapy or a bridge-to-transplant, as the HeartMate 3 is used. Unfortunately, only 1 in 10 people waiting for a new heart receive one because of the shortage of donors. In New York, organ donation is low and upstate patients have longer wait times than many areas of the country.
Strong Memorial is one of the highest volume LVAD centers in the nation. UR Medicine cardiac surgeons and cardiologists participate in clinical studies of the newest devices, providing patients access to next-generation technology before other sites in the nation.
Prasad said the collaborative nature of the heart and vascular program led to this advance, which is expected to be studied by peers at other academic medical centers.