Transcription:

Melanie Cole (Host): According to the CDC, approximately 5 million adults in the United States suffer from heart failure. Lourdes’ new program in LVADs offers hope for patients with severely debilitated hearts. My guest today is Dr. Robert Mohapatra. He is a cardiologist and the medical director of the heart failure program at Lourdes Health System. Welcome to the show, doctor. When we are talking about heart failure, people think it’s the same thing as a heart attack. Please just start with a working definition of what heart failure is.

Dr. Robert Mohapatra (Guest): The simplest way to describe heart failure is that heart failure can be related to a variety of conditions, but essentially what happens is that the heart is just not able to pump enough blood to meet the demands of the body. It can happen because of a variety of reasons. It can be because the patient had a prior heart attack. It could be related to them having arrhythmias, problems with heart valves, which can contribute to this as well, but there are a variety of different conditions which can lead to it. The bottom line is when a patient is diagnosed with just a heart failure, the heart is not able to pump enough blood to meet the demands of their body.

Melanie: People I have heard in the media and on television shows about LVADs. What is that?

Dr. Mohapatra: LVADs are ventricular assist devices or mechanical pumps which are attached to a patient’s heart, which serve to help the patient’s heart pump stronger and get more blood out to the rest of the body. They are pretty significant devices which are intended only for patients that are really the sickest patients we have with congestive heart failure. So, usually one of the classification criteria that we have for our patients to receive a ventricular assist device is the patients who are classified as having end-stage heart failure. The purpose of the ventricular assist device will be to help a patient’s heart with the device to pump enough blood to meet the demands of their body.

Melanie: This used to be, really, abridged to a heart transplant necessarily. Is it being used in some cases as a long-term solution?

Dr. Mohapatra: That’s a great question, Melanie. You’re absolutely right. The initial indication for a ventricular assist device is what we would call a “bridge” for getting patients to heart transplant. So, a patient would have, as I described earlier, end-stage heart failure where they would have very significant symptoms and a very poor quality of life, really unable to carry out any regular daily activities, just getting out of bed or being able to prepare meals, and when we had patients in those situations and we came to realize that a lot of these patients weren’t making it to heart transplant because they weren’t able to live long enough to get the transplant. So, once the ventricular assist devices came out and were approved by the FDA, they were used to help carry patients over until they could get that heart transplant. What’s happened over the last few years now is the devices have got improved with their technology, and we’ve noticed that patients are living longer with ventricular assist devices. And as a result of that, a few years ago the FDA did approve ventricular assist devices for what we call “destination therapy”, meaning that the device is implanted on a patient who may not be a candidate for a transplant and that patient is just going to live with is ventricular assist device going forward.

Melanie: Who can get an LVAD?

Dr. Mohapatra: There are various criteria for patients to receive an LVAD. A couple of the simplest criteria are they have to be patients with end-stage heart failure, which is classified as ejection fraction of 25% or less, and then patients that we would also classify as being either New York Heart Association IIIB or Class 4 heart failure patients. Those are two of the main criteria. So, essentially, patients with very weak hearts and patients who have the most advanced form of heart failure.

Melanie: If it is being used as a destination therapy, how will medications change after LVAD procedure? If people have been on Coumadin or various medications for their heart failure, does any of that change with LVAD?

Dr. Mohapatra: Medications will change after patients have ventricular assist devices placed. It is not a cure for patients having congestive heart failure. It is just another treatment option that we have, but patients still will still require to be treated with medication. But, what we see more often than not is that patients are going to require fewer medications compared to prior to having the operation done. So, even though it’s not a cure, patients are going to feel much better once they have the device placed and will require fewer medications. The one medication that will require, however, is Coumadin, because most of the ventricular assist devices are mechanical pumps which are in a patient’s body, essentially their heart. So, they do require the treatment of the blood thinner.

Melanie: So, then, what is life like for that patient that’s had ventricular assist device implanted? Can they have sex, can they take showers, can they be active and do exercise? What is life like?

Dr. Mohapatra: There’s two reasons that we encourage our patients with end-stage heart failure to receive these LVADs. First off, they’re going to live longer. The data is very clear that when you have patients who receive left ventricular assist devices, and compare them to patients that are treated medically, the patients with LVADs clearly live longer. Just as importantly is that patients regain the quality of life. They become more functionally active, they’re able to carry out activities that they would normally like to do--go shopping, walk around comfortably without having any symptoms. And with some of those other cases, they may be a little bit on the rare side are, there was a recent video that one of my colleagues sent me the other day of a patient who is actually body builder, who went back to training after he had an LVAD placed. So, patients can live longer with the devices, they can have an improved quality of life, and for the most part go out and carry out day-to-day activities of life without a problem.

Melanie: Are they still waiting for a heart transplant at that time?

Dr. Mohapatra: It depends on the patient, Melanie. A lot of times the patients are referred when they have end-stage heart failure, and the first question we will ask is, is the patient a candidate for heart transplant or not. And then, based on that, that’ll help guide us as we go down the road with these patients. If a patient is seen to be a potential candidate for a transplant, then this may be what we call a “bridge” until they’re capable of getting a transplant. For other patients, for different reasons, it may be because they’re a bit older and they don’t meet the age cut-off for patients who receive transplants, or they have other annoying medical problems that prevent them from getting a transplant, such a history of cancer within the last few years, they may be candidates for LVADs with the intention of this being placed as what we call “destination therapy”, meaning they’re going to have the LVAD implanted and that they’re going to ahead and live with that device afterwards.

Melanie: What’s the battery situation? Is this worn outside the chest, and does it have to be replaced?

Dr. Mohapatra: There is a battery which helps drive this device. The batteries are external and patients normally have some sort of a pack that they wear around their abdomen which contains the battery. The batteries do have to be changed and they are connected to the device by what we call a ‘drive line’ which goes through a patient’s abdomen, and there there’s a small little incision through their skin on side of their abdomen where the line comes out from. So, patients normally are given multiple packs of batteries and are educated in terms of the importance of how long the batteries lost, how often they need to be charged, and the importance of having fully charged batteries. The batteries last for quite a long time, so it’s not that patients are unable to go out of their house with concerns of having to constantly change your battery. So, usually, we educate our patients about it, when they’re going out, based on where they’re going. Normally, they may need to take one battery, but if they’re going out for an extended period of time, they may want to take two just to be on the safe side.

Melanie: Wrap it up and give us your best advice for people who may be suffering from heart failure, and tell us about the Lourdes dedicate heart failure program.

Dr. Mohapatra: What I would summarize LVADs is for, Melanie, is that for those patients that have end-stage heart failure, I think it’s very important that they know that there is another treatment option for them which can help them live longer, but, more importantly, improve their functional status and improve their quality of life because I think it is just as important as living longer. So, we’d encourage patients to talk to their doctor if they have been given the diagnosis of congestive heart failure that this is something that they may be a candidate for. In regard to Lourdes, our program takes care of patients with LVADs. This is something that I’ve been very passionate about, because as the Director of the Heart Failure Program here at Our Lady of Lourdes, I’ve noticed over the past few years that LVADs are not something that are new, they have been out for some time and a lot of the major tertiary centers in Delaware Valley, specifically in Philadelphia, have been implanting them. But a lot of times we were transferring our patients over there, and patients would come back and after they would receive them and they would tell us that the burden of having to constantly travel to get all their care across the river was very difficult for them. Once we heard that from multiple patients, we realized the importance of being able to offer this care locally. So with the share program that we have right now, essentially we identify these patients who have end-stage heart failure who are candidates for LVADs, we are in contact with some of the surgically implanting centers throughout the area, we’ll discuss the cases and complete the entire work up for these patients locally, so, that way, their cases have been discussed, the work up is completed, they may have to travel to the implanting center once or twice at the most to meet with the team, to discuss everything with the surgeon. Then, they are given operation date, they are operated on, and once everything is completed from there and they’re discharged from the hospital, they come back and continue to follow up with us locally for their care.

Melanie: Thank you so much, doctor, for being with us today. It’s really great information. You’re listening to Lourdes Health Talk. For more information you can go to the www.Lourdesnet.org. That’s www.Lordesnet.org. This is Melanie Cole. Thanks so much for listening.