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Scott Webb: On today's HeartSpeak Podcast, the podcast for Baylor Scott & White Heart and Vascular Hospital, Dallas and Fort Worth, Dr. Dan Meyer, Chief of Heart Transplantation and Mechanical Circulatory Support and a cardiac surgeon on the medical staff at Baylor University Medical Center, part of Baylor Scott & White Health, will discuss an advanced heart failure treatment option, ventricular assist devices or VAD for short, also known as LVAD.

I'm Scott Webb. And doctor, approximately 6.2 million adults in the US have heart failure according to the CDC. Of those living with heart failure, about 10% have advanced heart failure. So, Dr. Meyer, can you tell us what advanced heart failure is and how it's diagnosed?

Dr. Dan Meyer: Well, advanced heart failure is that condition where, you know, basically the heart has lost its ability to effectively pump blood to the rest of the body, into all the essential organs. And this can be due to longstanding hypertension, high blood pressure, prior heart attacks. Sometimes the patients don't even know they have had them or occasionally even a virus that has attacked the heart. And patients who have advanced heart failure, they have a hard time really doing much of anything. Just breathing when they would walk around the home is difficult and sometimes just even at rest, they may be short of breath in the most severe forms. And it's diagnosed partly by the symptoms that the patients have, partly by physical examination. And there are a lot of studies like echocardiography, where they use sound waves just to look at the function of the heart.

Scott Webb: Yeah. And that's just good information to have, as you say, you know, that some folks may not even realize that they've had a heart attack. I remember reading or hearing years ago that John Mellencamp had gone in for a checkup. And they said, "When did you have your heart attack?" And he said, "What heart attack?" You know? And that was the first time I realized that it was possible to, you know, have heart failure or a heart attack and not actually know it. So it's pretty amazing and so glad that we have experts like yourself. So naturally then with the heart becoming weaker, as you say, with heart failure, what are the options for treatment?

Dr. Dan Meyer: Well, there's lots of them. And these days, you know, we live in a quite incredible time. And the medications that have been developed and are continuing to be developed are really unbelievable in terms of what they can do to really reformat the function of the heart and treat heart failure. So in the early stages of heart failure, medications are really the key as well as the healthy lifestyle and not eating too much salt and that type of thing and getting some exercise, but really medical therapy is the key early on.

As the disease progresses, however, that's when things get a little more complicated in terms of treatments and there's a lot more options. And, you know, at Baylor, we have a really good team of different types of physicians, cardiologists and internists, then a whole team that looks at the patients to see what the best plan of care is for that particular patient. But when the medications stop working or they just stop working as effectively, that's when we talk about more major type of procedures that do not exclude heart transplantation, but we have other things we can do before that or in lieu of that, including these heart pumps called left ventricular assist devices. We call them LVAD, L-V-A-D, and that really takes over the function of the heart. And that's one thing that we have to offer. And it's a big procedure, but pretty commonly done for patients either that are not transplant candidates because of maybe age or other diseases or they don't want a heart transplant or they're too sick and they can't get one yet. So there's a lot we can do once the patients go beyond the basic medical therapy.

Scott Webb: Yeah. And as I mentioned in my intro, you're the chief of heart transplantation, so transplants is kind of your thing, right? But I'm guessing that's more of a last resort, a last option in a lot of cases. And you mentioned LVADs, so let's talk about that. Is that really a long-term treatment option for patients with heart failure?

Dr. Dan Meyer: Yes, it can be. There's been a lot of changes over the years and a lot of great developments and we've been involved from the early days of these big pumps that patients would have, that they could never leave the hospital. And they were really used while we were waiting for patients to get a transplant. But now, these devices are pretty small and all the patients really see is this kind of this cord that comes out, which is the connection of the pump itself to a computer that kind of runs it and the batteries that power it. And so patients again, while they're either waiting for a transplant at home or they are living with this LVAD as their new way of life, they can have pretty normal activity levels. The only thing they can't do is swim, but we try to get patients go back to work and the whole idea is to get them back to a normal life as normal as can be with one of these pumps. So people travel, they exercise. They really get out and kind of live their life with this pump and adapt to it pretty well.

They're pretty commonly done. In fact, there's more LVADs put in the US per year, than there are heart transplants today. A heart transplant still, of course, being the gold standard, but LVADs are quite good. And at any one time, we may have 150 or 200 outpatients on these devices.

Scott Webb: Wow. That's pretty amazing. And I'm glad you touched on that, the patient outcomes and just what it's like to live with LVADs. And maybe you can kind of drill down a little bit more into that because I'm sure listeners would want to know, you know, because again, heart transplantation is an option, as you say, still the gold standard, but, you have to have a heart to be able to transplant, right? So these, the LVADs, are more readily available and, as you mentioned, people live pretty normal lives. So maybe we can just talk a little bit more about that.

Dr. Dan Meyer: They're trained to live with a device. It's not perfect because it's a machine and it can fail. But you know, over the years, that has gotten much less common. So patients can live in general. We have patients out over 10 years on these devices. Usually, if they can get a transplant at some point, that's our goal. But again, some patients because of age or other medical problems aren't candidates or they just don't want one. And so these pumps, again, the issues we get into are the small area where the pump leaves the side of the body can get infections. But in general, patients just go on their way and live a pretty normal life, but it's not minimizing the enormity of having to live on a basically artificial heart, but patients adapt and move on with their lives.

Scott Webb: That's pretty amazing to hear and just to hear you say it that way, basically living with an artificial heart, right? And I'm thinking to myself, I'm thinking, you know, part of me would feel like, "Well, I got a second lease on life. This is amazing, right? I was suffering from heart failure and now I have this sort of artificial heart." on the other hand, I think I would always be worried that I have an artificial heart. And is it possible to put too much stress on it? As you say swimming is out. And so maybe just for listeners' sake and for mine as well, you know, you can reassure people that if you are inline, if you will, for a heart transplant and you're living with an LVAD, that you can just live your life, right? Get out there and get doing stuff, get golfing and whatever it might be right?

Dr. Dan Meyer: Right. Yeah, as patients get more active, we have to kind of tell them, "Remember, you do have an LVAD, so you do have to make sure it doesn't get caught on anything." And, you know, over time, you know, there's some wear and tear just because people get so active. But patients, we just tell them the ones that are waiting for a transplant, you know, we tell them, "Now that you have an LVAD, we have a little bit of a luxury of time so we can wait further more." Not that we don't always try to get the perfect donor organ, but we can really be very selective because the patients are supported well and safely on an LVAD.

Scott Webb: Yeah, that's great to hear. And you mentioned earlier, there are just a lot of options for patients suffering from heart failure. So let's go through some of them. We've talked about LVADs, but what's some of the other stuff you guys are working on, as you say, innovations, the advancements in drug therapies and all the different options for patients. Not that anybody wants to suffer from heart failure, but now's a pretty good time just because of everything that's available, everything that's in your toolbox. But let's talk about some of the other research your facility's doing and what that might mean for patients?

Dr. Dan Meyer: At Baylor, we have quite a big army of cardiologists and researchers, so, you know, many trials with medications as well as with the different devices. And there's some really neat things that are out there from a medication standpoint and then how we use the medications and treat the patients while they're undergoing the different therapies, but there's a small implantable sensor that the cardiologists put in that goes basically into the pulmonary artery and it measures the blood volume in the heart and the pressures within the heart. And so the cardiologists can thereby adjust the medication with more sensitivity based on these measurements. So that's pretty neat.

And then we have a few new LVAD pumps that are out there. We're in one trial of a pump. Because all the pumps, they've advanced an incredible amount over the last 25 years since we'd been doing these, but mostly in the last five to ten years. And while they do have some complications, all the newer pumps are trying to start chipping away at those complications. And there's a new one out there that we're in a trial that tries to decrease the bleeding problems that can happen with these pumps and so it's an exciting new device with new algorithms on how they work. It's a randomized controlled trial. So sometimes you get the current state-of-the-art pump or sometimes you may get the experimental pump, but it's an exciting trial we're in. There's a total artificial heart trial that Baylor is part of that's awaiting FDA approval to start, but we're one of seven sites in the US. And some patients, the LVAD is not enough because the right side is also too weak to just function with the LVAD and so we're in a trial for that with an innovative new pump that again we're waiting to enroll patients.

Scott Webb: Well, it sure does seem like there's a lot of room for optimism. You know, as I said, nobody wants to suffer from heart failure, of course, but if you are suffering from it and you've been diagnosed and you're lucky enough to work with someone like yourself, there's a lot of reason for optimism. And maybe that's how we should finish up here is just, you know, tell folks in your own words take-aways. If they have been diagnosed with heart failure, what they can expect, their level of optimism, you know, what that should be and just as they look forward to living the rest of their lives, should they look forward to that, I guess?

Dr. Dan Meyer: I tell the patients obviously when we see them, it's a scary time because sometimes they are just finding out they have this problem and it's a shock. Sometimes they've been living with it and they're just tired. But what I tell them is that we also look at is there anything else that can be done short of transplant or LVAD, you know, like high-risk coronary bypass surgery or something like that, because we have all these other options to support the heart. We can also take the higher risk patients, and if they're appropriate, do coronary bypass surgery. And if for some reason, their heart's too weak, they recover from that, then we can put one of these pumps in. We can always keep you safe because we have this technology. We have the LVAD. We tell them it's like a parachute.

The day where, you know, patients are waiting for a heart transplant, they're not going to get one, they're going to die, that should not happen because we always keep them safe. So I tell patients, "No one wants to go through this, of course, but we're going to keep you safe and we're going to keep moving on and you're going to live your life. And, with the LVAD, if that's the way we have to go and/or a transplant, that you're going to be safe and you're going to have a good life ahead."

Scott Webb: That's great. And I'm sure that's reassuring for patients. Great to hear, great to speak with you. Thanks, doctor, and you stay well.

Dr. Dan Meyer: Okay. Thanks. Thanks for your time.

Scott Webb: To find an advanced heart failure cardiologist or a cardiac surgeon specializing in advanced heart failure on the medical staff at Baylor Scott & White Heart and Vascular Hospital, Dallas and Baylor University Medical Center, call 1-844-BSW-DOCS.

And to learn more about the advanced heart failure program. Visit BSW health.com/heart Dallas. Or download the Baylor heart center app on your apple device. Thanks for listening to heart speak the podcast or Baylor Scott and white heart and vascular hospital in Dallas and Fort worth. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest.

I'm Scott Webb. Thanks for listening.

Baylor Scott & White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.