Heart Failure: Assist Devices

Catastrophic myocardial infarction presents a very difficult management problem. The immediate loss of ventricular function rapidly leads to multiorgan failure and death. Options are limited to preserve life, minimize end-organ dysfunction, and hopefully allow the failed ventricle enough time to recover from the immediate injury. Ventricular assist devices have been developed to provide immediate support for patients. The hope is the patient’s heart will recover completely or the patient will survive until a heart transplant can be arranged.

For the past several years, we at Northern Michigan Hospital have used the Abiomed BVS 5000 Assist Device for such extremely sick patients. This device is a surgically implanted mechanical pump that functions in place of either the failed right ventricle (RVAD) or the left ventricle (LVAD). Conduits are connected to divert blood away from the failed ventricle (right atrium or left ventricle) to the assist device pump. Pumped blood under pressure then passes through a second conduit to the outflow artery (pulmonary artery or aorta) of the failed ventricle. The failed ventricle no longer participates in the pumping component of the circulation and is therefore allowed to rest. It is hoped the rested ventricle will have time to sufficiently recover thereby allowing removal of the assist device. If the device cannot be satisfactorily removed, a heart transplant must be considered if the patient is to survive.

We recently treated a 50-year-old man with a dissection of his ascending aorta. The dissection process sheared off his right coronary artery producing massive ischemia of the right ventricle. He was taken to surgery where the dissection was repaired. However, his right ventricle failed to work and he could not be weaned from the heart lung machine An Abiomed RVAD (Right Ventricular Assist Device) was inserted to take over the function of his failed right ventricle. He was then successfully weaned from the heart-lung machine. Over the course of the next several days his right heart function recovered satisfactorily and we were able to remove the RVAD assist device. The patient was subsequently discharged to home with excellent biventricular cardiac function.

However, if this man’s heart had not satisfactorily recovered, arrangements would have been made to move him to a transplant center for consideration of a heart transplant – clearly a less desirable option than the recovery of his own heart.

The use of the assist device has allowed us to successfully support such critically ill patients. Because of the assist device, this man was able to survive and return home to his family. We are pleased to have this technology available for our patients at Northern Michigan Hospital and hope it will continue to allow us to provide optimal care for this type of desperately ill patient.