Cardiac Assist Device Options

The Thoratec HeartMate II® Left Ventricular Assist Device (LVAD) is approved as both a bridge-to-transplantation and a destination therapy.The choice of cardiac assist device to treat end stage heart failure is determined by the needs of the individual. Our program works with the most up-to-date devices available and carefully selects the one best suited to each patient based on heart anatomy, heart health, and overall clinical history. Some devices are implanted in the body, while some operate outside the body.

How LVADS Work

LVADs are designed to take over the function of the weakened heart's left ventricle, which delivers oxygenated blood from the heart to the body. The device, which is implanted in the patient's chest, consists of an electric motor and a driveline. A tube placed in the left ventricle diverts blood from the heart to the pump. The motion of the pump then propels the blood back into the aorta—with enough force to be distributed adequately throughout the body.

The pumps used in LVADs can be divided into two main categories: pulsatile and continuous-flow. The HeartMate II, pictured to the right, is a continuous-flow device. In addition to extending the life of the patient's own heart, the improved blood flow to the body allows patients to breathe easier and experience less fatigue. Since the LVAD system is relatively easy to use, patients can leave the hospital setting with the implanted device and return to the activities of normal life.

FDA Approved Implantable LVADS: HeartMate I and HeartMate II

Thoratec's HeartMate® I, a mid- to long-term left ventricular assist system, is currently the only option for patients who cannot tolerate systemic anticoagulation. This device has been successfully implanted in more than 4,500 advanced heart failure patients worldwide, and can be used for bridge to transplant or destination therapy.

The HeartMate ® II LVAD is a next-generation implantable device intended for a broad range of advanced-stage heart failure patients. HeartMate® II is FDA-approved for both bridge-to-transplantation and as destination therapy for patients ineligible for transplant.

Learn more about HeartMate I and II.

Investigational VADS

HeartWare® VAD

The HeartWare® VAD device, currently available only through clinical trials for bridge-to-transplantation, helps a patient's weakened heart pump blood throughout the body, first by removing blood from the left side of the heart and then by pumping the blood into the aorta. This device has shown much promise and we are now investigating HeartWare® as a destination therapy as well.

HeartWare's® small implantable pump draws blood from the left ventricle and propels it through an outflow graft connected to the patient's ascending aorta. The device is capable of generating up to 10 liters of blood flow per minute.

This VAD has only one moving part—the impeller—suspended within the pump through a combination of passive magnets and bearings. The size of a golfball, the impeller spins at rates between 2,400 and 3,200 revolutions per minute, then works with the HeartWare® system to propel blood from the heart to other parts of the body.

The pump's inflow cannula is integrated with the device, ensuring proximity between the heart and the pump itself. This proximity facilitates ease of implant and helps ensure optimal blood flow. The wide-bladed impeller and clear flow paths may help minimize risk of clotting and damage to blood cells.

How HeartWare® is Implanted

The HeartWare® pump is implanted in the pericardial space, directly adjacent to the heart. There is no surgical pocket required for the pump. Thus patients may have both a relatively short surgery and a quicker recovery.

How HeartWare® is Worn

The pump rests inside the chest and a driveline (cable) exits the skin and connects to an externally worn controller. The controller is powered by a battery pack, consisting of two batteries or one battery plus an adaptor that connects to a wall socket or an automobile outlet. The controller operates the pump and provides the patient with feedback, including signals and alarms, concerning the state of the system. Both the controller and batteries fit in a carrying case can be worn in a waist pack or a shoulder bag.

Terumo DuraHeart™

In 2009, surgeons at NewYork-Presbyterian/Columbia University Medical Center were among the first in the United States to be implant a next-generation artificial heart pump called the DuraHeart™ Left-Ventricular Assist System.

The DuraHeart™ is designed to sustain patients with severe left-ventricular heart failure while they wait for a donor heart transplant and is now being studied in clinical trials as a bridge-to-transplantation.

The DuraHeart™ is considered a third-generation device, with unique features—including a paddlewheel-like component called an impeller that is suspended by an electromagnet—eliminating any bearings or contact points and allowing it to work at slower speeds, potentially reducing device wear and risk of blood cell breakage.

How the DuraHeart™ is Implanted

Because of its small size, the pump fits comfortably inside a pocket created in the upper abdomen. It is connected to the left ventricle and the aorta to help the weakened heart pump blood. The pump is connected by a cable to a rechargeable battery outside the body.

How the DuraHeart™ is Worn

The entire system is designed to be portable and travel easily as patients go about their daily activities. The batteries and controller are worn in a waist pack or shouder bag. The DuraHeart LVAS is built to be durable and simple to use as well as highly portable. Patients can move about freely for up to five hours using two fully charged batteries, and the patient can extend this time simply by carrying extra batteries.

Biventricular VADS

The Thoratec® PVAD and IVAD are FDA-approved both for bridge-to-transplantation and postcardiotomy recovery from open-heart surgery. Both VADs rely on prosthetic ventricles comprised of blood sacs inside of a hard plastic casing. A pressure/vacuum system allows air to enter the casing around the blood sac. This expansion and contraction of the air sacs allows the VAD to fill and eject blood, and provides the body with blood flow similar to that of the native heart.

Thoratec® IVAD

The Thoratec® IVAD (Implantable Ventricular Assist Device) is the first biventricular pacing device approved for at-home use in bridge-to-transplant patients and post-cardiotomy recovery. The IVAD has been proven in more than 560 patients worldwide who require intermediate-to-chronic circulatory support.

How Thoratec® IVAD is Worn

This differs from the PVAD in that the pump is implanted inside of the body within the abdominal wall. The driveline connects to the pump and then to a CONTROLER outside the body that provides the same feedback as the PVAD.

Thoratec® PVAD

The Thoratec® PVAD (Paracorporeal Ventricular Assist Device), now in use for more than 20 years, is the only system that provides acute-to-intermediate support for right, left, or biventricular function in patients of virtually any size. The PVAD has been proven in more than 260 centers and 4,400 patients worldwide and allows patients to be discharged home.

How Thoratec® PVAD is Worn

Unlike the implantable LVADs, this pump rests on the abdominal wall outside of the body. It connects to a driver that operates the pump and to a controller that provides the patient with feedback: signals and alarms alert the wearer when it is time to adjust or repair the system.

Percutaneous VADS

Technological advancement allows us to provide mechanical support or VAD percutaneously (though the skin) without open surgery. This procedure is commonly done in the catheterization laboratory. External pumps connected to the ventricles by a catheter or cannula.

Impella

The Abiomed™ Impella 2.5 is the world's smallest heart pump delivering 2.5 liter per minute of forward flow. In a standard catherization procedure, this device is inserted through through the femoral artery, into the ascending aorta and across the valve into the left ventricle. Once in place, Impella pulls blood from the left ventricle and expels blood from the catheter into the ascending aorta.

The Impella 5.0 catheter, a slightly larger device, delivers up to 5.0 L/min of forward flow blood from the left ventricle to the aorta.

Tandem Heart

The TandemHeart™ Percutaneous Ventricular Assist Device (pVAD) can be inserted the cardiac catheterization laboratory to assist patients suffering from postcardiotomy cardiogenic shock. This device buys valuable time for the surgeons to decide on the next course of treatment, and provides short-term support from a few hours for up to fourteen days. During the time, the heart may also strengthen and potentially regain its native function.

Cannulas are inserted through the femoral vein then advanced into the left atrium. The pump withdraws oxygenated blood from the left atrium, then a magnetically driven, six-bladed impeller sends it through the outflow port, returning it to one or both femoral arteries through arterial cannulas. Weighing only eight ounces, the pump is capable of delivering blood flow up to 5.0 liters per minute.

Short term Devices: ECMO

An extracorporeal pump, another external device, can be used as a short-term support. Our team has successfully used this technology to help patients recover from acute heart failure/cardiogenic shock.

ECMO is a life support system that partially replaces the function of the heart and the lungs. This is a life-saving measure often used in the ER or at the beside to assist patients who have no blood pressure and failing after a large heart attack.

CentriMag

Thoratec CentriMag® Blood Pump is a newer extracorporeal circulatory support device providing hemodynamic stabilization in patients in need of cardiopulmonary support. This pump has no bearings but instead uses magnetic levitation. This approach diminishes both hemolysis (destruction of red blood cells) and the likelihood of mechanical pump failure. CentriMag® may be used as a short-term solution to support the circulation while longer-term options are considered. Our physicians are among the most experienced in the nation with this device.

View CentriMag Magnetically Levitated Circulatory Support System (PDF File)

CardioHelp

CARDIOHELP Life Support SystemThe CARDIOHELP Life Support System, the smallest and lightest ECMO system, supports the function of the heart and/or lungs by continuously pumping some of the patient's blood out of the body to an oxygenator (artificial lung). This device adds oxygen to the blood, removes carbon dioxide and then warms the blood warmed before it is returned to the patient. Used to treat cardiogenic shock, CARDIOHELP gives the patient's heart and lungs time to rest and recover.