Advanced Heart Failure STORY HIGHLIGHTS The ventricular assist device (VAD) becomes a “destination” therapy offering a potentially lifesaving option for some end-stage heart-failure patients. The UCLA advanced-heart-failure program is developing shared-care sites to assist community physicians in managing this growing patient population. The portability of the HeartMate II enables patients to resume many of their normal daily activities. Images reprinted with permission from Thoratec Corporation Lifetime Mechanical Support Viable Option for Many Patients with Advanced Heart Failure The emergence of the left ventricular assist device (VAD) as “destination” therapy rather than a temporary bridge to transplantation offers a potentially lifesaving option for end-stage heart-failure patients who are not candidates for transplantation. Moreover, the expected continued improvement and growing demand for VADs will be invaluable in meeting the needs of the advanced-heart-failure population in the face of the limited supply of donor organs, says Mario C. Deng, MD, medical director of the Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplant Program at Ronald Reagan UCLA Medical Center. “The ventricular assist device continues to improve as it moves into its second and third generations, to the point that it is now rivaling the one-year and five-year outcomes after heart transplantation,” Dr. Deng says. “Given that transplantation can’t come close to meeting the needs of the large advanced-heart-failure population, we need to spread the word that lifetime mechanical support is a very viable long-term option. And because we expect the demand for this therapy to grow dramatically in the years ahead, we are working with community physicians to develop a shared-care infrastructure to care for these patients.” “For patients whose only option in the past would have been hospice, we can now offer the left ventricular assist device for destination therapy,” says Ali Nsair, MD, a UCLA interventional cardiologist and associate director of mechanical circulatory-support-device services. “To maximize the potential benefit of the therapy, we need to be engaged in their care earlier than in the past.” Dr. Nsair recommends that end-stage heart-failure patients who are no longer tolerating cardiac-protective medications, as well as older patients or those with co-morbidities that would make them poor transplant candidates, should be referred for evaluation and potential co-management with the UCLA heart-failure team. When VADs were first introduced, in the 1960s, they were bulky and came with a significant risk of side effects that led to serious complications, Dr. Deng notes. In the ensuing years, the devices have become smaller, safer and more reliable, with fewer complications and improved quality of life and survival outcomes. But until 2010, they were offered only as a bridge to heart transplantation. That changed when the U.S. Food and Drug Administration approved the HeartMate II, a left ventricular assist device manufactured by Thoratec, for use as destination therapy. “The VAD can now be used for patients who are not heart-transplant candidates,” says Richard Shemin, MD, Robert and Kelly Day Chair in Cardiothoracic Surgery, chairman of cardiothoracic surgery at Ronald Reagan UCLA UCLAHEALTH.ORG 1-844-4UCLADR (1-844-482-5237)