Implantable heart devices are now lasting as long as heart transplants

A heart transplant usually includes a long wait for a donor heart. However, with newer and better implantable mechanical heart devices - left ventricular assist devices (LVADs) - this may no longer be necessary for some patients.

“A heart transplant will always be the gold standard. But for patients unsuitable for heart transplants, these devices can be used for long-term support, helping them return to independent living,” said Adjunct Associate Professor Lim Chong Hee, Senior Consultant, Department of Cardiothoracic Surgery, and Director, Heart and Lung Transplant Programme, NHCS, a member of the SingHealth group.

The statistics speak for themselves. The survival rate of heart transplant patients at the National Heart Centre Singapore (NHCS) is 78 per cent one year after the transplant, and 66 per cent after 10 years.

With left ventricular assist devices (LVADs), which can keep a patient alive till a heart transplant is done, the five-year survival rate seen at NHCS is 80 per cent.

Left ventricular assist devices (LVADs) as a “destination therapy”

Newer, better LVADs are lasting as long as transplants do, and are now becoming a “destination therapy” (treatment in itself) for patients not suitable for heart transplants, such as the elderly. Heart transplants are also rare, due to a lack of donors. Since 1990, only 60 have been done in Singapore.

Which mechanical heart implant to choose?

Over the years, NHCS has introduced newer, more durable LVADs. In 2009, it introduced the small, light Heartmate II, and in 2012 a golf ball-sized Heart-Ware Ventricular Assist Device (HVAD).

“They give us some flexibility in customising responses to patients’ needs. For example, the smaller HVAD is suitable for smaller-sized patients,” said Adj Assoc Prof Lim.

With LVADs, patients lead a near-normal life. “Because they’ve had heart failure symptoms for years, once an LVAD is implanted, they enjoy a better quality of life. They can eat, sleep comfortably and go back to work or school. Some even gain weight due to an improved appetite!” said Ms Joycelyn Tan, Clinical Coordinator, Mechanical Circulatory Support, Heart and Lung Transplant Unit, NHCS, a member of the SingHealth group.

The future – batteries in the body charged through skin

The future is looking bright. Already, heart surgeons are talking about transcutaneous charging of the battery through the skin, and ‘witricity’ (wireless energy transfer). In a few years, patients will be able to charge LVAD batteries by placing a charger on their skin, or by sitting next to a Wi-Fi power charger, according to Adj Assoc Prof Lee.

“Currently, we have cables coming out of the body so the patient can charge the device, but looking at technology today, we are talking about possibly implanting the battery inside the patient,” says Adj Assoc Prof Lim. “Without cables exiting his body, he can even go swimming!”

Read on to learn more about heart failure.

Ref: Q15