• ​New heart assist device designed to reduce damage to blood cells and clotting which may cause stroke in patients with advanced heart failure
  • Trial results indicate improved survival rate and significant relief of symptoms with new device
  • Heart assist devices are crucial in prolonging patients’ lives and giving them a better quality of life as they wait for a suitable donor heart for transplantation

The National Heart Centre Singapore (NHCS) has implanted Asia’s first HeartMate 3 heart assist device in a 44-year-old Indian male patient on 9 November 2015. The new heart assist device is designed to improve survival, quality of life and outcomes for patients with advanced heart failure. The three-and-a-half-hour surgery performed by the NHCS multi-disciplinary team involved implanting the device next to the patient’s weakened heart to help it pump oxygen-rich blood to the rest of his body.

The patient, Mr Rajamohan s/o Pekrisamy, was discharged after a three-week hospital stay following his successful device implantation. He has since recovered and is looking forward to return to the workforce soon.

“I have been suffering from heart failure symptoms for more than eight years, and I was tired and coughing most of the time and I could not walk far,” said Mr Rajamohan, “Now I feel like I am almost 90 per cent of my healthy self.”

The former security guard was diagnosed with dilated cardiomyopathy in 2003. He experienced breathing difficulties, fatigue and coughs that persisted through the day. In 2015, his condition worsened, leaving his heart function at a mere 23 per cent two weeks before his surgery. Dilated cardiomyopathy, one of the causes of heart failure, occurs when the heart becomes weakened, enlarged and unable to pump blood efficiently.

The HeartMate 3 device received the CE mark on 8 October 2015 after a one-year trial involving 50 patients from ten centres in six countries. Patients involved in the trial were followed up after the pump implantation, and results showed a survival rate of 92 per cent at the end of six months for these patients, with 83 per cent of them having a significant reduction in heart failure symptoms and no incidence of pump malfunctions during the trial period. 

“Though the clinical trial results for the HeartMate 3 device are promising, we recognise that long term data is needed for us to better understand the outcome for patients, therefore we remain careful in assessing which patients will be suitable for such new devices,” said Dr C Sivathasan, Director, Heart Transplant and Mechanical Assist Device Programme, NHCS, and one of the surgeons involved in the landmark surgery.

For many advanced heart failure patients, their hearts have weakened to a stage where the only cure is a heart transplant surgery. The device prolongs the lives of these patients while they wait for a suitable donor heart.

“Without the heart assist device, less than half of these patients will survive beyond one year just on medications alone,” said Adjunct Associate Professor Lim Chong Hee, Senior Consultant, Department of Cardiothoracic Surgery and Director, Lung Transplant Programme, NHCS. He is a member of the multidisciplinary team behind Asia’s first HeartMate 3 implantation, which includes cardiothoracic surgeons, a cardiac anaesthetist, heart failure cardiologists, perfusionists, nurses, clinical coordinators specialised in heart assist devices and paramedical staff.

The HeartMate 3 device runs on a new technology that is aimed at reducing the risk of blood clots forming and hardware issues. Its MagLevTM technology allows the rotor to float in the pump even without the presence of any blood or fluid. It also helps to keep a consistent and large flow gap which lets blood flow through the pump with minimal damage to the cells.

“Ruptured blood cells can promote clotting within the device, which may lead to a stroke or problems with the pump,” explained Adj Assoc Prof Lim.

The HeartMate 3 is also the first heart assist device to feature an artificial pulse which mimics the natural heartbeat. The pump does this by ramping up and down its speed in two-second intervals, effectively washing out the pump and reducing the likelihood of blood becoming stagnant and clotting, which can lead to stroke and pump failure.

In addition, the HeartMate 3 pump is inbuilt with control electronics that enable it to store data on its parameters, speed settings and a log which records its regular operations and any anomalies. The HeartMate 3 pump is designed to be able to continue running even in the event of a transmission problem with the controller. Earlier devices do not have any data stored within the pumps.

The pump is connected to an external controller and batteries via a cable known as a driveline. The HeartMate 3 separates the driveline into two segments – the pump cable and modular cable – so that doctors may easily replace the cable outside the body, if necessary, without putting patients through another surgery. 

With the pump implanted in his chest, Mr Rajamohan now walks around with a controller that is powered by two lithium ion batteries. Each battery weighs 500g and a pair will last him about 17 hours as he goes about his daily life.

Heart failure is a common chronic condition in Singapore and it accounts for about 6,000 hospitalisation cases annually.

“NHCS receives more than 20 referrals for heart transplantation each year but only about three on average will eventually get transplanted due to the lack of suitable donor hearts,” said Adjunct Assistant Professor David Sim, Senior Consultant, Department of Cardiology and Director of the Heart Failure Programme at NHCS.

NHCS was the first in Singapore to establish the Mechanical Heart Device Programme in 2001 to provide advanced heart failure patients with a means to prolong their lives and improve their quality of life while waiting for a suitable donor heart. Through this programme, new technology, such as the HeartMate 3 device, are introduced as treatment options for these patients. To date, NHCS has implanted 67 of the newer generation heart assist devices.