Success with LVAD Implant Requires Team Approach
The Nebraska Heart Institute (NHI) track record of success with LVAD implants is achieved by using a team-first approach, according to Dr. Sagar Damle, a cardiothoracic surgeon at NHI in Lincoln. He leads a surgical program for heart-failure patients who may be candidates for the left ventricular assist device (LVAD).
While Dr. Damle is front and center when a patient receives an LVAD implant, he insists the recipe for success involves much more than just his work during a typically four-hour procedure.
“The most important thing to understand about these surgeries is that it’s not about the surgeon or the pump,” Dr. Damle said. “It’s about the whole team. Everyone on the entire team at Nebraska Heart is focused on making sure our patient has the best outcome — from pre-operative nursing care to the post-op ICU care to the nurses, the anesthesiologist to the cardiologist to the social workers and our therapists.”
“It’s totally a team procedure and not one of those procedures that depends highly on the surgeon. It’s a situation where everyone on the team is important and everyone acts as a team,” he said.
The LVAD can be implanted in patients who have reached end-stage heart failure. The battery operated mechanical pump helps the left ventricle, which is the heart’s main pumping chamber, circulate blood to the rest of the body.
Dr. Damle, who performs LVAD implants between 20 and 30 times per year, said the procedure remains somewhat less common than other heart procedures in Nebraska. Before a patient can receive an LVAD implant, insurance carriers mandate they must undergo a selection process to determine if they are eligible. At NHI, the selection committee includes nurse coordinators, a cardiologist, a cardiac surgeon, social work and palliative care.
“It’s a very expensive therapy and the insurance companies really want to make sure that we’re not using it inappropriately,” Dr. Damle said.
Damle said the LVAD implant is a somewhat complicated procedure because most patients have had previous heart procedures, such as valve replacements or a bypass.
“In that sense, it makes the surgery a little more complicated, but the real complication and the difficulty comes in the patient’s management after surgery,” Dr. Damle said. “It’s generally a very stressful operation for a very sick group of patients.”
The national average for a patient receiving a LVAD implant is 23 days. At NHI, the average is 13 days — a feat Dr. Damle said is accomplished by the NHI team’s pre-surgery approach. Among the practices NHI uses to shorten recovery time for LVAD implant patients:
- An aggressive use of IV medication at home before the surgery
- Making sure the patients don’t enter surgery with excess fluid in their body
- Cardiac rehabilitation to get the patient in the best possible shape pre-surgery
- Having a dedicated group of coordinators working closely with the patients
After a successful LVAD implant, Dr. Damle said, patients usually have an immediate feeling of being able to breathe more easily and have more energy. Depending upon the each patient’s situation, the LVAD procedure can be either a bridge to a heart transplant or destination therapy.
Dr. Damle said patients can live 10 years with the same pump, but pointed out those patients received LVADs under a randomized-trail scenario prior to their FDA approval in 2007. Also, Dr. Damle said, the lifespan of the heart pump is affected by the fact that most recipients have other conditions that greatly impact their life.
The one-year survival rate of LVAD implant patients at NHI is 85 percent — 10 percent above the national average. The two-year LVAD recipient survival rate is approaching 75 percent at NHI.
“When you consider that the one-year survival rate of these patients if they had no heart pump is about 50 percent and the two-year survival rate without it is about 10 percent, it’s a marked improvement,” Dr. Damle said.