Today, mechanical assist devices offer patients yet another option in treating heart failure. Patients who require total or partial circulatory support as Bridge to Recovery, Bridge to Transplant, or Destination Therapy will find considerable resources at Westchester Heart and Vascular. In some cases, the ventricular assist device will significantly rest the heart so that sufficient recovery occurs and the device can be explanted. Bridge to transplant is utilized when a listed patient will not survive the wait for an acceptable donor. Destination therapy is used for endstage congestive heart failure patients who are not eligible for transplant and can offer a meaningful quality of life.
Recently developed percutaneous assist devices can be an important intervention in critically ill patients such as those with acute myocardial infarction with cardiogenic shock and acute decompensated heart failure. Westchester Heart and Vascular offers both available percutaneous devices, the TandemHeart by Cardiac Assist and Impella 2.5 and 5.0 by Abiomed; the latter is also part of an ongoing clinical trial in the Cardiac Catheterization Lab for high-risk coronary interventions. The TandemHeart can reduced mortality from cardiogenic shock by up to 50 percent, compared to the national average. At Westchester Heart & Vascular, our survival at discharge is over 75%.
The Impella 5.0 is a catheter-based assist device designed to directly unload the left ventricle, reduce myocardial workload and oxygen consumption and increase cardiac output.
The Impella 2.5 is a catheter-based assist device designed to directly unload the left ventricle, reduce myocardial workload and oxygen consumption and increase cardiac output.
Westchester Heart and Vascular offers several types of ventricular assist devices including HeartMate I, HeartMate II, Thoratec paracorporeal and implantable, the Jarvik 2000 and Abiomed AB5000. Westchester Heart and Vascular physicians also participate in clinical trials with mechanical assist devices, affording patients access to promising treatments years before they are available to the general public.
The HeartMate I (left ventricular assist system), also known as the HeartMate XVE, is one of the most widely used left ventricular assist devices in the world. It provides complete unloading of the left ventricle in refractory heart failure patient; has a proven; low stroke rate; and does not require systemic anticoagulation. Patients supported by the HeartMate XVE while awaiting transplantation have had better outcomes following transplant than those who received continuous inotropic infusions. For greater freedom of movement, patients can wear a battery pack around the waist that is capable of supporting the pump for up to eight hours.
The HeartMate II, FDA-approved in April 2008 as a bridge to transplant, is a high-speed, axial flow, rotary blood pump that produces no pulsatile action. At 1.5 inches by 2.5 inches, it is smaller than other LVADs and may be suitable for adults of small stature. Patients can wear a portable battery pack around the waist that permits the pump to operate tether free for three hours. It is currently in clinical use as a Bridge to Transplant, and an ongoing clinical trial is investigating its use for Destination Therapy.
Jarvik 2000 FlowMaker is a small axial flow pump with just one moving part, a small impeller that pumps blood at a rate about 7 liters per minute. It is designed to achieve adequate outputs and is applicable to all patients regardless of size. This device is currently undergoing clinical trials for use as a "bridge to transplant."
Abiomed AB5000 Circulatory Support System provides temporary support for one or both sides of the heart, giving the patient's heart time to rest and possibly recover. The pump, which is connected by cannulas placed in the heart, fills by gravitational force and a vacuum assist. It provides flow rates of up to 6 liters per minute.
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Westchester Medical Center
100 Woods Road
Valhalla, NY 10595
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