An article in the Wall Street Journal this week highlights ongoing research at Penn Medicine looking at a new way to use ventricular assist devices (VADs) for heart failure patients. This same research was also featured in the article “Rest, Recovery, Reconditioning” in a recent edition of Penn Medicine’s System News publication.
Both articles focus on an innovative protocol known as “bridge-to-recovery,” where doctors at Penn Medicine and a few other centers in the U.S. are embarking on a new clinical trial to see whether or not they can successfully help patients recover heart function with a left ventricular device (LVAD) after heart failure.
VADs have been in use for over two decades and are used in several approaches to treat patients with ailing hearts – either as a bridge to a heart transplant, or more recently, as destination therapy, where the device is left in the patient permanently, in lieu of a heart transplant. The bridge-to-recovery protocol, where the device is implanted for a short amount of time to let the heart heal from an illness, is at the center of the new RESTAGE-HF clinical trial. In these cases, after careful evaluation and monitoring by a team of doctors, the patient’s device is removed and the heart continues to pump on its own.
Penn’s multidisciplinary research team includes specialists from across the Penn Medicine Heart & Vascular Center, and is led J. Eduardo Rame, MD, assistant professor of Medicine and medical director, Ventricular Assist Device Program, Y. Joseph Woo, MD, associate professor of Surgery and director, Cardiac Transplantation and Mechanical Circulatory Support Program, and the Mechanical Circulatory Support Device (MCSD) Coordinators Christine Hill, RN, BSN, Mary Lou O'Hara, MSN, RN, CCRN, Judy Marble, RN, BSN, Sherri Walsh, RN, BSN, and Christyna Zalewski, RN, BSN.
The WSJ article describes part of the process involved in evaluating a patient with an existing LVAD to determine whether or not their heart is healthy enough to have the explant procedure:
Dr. Rame last week performed the first "turn-down" test on George Smart, a 51-year-old LVAD patient from Norristown, Pa., who could be a candidate to have the device removed. The propeller in Mr. Smart's device that takes the workload off his heart spins 9,000 a minute. Dr. Rame turned it down to about 6,400 rpms, so the heart was taking on most of its normal load. Mr. Smart did well, Dr. Rame said, but will repeat the test several times before a decision is reached on removing the LVAD.
During the turn-down, echocardiograms chart the heart’s changes while the speed of the LVAD is slowly decreased. The echocardiogram provides detailed information during the turndown, including the heart’s size and function level, how the right ventricle handles the increased blood flow, and a measure of the flow through the aortic valve.
The echo also shows any leakage of the mitral valve, which would occur if the blood went backwards into the left atrium. Most important, if a patient does start to experience symptoms during the turndown, the echo will help the team determine why. The patient also performs a six-minute walking test during the evaluation.
Eventually, if the patient continues to tolerate the turndowns, the LVAD’s speed is down to a point where the patient is getting very little support from the device. If all gathered data -- including the echos and stress tests -- show evidence the heart has recovered, the LVAD will be explanted.
Penn Medicine Communications staff attended Mr. Smart’s first turn-down session and documented this amazing process.