Expert Q&A: Lynne Martin

Ventricular Assist Devices, or VADs, are surgically implanted devices that take over the pumping action of the heart for patients in heart failure. They're used short-term during heart surgery, and also long-term for patients waiting for a heart transplant.

Since 2005, UCSF has been implanting portable VADs that allow the patient to return home with the device to wait for a transplant. Perfusionist Lynne Martin, who is trained extensively in the devices, supports patients in this small but growing program.

What's your role in the VAD program?

I provide what I call head-to-toe patient care. Because we're so small we're able to provide a bit of boutique service, and I'm there through the whole process. I attend the discussion on whether the patient is a good candidate for an implant. I'm there for the procedure to implant the VAD. Afterwards I teach the patient and the friend or relative they've chosen as their caregiver about the device.

I also talk to the firefighters or ambulance service in the patient's hometown to alert them that the patient has a VAD and what to do in an emergency. Some VADs produce a continuous flow of blood instead of a pulse, so if the first responder is called and doesn't know the person has a VAD, they could have someone awake and talking to them, with no pulse — which would be very disconcerting.

When we send patients home they have my pager and cell phone number, so they know that if they have a problem, they can always call and they're not going to get some answering service, they're going to get me.

How has this technology changed over the years?

The first artificial heart came out in the late '70s or early '80s. It started out very big and clunky. Now the rates of complications, such as stroke and infection, have dropped. Patients can return home with a VAD rather than remaining in the hospital until they get their heart transplant.

Newer models are much smaller and quieter. I never thought I'd see the day when there was a VAD that didn't make any noise, but the HeartMate II is completely silent. The person wears the computer and the battery for the device strapped to their body, under their clothes. You could be in the elevator with them and not know they had anything going on.

Before VADs became portable, patients had to stay in the hospital until they got a transplant. How long would that take?

For a big guy with O blood type, it could be six to eight months.

Patients can live on HeartMate II, one of the newer models of VADs, for four years. This allows us to be really picky about waiting for just the right heart — the heart with the greatest chance of giving us a successful transplant — to become available. When the person's not critically ill, we can afford to be more choosey.

How do patients do on them?

I have one patient who went back to work full-time. He's the only I've had who has worked full-time on the VAD, but he just couldn't wait to go back. I had a woman who put the computer — the 'brains' of the VAD — in a baby carriage and ran around Lake Merced. It can be very dramatic; the person can go from being in heart failure to not being in heart failure literally overnight.

The goal with VAD is to help the patients get going with their lives, go home and get stronger and get ready for their transplants.

Are patients nervous about going home with this device implanted in their body?

By the time I send them home they feel very prepared. At this point they know the device as well as any of us. They become the experts.

What's the best part about your job?

I love when a patient gets a successful transplant, of course. But with the VADs, watching someone who is so sick return home and get back to some kind of life is just awe-inspiring. Also, no two days are the same here. The technology is constantly changing, and I love change.

Related Information

UCSF Clinics & Centers

Organ Transplant

Heart Transplant Program
400 Parnassus Ave., Fifth Floor
San Francisco, CA 94143
Phone: (415) 353-4145
Fax: (415) 353-4166