Summer 2005

Destination Therapy in Heart Failure

Implanting a mechanical ventricular assist device early in end-stage heart failure can be beneficial as a long-term solution -- not merely as a bridge to heart transplant, according to surgeons at UCSF Medical Center. "Destination therapy for heart failure patients has quietly become a lot more successful in recent years, with morbidity and mortality rates low enough to make it a good option," says UCSF cardiovascular surgeon Charles Hoopes, M.D.;

Destination therapy may be underused because survival times for patients with a mechanical ventricular assist device used to be much lower. Early on, patients had a 25 percent chance of surviving for long with a ventricular assist device, but now have a 50 percent chance of survival over two years. Increased survival times probably have resulted because more appropriate patients are getting the devices.

Another reason that heart failure patients may not be given the pump option is that the devices are perceived as being expensive and invasive. Hoopes says that on these points, the ventricular assist pump compares favorably with putting in a pacemaker on these counts, while providing dramatic benefits that the pacemaker cannot match. "The difference is that when you leave the hospital after getting a pump, you have the cardiac output of a 40-year-old," Hoopes says.

Putting someone on a ventricular assist pump also provides benefits to other organ systems that may be under stress, thereby improving overall health and moving a patient up the list for heart transplant if one becomes available. Even if a heart never becomes available or the patient is considered too old, the pump may provide years of quality life, Hoopes says.

"If you are 70 and healthy, you might be told that you are too old, but are otherwise a good candidate for heart transplantation," Hoopes says. "A pump might go for 14 years, getting you up to 84."

To contact Dr. Charles Hoopes, call (415) 353-1606.

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