Summer 2013

Cardiac Transplantation and Mechanical Circulatory Support

UCSF Medical Center is entering a new era of treatment for patients with advanced heart failure. In late 2011, Georg Wieselthaler, M.D., a leading heart transplant surgeon and an expert in ventricular assist devices (VADs), was appointed as the director and surgical chief of Cardiac Transplantation and Mechanical Circulatory Support.

"The vision is to make UCSF an internationally renowned center for late-stage heart failure treatment," said Wieselthaler, who was recruited from the Medical University of Vienna in Austria. "We also want to provide direct contact and acute information for referring physicians. We are available to take their calls and provide a second opinion, no matter when it is."

Wieselthaler has performed or supervised 400 heart transplants and implanted over 250 VADs to date. In 1998, he was the first surgeon in the world to implant a new miniaturized heart pump (MicroMed DeBakey VAD) into long-term survivors. Wieselthaler, who trained as an electrical engineer before becoming a surgeon, has also conducted decades of research into the development of nonpulsatile, continuous flow VADs.

Innovations in VAD Technology

Since Wieselthaler's arrival, he and his team have performed 13 heart transplants in the last nine months of 2012. During the same period, the team performed 18 VAD implants. In November 2012, the Centers for Medicare and Medicaid Services and The Joint Commission certified UCSF to implant VADs as destination therapy for heart failure patients who are not candidates for heart transplant. This means that VAD implantation is now a covered procedure for Medicare patients who would benefit from VADs as destination therapy, in addition to those who receive a VAD as a bridge to transplant. Until recently, the Thoratec HeartMate II was the only FDA-approved VAD in the United States. In November 2012, the FDA approved the HeartWare HVAD for bridge-to-transplant therapy. The HeartWare HVAD is about the size of a hockey puck, and is significantly smaller than the HeartMate II, which can make implantation more tolerable for smaller individuals. A recent study showed that the HeartWare HVAD produced similar outcomes as the HeartMate II.

The HeartWare HVAD, a so-called "third-generation pump," features a miniaturized centrifugal pump with a magnetically levitated rotor spinning inside the pump housing, which avoids the mechanical wear associated with standard mechanical bearings. The HeartWare HVAD is inserted in the left ventricular apex and is placed intrapericardially, rather than requiring placement in an abdominal wall pump pocket. This reduces the risk of bleeding. Also, the driveline that connects the pump with the external power source is very flexible and thin, which reduces the risk of infection associated with skin irritation where the driveline exits the body.

Wieselthaler served as a consultant to HeartWare on the development of this pump. Among other innovations, he helped guide the implementation of a storage unit into the device's controller, allowing physicians to download up to a month's worth of data about power consumption, flow and other clinically valuable information about the pump. In 2006, Wieselthaler was the first to implant the HeartWare HVAD in patients in Europe. He went on to implant more than 60 patients with this device all over Europe and the Middle East. Wieselthaler is now in the process of establishing a West Coast training center at UCSF for implantation of the HeartWare device. UCSF will also participate in a clinical trial, likely within the next year, which will offer access to an even smaller pump, the HeartWare MVAD.

"Dr. Wieselthaler has traveled all over the world to teach people how to put in these HeartWare devices," said Scot Merrick, M.D., chief of the Division of Adult Cardiothoracic Surgery and the Helen and Charles Schwab Distinguished Professor in Surgery. "He has a wealth of experience, and we are really lucky to have him.

"There is a huge population of patients with late-stage heart disease who are currently untreated," said Merrick. "Some of these new LVADs [left ventricular assist devices] may be the way to go, because you don't have to worry about donor shortages. The results are just as dramatic as transplant. You take these patients who can’t walk 20 feet, and six weeks later, they're off playing tennis.

"The reason we are successful is not just the talent of our surgeons, but the honest-to-goodness teamwork with all the support groups, including the phys¬ical therapists, the physician assistants, the mechanical circulatory support team, the OR staff and many others," said Merrick. "Together we are focused on obtaining great outcomes."

Early Referral Helps Patients

Teresa De Marco, M.D., director of the Advanced Heart Failure and Pulmonary Hypertension Programs and medical director of the Heart Transplant Program at UCSF Medical Center, encourages physicians to refer patients early.

"By seeing patients earlier, we may be able to improve quality of life and help patients avoid developing additional complications, such as kidney failure," she said. "We can sometimes delay disease progression with state-of-the-art treatments and devices that may not be available at other centers. When the disease advances to late-stage heart failure, we can draw on specialized experience and expertise to make sure each patient continues to get the best therapeutic option for their needs."

Program highlights include:

  • Dedicated heart and vascular transfer bed for any patient with cardiogenic shock.
  • 24/7 ECMO center; in addition to cannulating patients on-site, the team can also place patients at community hospitals on ECMO and transfer them to UCSF for further treatment, including VAD implantation or heart transplant.
  • Expertise in management of right heart failure and pulmonary hypertension associated with left heart failure.
  • Capacity to evaluate heart failure patients with renal dysfunction; UCSF Medical Center has performed 25 combined heart-kidney transplants, with excellent outcomes. UCSF has also performed 11 combined heart-lung transplant, also with very good outcomes.
  • Ongoing studies available to patients, including those focusing on heart failure, post-heart transplant and VADs.

"We want to serve as a resource to the community," said Wieselthaler. "Late-stage heart failure can be treated medically for a long period of time, and Dr. Teresa De Marco and Dr. Liviu Klein are the specialists in this area. For patients who are experiencing medically refractory end-stage heart failure, we can offer surgical options, including ECMO, VADs and transplantation. We encourage physicians to refer patients early to avoid additional long-term comorbidities like kidney and liver failure, and to help provide them with the most options possible."

Consultations and Referrals

Please contact Georg Wieselthaler, M.D., on his cell phone at (415) 269-3575or by pager at (415) 443-0548, or call the Advanced Heart Failure Attending 24/7 Hotline at (415) 514-8866.

Related Information

News Releases

Heart Failure Patient Loses 100 Pounds Before Transplant Surgery
Suitulaga "Sugi" Hunkin has been overweight most of his life. Because of his size, he also had trouble breathing and experienced irregular heartbeat — symptoms his doctors diagnosed as a heart disease called cardiomyopathy, which usually leads to heart failure. He needed heart transplantation surgery to replace his failing heart, but before that could happen, he needed to lose at least 100 pounds.

Teen Liver Transplant Recipient to Honor Donor at 2013 Rose Parade
Alfonso Garcia still carries around a baseball cap that belonged to a 22-year-old man who passed away in 2010 having never met him. But the cap is just a small token of an even bigger reminder that the 18-year-old college freshman carries with him every day: the man's liver, which saved Garcia's life. Since receiving the liver transplant at UCSF, Garcia has made it a mission to spread the word about the value of organ donation.