In 1984, the FDA approved the Left Ventricular Assist Device (LVAD) as a "bridge" for patients on a path toward needing a heart transplant. Some patients did so well with LVAD support that they no longer needed a transplant, and the FDA approved the device for permanent use in 2010. But an estimated one to two percent of LVAD patients' hearts recover enough to no longer need that mechanical support. Removing the device completely is a possibility for younger patients who are able to tolerate major surgery. But the surgery poses major risks for older patients.
Doctors at Stanford have developed a new way to help older patients free themselves from the externally worn LVAD device. Their solution — a minimally invasive, catheter-based procedure unlike any previously reported — is described in a paper published in the August 2014 issue of the Annals of Thoracic Surgery. Physicians threaded a slim plastic tube through a small incision in the patient's femoral artery in the groin and up to the aorta, allowing them to plug the flow of blood to the LVAD. Then, they cut, cleaned and capped the wiring powering the LVAD so it no longer emerged from an opening in the patient's abdomen. (The LVAD remains inside the patient's chest, but she is free of the device's batteries, controller, and external driveline).
"We decided the best thing to do was to use a catheter-based approach because it would involve only a small incision in her groin and the smallest amount of anesthesia possible," said Richard Ha, MD, clinical assistant professor of cardiothoracic surgery, and surgical director of the hospital's Mechanical Circulatory Support Program. Other minimally invasive techniques to deactivate the LVAD already existed, but they require small incisions in the chest and the abdomen, which some patients cannot tolerate.