Our Intensive Care Unit has pioneered the ICU management of patients needing mechanical heart support in Australia and since 1999 we have successfully managed over 240 patients with a long term survival rate approaching 70% which is significantly above the international average survival rate.
During this time the technology of mechanical heart support has changed out of all recognition.
The initial devices built on the model of the natural heart, were large and noisy and for technical reasons located outside the body and connected to the heart by tubes passing through the skin in the upper abdomen. This necessarily meant that the first 178 of our patients were largely confined to bed attached to a large control console.
In 2003 we commenced the ICU management of the next generation of mechanical hearts and we have now managed over 90 of these. In these pumps designers have abandoned the natural heart model in favour of rotary blood pumps which are much smaller, silent, can be located inside the body and are designed to last indefinitely. These have revolutionised the lives of our patients who now can live a normal life at home, able to travel in commercial planes and with a much greater life expectancy
With the newer VADS patients have been able to go home even when they live interstate and many of the Victorian patients live a number of hours form Melbourne. The VAD team encourage patients to achieve the best possible quality of life they can (e.g. having patients go back to study or work if it is a suitable role, carers going back to work, patients using public transport, patients returning to their home towns rather than residing in Melbourne).
Patients requiring mechanical heart assistance fall into two groups called 'bridge' and 'destination' patients. The first includes those people who are suitable for transplantation but would probably die before a donor heart becomes available if the mechanical heart was not used. The second and smaller group includes those patients who for age or other reason are not suitable for heart transplantation. Patients in this group can live with their mechanical heart for some years. Our longest surviving patient with a pump still in situ is still very well at 65 years. Many patients have been successfully “bridged’ to heart transplantation. A smaller number have had recovery of their native hearty and have had the VAD explanted.
Ventricular Assist Devices
Types of pump
The Alfred was the first site worldwide to implant VentrAssist in 2003 and many of the Alfred team were involved in the design and early trials of that pump. Sadly the VentrAssist pump is no longer being manufactured.
We currently use 2 different types of continuous flow pump.
We have used Heartmate II since 2011. This is an axial flow pump manufactured by the Thoratec Corporation. It is an implantable pump which sits in the patient’s chest. Worldwide there is a very large experience with the Heartmate II pump with more than 15,000 implants to date.
In 2015 The Alfred was one of a select few International sites to participate in the Heartmate III trial
This is a miniaturized centrifugal pump with advanced technology meaning hat it has no fixed bearings. It weighs only 50g and sits in the pericardial space. Since 2011 we have been using Heartware in a BiVAD configuration (where there are two pumps- one supporting each ventricle) for selected patients.
This is a new role for rotary pumps and expands the usefulness of these devices.
One of our patients exercising at the physiotherapy gym with his pump on the bike handlebars. Patients come to the gym regularly after discharge from hospital.