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We see a lot of patients who have come to us
because they're at the end of the line.
They really have no other options
and they're quite ill.
Receiving a heart transplant is something
that very few people have the advantage of receiving,
and it's a gift not only of life,
it's a gift of love,
it's a gift of someone else's family.
So I think one of the things that we impress upon patients
is that this is a gift that they have to take care of,
and this is a gift that we as caregivers
significantly strive to make certain
that goes well for them, as well for their family
and that's one of the reasons why
the team that we have and the strategy
that we put forth is key.
The difficulty with heart transplant
is that we have organ shortage,
and in the United States we do
only about 3000 heart transplants a year,
but the number of patients
who need heart transplants are a lot more.
So because of the long wait times,
the average wait time is about a year to a year and a half,
a lot of these patients will die on the wait list
if we didn't have any other support for them,
so LVADs have been developed to remedy this situation.
An LVAD is a Left Ventricular Assist Device.
It is a small pump that gets implanted
into the tip of the heart
that allows the left ventricle to pump better.
And it is implanted in two different strategies.
The first is a bridge to transplant.
These are patients who are transplant candidates
but for whatever reason, they can't wait for a transplant.
Either they're too sick,
or their blood group and size or immune system
is such that it's gonna take a long time
to find a transplant for them.
The other type of strategy we implant LVADs in
is what's called a destination therapy.
These are patients who, for whatever reason,
are not transplant candidates.
Once the device is fully implanted,
there is a cable that comes out.
We would bring the cable out from the abdomen area,
and that cable is then attached to a computer
about the size of an iPhone.
That computer will then also need power,
so patients will wear two batteries,
and the batteries are typically strapped to their shoulders
like suspenders, and the computer itself
is worn usually with either a fanny pack
or inside a bag.
I think we need to remember how sick these patients are.
Patients who have end stage heart failure
typically have a one year survival
of less than 50%, and often less than that.
To survive on LVADs now, the one year survival
is greater than 90% for a lot of these patients,
and long-term, we've had patients
who continue to live well on LVAD
for more than 10 years now.
And so these devices have come a long ways,
they continue to get better.
Within the next decade or two,
we may see LVADs replace heart transplant
as a treatment of choice for most patients
who have heart failure.
That would alleviate the fact
that we just don't have enough organs to go around.
One of the advantages of the Cleveland Clinic
is just the sheer volume of surgeries
that we perform here.
We've had the luxury of having a very well-established
and long heart transplant program.
The LVAD program, similarly, has had great success.
This really puts us at the top
in terms of volume across the country.
The advantage of a place like Cleveland Clinic
is the multidisciplinary team that we have.
So we have team of about 14 cardiologists
and four surgeons that are involved
in the heart failure program.
In addition, we have a whole slew
of other team members: nurses, nurse practitioners,
social worker, nutritionists, pharmacists et cetera,
and the whole team is working together
for the patients.
We get referred patients who are denied surgery
at some other very high volume centers.
We do have a very high acuity risk.
Our patients are very sick.
That gives an advantage to patients
in the sense that they know they're being cared for
by teams that have seen just about everything.
The difference you see in patients
before and after a heart transplant LVAD
is one of the most gratifying experiences
any human being can experience.
To see them back after all these years
and see how well they're doing.
And we will do whatever it takes
to accomplish that for every patient.
It is a true gift,
whether it be a transplant or an LVAD,
because they are survivors.
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