Tuesday, October 12, 2010

Life and Death With an LVAD

Left ventricular assist devices (LVADs) are dramatically altering the field of heart failure care. There are pros and cons with the use of these devices, and this Reuter's article does a good job exploring them in simple terms.

Cardiologists need to become more familiar with these devices' limitations, too:
We have to address what is the meaning of death on one of these pumps," said Dr. Valluvan Jeevanandam, chief of cardiac and thoracic surgery at the University of Chicago Medical Center and an investigator for Thoratec's clinical trials.

Roughly 70 percent of patients on the HeartMate II were alive after a year, and nearly 60 percent were alive after two years, according to the latest data.

"It's not hard to imagine a person who has had severe stroke that has impacted both sides of the brain, the kidneys are shutting down, he is on a respirator, but yet the LVAD just keeps churning along," said Martin Smith, a clinical ethicist at the Cleveland Clinic.

Under U.S. law, patients are allowed to ask that implanted devices be turned off. But Dr. Diane Meier, a professor in the department of geriatrics and palliative medicine at the Mount Sinai School of Medicine, said cardiologists are particularly bad at preparing patients for death, especially this kind of death.
Like pacemakers and ventillators, these devices intervene on the natural course of the dying process and when the quality of life declines sufficiently after their use, it is ethical for patients and family members to request such support be withdrawn.

The challenge, of course, is what to do when these members of the care team aren't there...



Named Just Bob said...

Alas, one of the provisions of healthcare reform that was universally derided as the death panel was intended to help with this. Having patients and/or family aware of their options when near death is critical education that needs to take place across the public continuum.

DrJohnM said...

The more we can do (like LVADs), the more complicated medical decisions get.

When, and for how long to unleash the fury of medicine continues to challenge.

Then, there is the obvious…which sits in front of the cardiologist, but often remains unseen.

Well said.


Anonymous said...

My fiancé had the Lvad put in on the 20th of last month. he caught a real high fever after and now his kidney and liver isn't functioning. He can do commands like squeeze hands and shake his head and starting to open his eyes. He also has some issues with his feet which the doctor says he will lose them. with that said have you seen patients in the hospital for several months due to complications and come back fine or would it be best to go ahead and have them remove him from the machines?

DrWes said...

Anony -

I am so sorry to hear about your fiancé. While I cannot offer medical advice on this blog, I would recommend you discuss your feelings and concerns with his doctor. Only he or she knows the full situation.

God bless.

Diane said...

My husband received his LVAD 3 years ago. At that time we were not properly of the very serious complications that could result. He suffered with gastro bleeding the entire 3 years, he had a stroke, he had blood clots and finally he developed a driveline infection which led to sepsis. He passed away last week. In the 3 years he had the device he probably spent a full year in the hospital. I believe the medical community needs to re-evaluate the benefits of this device.k