cardioloGy and hearT surGery specialTy ranks amonG BesT hospiTals Froedtert & The Medical College of Wisconsin were ranked as a regional high performer for cardiology and heart surgery by U.S. News & World Report. Froedtert & The Medical College also rank as the top hospital in metropolitan Milwaukee.
“It’s our role to explore all options for the patient,” said
Michael Cinquegrani, MD, a Medical College of Wisconsin interventional cardiologist. “Many patients who are referred to us for transplant evaluation end up getting changes to their therapy or a different therapy, including a VAD, possibly in place of transplant. We critically assess the patients and the role of advanced therapy for each patient.”
Vads – a Game chanGer A VAD is mechanical pump that is surgically
n A typical VAD
connected to the heart to help support blood flow and improve heart function. Different types of VADs are used, depending on the patient’s individual needs.
Patients are usually connected to a heart-lung
bypass machine during the procedure and recovery depends on how sick the patient was before surgery. VAD patients are closely monitored, and can return to many normal activities after they are released from the hospital.
Chapman was immediately
admitted to the hospital and had a VAD implanted, which kept him alive while he waited for a donor heart. He had ischemic cardio- myopathy, which means his heart was too weak to pump enough blood to his body. His heart was working at about 10 percent of its capacity, so his implanted VAD was doing about 90 percent of the work.
Chapman’s recovery after the
VAD was longer than most because his heart had been so damaged. Still, his health improved with the VAD.
“The machine gave me a
somewhat normal lifestyle,” Chapman said. “I was walking as much as I possibly could. It’s good because you’re out of the hospital and you’re home with your family.”
He had to learn to manage the
external batteries that powered his VAD, and he had to plug into a machine at night while he slept.
n alfred nicolosi, md
game-changers,” he said. “They’re getting smaller, better and more sophisticated with every iteration. They are rapidly improving to the point that for certain types of patients, the VAD outcomes – specific data referring to patients living after receiving them – are almost as good as for those who received transplants.”
In some cases, the patient will choose a VAD as their
destination therapy, and forgo a potential heart transplant. Long-term survival rates for VADs are still unknown
because there haven’t been enough patients with VADs for lengthy periods and the devices keep changing and improving, according to Dr. Mahr. He said that for certain VAD patients, the two-year survival rate is getting close to 70 percent. He explained that 80 percent to 85 percent of all heart transplant patients will survive for at least two years.
“Given our often highly complex patients, our outcomes
are excellent, and speak to our team’s ability to care for these patients long-term,” Dr. Mahr said.
TransplanT candidaTes
There are roughly 250,000 to 300,000 people with advanced heart failure, making them potential candidates for heart transplantation. However, only an estimated 2,200 heart transplants are performed each year nationwide because there are simply not enough donor hearts suitable for transplant.
Donor hearts are allocated based
on blood type, body size, time on the waiting list, how sick the patient is, and the region of the country where the heart was donated. During the transplant procedure, the patient is hooked up to a heart-lung bypass machine that pumps blood through the body. Patients may spend as much as two weeks in the hospital and are closely monitored for any signs the body is rejecting the new heart. At Froedtert & The Medical College of Wisconsin, heart transplant
“Patients have a VAD implanted and they go literally
from not being able to do anything, to being able to go back to work, play with the kids, and get back to their life,” Dr. Cinquegrani said.
While early VADs were cumbersome, with limited durability, according to Dr. Mahr, the newer VADs “have become complete
8 Froedtert Today January 2012
froedtert.com
patients receive close follow-up care for the rest of their lives. “The median survival for a heart transplant in the United
States is about 12 years,” Dr. Nicolosi explained. “That means that if you get a heart transplant, chances are 50/50 that you’re going to live 12 years. You may live 20 years or you may live two years.”
Chapman’s VAD kept him alive for 16 months, and he
was ready when he got the call in May 2011 with the news that a donor heart was available.
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