Patients In-Line For Heart Transplants Rely On Temporary Devices

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Gosset and colleagues Sunjay Kaushal and Carl L. Backer display the Berlin Heart. (courtesy Jan Terry, Children’s Memorial Hospital)Gosset and colleagues Sunjay Kaushal and Carl L. Backer display the Berlin Heart. (courtesy Jan Terry, Children’s Memorial Hospital)For people of all ages on the waiting list for a heart transplant, the wait can be long and uncertain. Now, artificial heart technology is revolutionizing the transplant process by making temporary hearts available immediately.

The devices are prolonging the lives of transplant candidates and buying them time that can make the difference between life and death, Chicago physicians say.

About 2,800 Americans currently line the waiting list for a heart transplant, 109 of them in Illinois, according to the United Network for Organ Sharing. "Ventricular assist devices" fill the gap to help patients with weak hearts pump blood throughout the body while they are waiting for a transplant.

The typical waiting time for a heart transplant for patients between the ages of 18 and 64 is approximately 170 days, according to the most recent statistics of U.S. Department of Health and Human Services.

"Most programs use ventricular assist devices as a bridge to a transplant," said Dr. Robert Higgins, chairman of cardiovascular surgery at Rush University Medical Center. Another use for such devices, he said, is to prolong and improve the quality of life for patients who do not qualify for a heart transplant.

"That's just how that technology has been applied in recent years," he said.

As of right now, if a patient needs a heart transplant, there is no other, better option than a transplant, said Dr. Jeffrey G. Gossett, attending physician for the Division of Cardiology at Children's Memorial Hospital. There are currently no available total implantable artificial hearts, but this is an active area of investigation, he added.

"It's going to be a reality, but it will take a number of years," he said.

According to Children's Memorial Hospital, the hospital is one of 40 pediatric centers in the country authorized to apply for an FDA humanitarian exemption to use the Berlin Heart, a German ventricular assist device intended for infants and children, as temporary assistance to transplant candidates. The device, widely used in Europe, doesn't have FDA approval as yet in the U.S.

The Berlin Heart pumps blood from outside the chest using catheters within the heart attached to two pumps. The device was used in July of 2008 to help a child with dilated cardiomyopathy, a condition that weakens and enlarges the heart, according to the hospital. The child later received a heart transplant.

Some 160 children in the United States have used the Berlin Heart so far. Two successful implants of the device have been performed at Children's Memorial, Gossett said.

Another advance is the CardioWest Temporary Total Artificial Heart. The heart was originally designed as a permanent replacement heart but is currently FDA-approved as a temporary device for people waiting for a heart transplant, according to Rush University Medical Center.

The device uses a pump implanted in the chest that functions as the patients' left and right heart ventricles, according to the medical center. The implanted pump operates with tubes that extend through the wall of the chest and connect to a console that provides compressed air. A problem with the device is the cumbersome driver that forces patients who use it to stay hospitalized until they receive a transplant, Higgins said.

Currently, a portable, smaller driver is available in Europe, allowing patients to go home with the device. Rush is one of 20 American medical centers expected to be involved in clinical trials of the smaller driver this coming summer, Higgins said.

Nearly a million people die each year from cardiovascular problems and half die before getting to the hospital, Higgins added.

"If we were to develop innovative treatment for cardiovascular diseases, it would be a remarkable advance in the overall healthcare landscape," he said.

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