My mother is 57 years of age and was diagnosed with idiopathic/post-partum cardiomyopathy at the age of 27. At that time, she was told that she would not live 10 years without a heart transplant and was put on meds such as Coumadin, Lasix and digitalis, which she has been on since. Thirty years have passed and while she has done remarkably well given her condition, she now suffers from a hugely enlarged heart, class IV CHF, numerous arrythmias, tachy, etc. and is currently being considered for a heart transplant. She has an ejection fraction of 17% (right 18%, left 17%), which is down from 24% last year at this time. She weighs 90 lbs. and the doctors are recommending drastic measures because she is experiencing what they call cardiac cachexia and fear other organ involvement within a year's time. She currently takes Lanoxin, Lasix, Potassium, Coreg, Aldactone, Coumadin, Zoloft and Prempro. (Mom was part of the BEST study, and received Bucindolol for several years--the medication was a lifesaver and kept her at a maintenance weight, brought up her EF and overall improved her condition substantially. This was until a year or so ago when the pharmaceutical company discontinued the drug study--since then she has taken Coreg, which is not doing the trick). Our question is: What are the criteria for being considered for any of the Guidant Systems LVADs? Several studies are ongoing and we are interested in knowing if she is a candidate for an LVAD, particularly the InSync or any of the Guidant systems. She's been told something along the lines of "they're not really for you," but our question, which has so far gone unanswered, is this: Is she not a candidate because the focus of the ongoing research is narrowed to exclude types of CM, or is this something that truly would not help a person in her condition (we were under the impression that she was the type for whom the LVADs were invented)? I apologize for the length of my query and thank you in advance for your help.
A left ventricular assist device (LVAD) is a pump that helps blood flow in those individuals with severe (usually EF 10% or less) heart failure. It is usually used only as a temporary bridge to heart transplant but there are a few studies in people who have been turned down for heart transplant where an LVAD is placed permanently. There are still many technical challenges with LVADs and they are only for a selected population.
The InSync study you mention is for a different type of device called a biventricular pacemaker. This is a new therapy that "resyncronizes" the ventricles of the heart to beat more effectively. The preliminary results of a large trial using these devices was recently presented at the American College of Cardiology meeting with encouraging results. There was also a study published in the March 22, 2001 issue of the New England Journal of Medicine concerning biventricular pacing with positive results. This therapy may be more applicable to your mother depending on her baseline ECG and the future plans for transplant. We offer both LVADs and biventricular pacing here at the Cleveland Clinic and if she would like to be evaluated here you can make an appointment for her in the "heart failure clinic" by calling the number below.
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