Cardiomyopathy

[Brendy5046]

my husband is 50 years old.  he has had dialated cardiomyopathy for 7 years.  On December 23, 2010, he had an ICD put into his heart.  I was told it was because of sudden cardiac arrest because his heart is very weak and his ejection fraction is down to 28% and he is on the max of his medication.  We were told that he could not get more medication because his blood pressure is low enough already and he would just pass out.    how long does he have to go before he can be eligible for a heart transplant?
Thank you ,

Brenda Titus

[ed34]

If there is a slight chance the native heart could recover, my personal view would be to piggyback. It's a shame they can't keep your original heart beating in a lab to allow recovery making transplantation a temporary measure.

[kenkeith]

Yah!  that is interesting. Piggyback (my characterization) a donor's heart with native heart. That begs the question when would it be practical to piggyback rather than replace native heart?

Thanks for the comment.  Take care

[vienna13]

How your husband feel about having a heart transplant?
How high -low his EF was before?
Is he a smoker?
Does he take natural suppliments like Coenzyme Q10?

I just passed my 7 years.

My Best for booth of you !!
  

[ed34]

http://www.mayoclinic.com/health/lvad/MY01077

Notice it states "or for your heart to become strong enough to effectively pump blood on its own".  

I would think that the ideal situation would be to get the VLAD in place before the heart is 'too' weak, giving a better chance of recovery.

This may interest you .....

"In July 2009 in England, surgeons removed a donor heart that had been implanted in a toddler next to her native heart, after her native heart had recovered. This technique suggests mechanical assist device, such as an LVAD, can take some or all the work away from the native heart and allow it time to heal"

[kenkeith]

QUOTE:  "LVAD's into patients who have a very low EF now because it has shocked them just how many people actually recover enough to come of the list with this tiny pump."

Low EF is not necessarily class IV heart failure...many of us have a low EF and function well.. LVAD is not new and has been around since 1994 and approved by FDA.  There has been approval for a self-contained electrical device to replace the pneumatically unit....but everything I have read over the years the unit is a bridge to a transplant.

The latest I have read class IV patients with LVAD have it implanted in the pericardial space and this has helped extend the bridging time for a decision and therapy. You may referring to better bridging time, and it is certainly no substitute for a transplant for class IV patients who have less than 6 months to live without a transplant. Its a big jump to go with a low EF to LVAD for class IV patients. I and many other have had a low EF and can function in class I or class 2 and class 3  without any thought of a transplant, and hopefully the OP's husband is in that category and never gets to class IV.

I haven't read LVAD implants can take one off the transplant list?  Do you have something in that regard?  

[cindy707]

I am so sorry you and your husband are going thru this....a couple of different answers to your questions....once his doc has decided that your husband needs a transplant the doc will let you both know and your husband will then be put on the UNOS list for transplantion the wait time could be anywhere from six months to three years depending on where you live and how long the list is.  It definately varies region by region and you can actually google the site to find out how long the list is for PA where you live.  Right now there are anywhere from 2200 to a little over 2500 transplants being done each year in the U.S,  One of the criteria's must be met if or when your husband hits the Status One mark...there are three actual points and one must be met according to UNOS and they are:
A. Already in a hospital
B. Receiving meds via an IV to help your husbands heart pump with greater force
C. Your husband is on a mechanical heart assist device.

As far as his ICD.....i think its great that your husbands doc is so pro active with his care and treatment and it sounds like he/she is taking no chances....an ICD is indeed a lifesaver for many many people.  It is actually used to detect a potentially fatal arrhythmia and to assist your husbands body in "preventing" cardiac arrest or other serious issues...an ICD does not have a benefit if cardiac arrest has taken place...it has to detect the arrhythmia that is bad and then correct it thru shock to re set the electrical of the heart and basically help his heart to beat in a normal rhythm as in re setting it...good luck to you both and i will keep my fingers crossed for you both......Godspeed................

[ed34]

"Doesn't appear applicable for brandy"

I didn't suggest it was, but it is a very promising development with CHF. The heartmate II trial gave very good results. In 2009 it was published...

Treating patients with HeartMate II leads to dramatically improved
survival (68 and 58 percent at one and two years, comparing
favorably to data on patients managed on medical management
alone), functional capacity (80% restored to and maintained at Class I
or II at two years; doubling in six-minute walk test) and substantial
improvement in quality of life unequaled by any other heart failure
therapy.

[kenkeith]

To eligible inaddition to what has been stated a candidate should be in NYHA class IV of heart failure.  Class IV is having unstable angina (chest pain), shortness of breath, etc. without little or no exertion...often is bedridden and a projected life span of 6 months or less..

Ed34, LVAD's are most commonly used, but when pulmonary arterial resistance is high, right ventricular assistance becomes necessary. Doesn't appear applicable for brandy!

However,  ICD's NYHA Class 4 drug-refractory congestive heart failure in patients who are not candidates for cardiac transplantation. It seems a patient with a low EF is vulnerable for a life threatening arrhythmia (irregular heartbeats) and can be a life savor having an ICD implant if and when there is an event (cardiac arrest, etc.).

Thanks for your question and sharing your husband's medical concerns.  If you have any further questions or comments you are welcome to respond.  Take care and I hope your husband's conditon has a favorable outcome going forward.  Take care.

[ed34]

You are right jrbon, about different countries having different criteria. Perhaps it's down to the availability of organs in different areas?  The UK struggles with donated organs, there's always a massive shortage so there has to be strict regulations. I believe the last rule stated anyone expected to survive a year or less was allowed on the list. As there is such a shortage of organs, Doctors fight like crazy to keep existing ones functioning as well as possible. I watched a documentary recently focused on a heart hospital near my home and they install LVAD's into patients who have a very low EF now because it has shocked them just how many people actually recover enough to come of the list with this tiny pump.

[jrbon]

Just for your info... I am in a similar objective situation: 62y old, EF 23%, maximum acceptable medication, and refusing the ICD since February 2009 ... however now I have no symptoms, therefore I am not thinking yet in the transplant.

Jesus

[jrbon]

I think it is difficult to say, it depends on the countries and on the drs.

My understanding is that when you are in class IV of CHF and need IV inotropics, and you meet the other criteria (age, live style, other organs health..) you are very likely to be included in the transplant list.

Jesus.