"The HeartMate II really changed everything," says Robert Adamson, M.D., medical director of the Cardiac Transplant Program at Sharp Memorial Hospital in San Diego. Unlike previous pumps, this device, approved by the Food and Drug Administration for long-term use in 2010, doesn't pump like the heart, squeezing blood out of a chamber. Instead, it spins like a tiny jet engine, pushing a steady flow of blood through the body. The pump is much smaller — roughly the size of a flashlight battery — so it can be implanted even in very small patients. And it has only one moving part, so it's also far more durable, lasting for 10 years or more in laboratory tests.
Studies show that the risk of infection and other complications has dropped dramatically with the new pump. In one analysis, two out of three patients were alive two years after implantation — an impressive number given that recipients are almost always in the end stages of heart failure. The stronger the patients are, the better their odds. "Most of the deaths occurred within the first few months among patients who were too sick to get through the surgery and recovery," says Boyle. "After those first few months, the curve flattens out, meaning if patients are strong enough to make it through the surgery and recovery, they're alive and doing very well."
Boyle's first patient to receive the device was a 79-year-old man with congestive heart failure who received it as part of a clinical trial in 2005. "A lot of people at the time might have said he was too old," says Boyle. "Six and a half years later, at 86, he's still going strong." Indeed, a recent study that compared results for patients under 70 and those over 70 found almost no difference in survival or quality of life.
Because the device restores normal blood flow to organs throughout the body, in many patients kidney and liver function improves. In some cases, the heart may even repair itself, especially in younger patients whose heart failure was caused by a virus that infected heart muscles, a condition called viral cardiomyopathy. Once the heart is strong enough, the pump can be removed.
When damage to the heart is irreversible, as in most cases of congestive heart failure, the pump can buy time until a donor organ is available for a heart transplant. Before he suffered a heart attack at age 47, Michael-Joshua Morris, of New York City, was exceptionally active. After his heart attack, he couldn't walk more than 10 steps without gasping for breath and leaning on his wife, Anne Marie. Two years ago he had the device implanted. "What the heart attack took away from me, the LVAD gave back to me," says Morris, who still hopes to undergo a heart transplant.