BELINDA SMITH needed a new heart. Congestive heart failure had reduced the pumping power of her own ticker by 90 percent. “I needed a heart transplant, but I couldn’t wait that long,” recalls Smith, now 50, a mother of four from Dayton, Ohio. “Doctors gave me less than a year to live.” New hearts aren’t easy to come by. There are about 4,000 people awaiting transplants, but just 2,500 donor hearts are available each year in the U.S. For people like Smith, though, there’s new hope: a battery-powered implant that plugs into the wall at night. Smith’s life was saved by one of these left ventricular assist devices (LVADs), which doctors installed in her chest in 2017. “It does the work my heart can’t do, pumping blood out into my body,” Smith explains. “I can do almost everything I did before — I just can’t get the cord and batteries wet. I have a waterproof bag for taking a shower, but I can’t go swimming.”
Her LVAD is the size of a D battery and weighs less than a pound.
During the day it runs on a battery pack attached to a power cord extending through her chest wall. “I carry two tote bags whenever I leave my apartment — with my controller, extra batteries, a car charger and an extra pump. If the batteries ever run out, I’ve got less than five minutes to plug in new ones,” she notes. “When I’m going to sleep, I plug myself into a wall outlet with a 25-foot power cord.” LVADs pump blood continuously; users don’t have a heartbeat. “You have to wear a medical-alert bracelet so EMTs don’t think you’re dead or try to give you CPR. That would crush the pump,” Smith says. “But I can hear the sound of the pump when I put my head on my arm at night. It purrs.”
Smith hopes to get a spot on a heart-transplant list soon. But for thousands of adults with heart failure, an LVAD is their future. The Food and Drug Administration last fall approved the first LVAD as a “destination therapy” for indefinite use for people with end-stage heart failure who aren’t candidates for a heart transplant.
“For more and more people, LVADs are a long-term option,” says Smith’s cardiologist, Hareeprasad R. Vongooru. “For someone with severe heart failure whose one-year survival odds are as low as 25 percent, this is a new lease on life.”
In-Artery Sensor Tracks Heart Failure
For 25 percent of the 5.7 million Americans with congestive heart failure, the heart’s ability to pump blood is dangerously weak. Just walking across the room leaves them breathless. The risk of dying within a year is as high as 15 percent. Catching signs of worsening heart failure early is crucial, so a daily weigh-in to check for water-weight gain is required.
Now the first miniature sensor for this purpose picks up heart changes sooner, by sensing blood pressure shifts inside the pulmonary artery. The device, called CardioMEMS, has cut the risk of death by a respectable 30 percent in people with severe heart failure, according to a brand-new study of 2,174 people presented at the American College of Cardiology’s 67th annual Scientific Session & Expo this year. The wireless sensor, about the size of a half-inch piece of spaghetti, transmits a constant stream of data to a website monitored by a health care practitioner who can quickly recommend medication adjustments.
On the Horizon: Heart Failure Treatment
"The big push is prevention. That means giving people not just aspirin and cholesterol-lowering statins but also beta-blockers, ACE inhibitors and the diuretic Aldactone (spironolactone), all of which help protect heart muscle after a heart attack. Though these drugs are recognized for helping to prevent heart failure, they are not always given to people after a heart attack. The other important push is controlling high blood pressure. Even in older adults, keeping blood pressure at a healthy level can reduce the risk for heart failure."
— HAREEPRASAD R. VONGOORU, cardiologist and assistant professor of cardiovascular health and disease at the University of Cincinnati