At the far end of the heart disease spectrum is Heart failure. Most sufferers will tell you it can be depressing. It’s when your heart muscle is beating but gradually losing enough strength to pump adequate amounts of blood, nutrients, and oxygen. It usually starts out on a minor level and progressively gets worse. It has numerous causes but generally only one outcome. In the US, roughly 670,000 people are diagnosed with some form of heart failure each year. It’s the main reason people older than 65 go to the hospital.
Like other diseases, heart failure has stages. The final stage (or end-stage) is the deadliest when not treated. End-stage sufferers cannot do most simple tasks or even get up without gasping for air. They sit around all day waiting for the inevitable. Medications, stimulators, and palliative care all help with symptoms but there are almost no effective treatments except a whole-heart transplant or an LVAD. If you are lucky enough to qualify for one of these, you might get a part of your life back. A few more precious years to add to your life.
Whole heart transplants work quite well for those few qualifying patients who can survive the procedure and are lucky enough to be matched with a donor. The population of older adults is growing, however, and qualified donors are getting harder to find. (Some people point to the improved safety of cars for this) These factors mean that human heart transplants will never scale up to meet the growing demand. Ultimately, only about 2% of end-stage patients per year receive a whole-heart transplant.
A motorized LVAD can also save your life. If your heart has failed to the point where it simply cannot pump enough blood to keep you going, then an LVAD might do it for you. Again, only about 2% of end-stage patents qualify for this.
LVAD’s are tiny electric pumps that are sewn into the left ventricle of the heart. They spin 24 hours a day, boosting blood flow. They are manufactured devices, so they aren’t limited by the lack of human donors nor the uncertainty of a match. Living with an LVAD comes with a profound lifestyle cost, however, that can be brutal.
The Tyranny of LVAD
Like I said, LVAD’s save lives. However, only a small minority of end-stage heart failure patients qualify or are given the option. Not every patient can tolerate the surgical procedure. Not every patient wants to live with the brutal consequences.
Implanting the device involves highly invasive surgery, permanent attachment to the ventricle of the heart, and direct contact with circulating blood. Once implanted, there may be no going back. Then there is the cost of the procedure, recovery, and follow-up.
Once successfully implanted, the patient has a permanent drive line (wire) that pokes through your body so that an external battery pack can be attached. Instead of a pulse, the electric blood pump runs continuously 24 hours a day, powered by batteries. The patient usually has a shoulder pack to hold these batteries underneath their clothing. Freshly charged replacement batteries must always be readily available. You no longer have a pulse. Swimming is out of the question. Intimacy is challenging.
Hospital readmission rates are high with LVAD patients. Many readmissions are related to stroke or life-threatening infections at the site where the driveline penetrates the body. Power failures become very scary if you are denied the ability to keep your batteries charged. If your batteries die, so do you.
What’s next?
As I indicated earlier, human heart transplants will never scale. The population of older people continues to grow as improved treatment for cancers and other diseases means more people are now dealing with heart disease.
Currently, only one company has an FDA approved LVAD on the market in the US, doing almost a billion dollars per year on only about 2% of the addressable market. This leaves about 95% of end-stage heart failure patients without a viable intervention beyond hospice care.
There is intense corporate interest in filling this “white space”. The problem is not expected to be solved with a blockbuster drug treatment. It calls for an implantable device that addresses the dual issues of effectiveness and energy efficiency while being small enough to be completely implanted with nothing sticking out of your body.
Not long ago, a researcher at Caltech wanted to understand how the human heart pumps enormous amounts of blood so efficiently. He figured out how to mimic the natural motion of the heart with an outer sleeve that supports it and gives it strength. The result is a naturally efficient heart support device for those with heart failure. It is small enough to be implanted and efficient enough to not require an external drive line. This device, known as Helix Cardia, is under development now and will eventually be available to patients.
Will this become the next blockbuster treatment for heart disease?
You can see more about Helix Cardia here: https://valvention.com
Want to learn more about heart failure?:
American Heart Association – AHA: https://www.heart.org/en/health-topics/heart-failure
Center for Disease Control – CDC: https://www.cdc.gov/heartdisease/heart_failure.htm
Help save a life. Consider signing up as an organ donor: https://www.organdonor.gov/
Medical Technology Insights 