Subtitles section Play video Print subtitles Hi. I'm Kathleen Schultz. I'm a clinical engineer at Aurora Saint Luke's Medical Center. I've been working there for 10 years with the ventricular assist device program. And I'm here today to tell you a little bit about our devices and how you may interact with them out in our community. When we talk about a left ventricular assist device, we're talking about a device that is going to take over some of the function of their left ventricle. It works in parallel with their native heart. So we don't remove their heart. We basically core a little piece of their left ventricle out and put in one of our devices. Then the blood that goes into their left ventricle is then pumped through our device back into the aorta, and pumped back into the rest of their body. It does take over the majority of the function of their left ventricle, but not all of it. They still will get some blood going from their left ventricle into the aorta through the aortic valve itself. At Saint Luke's, we currently use two different types of non-pulsatile LVADs. We use the HeartMate II and the HeartWare device. Both of these devices are able to have the patient go home on them. When we talk about devices and why we use them, there's a couple reasons. There's one called the Bridge-to-Transplant. With a Bridge-to-Transplant patient, these patients ultimately will be transplanted at the end of their device life. We are basically putting in a device to make them healthy for when they go into transplant because we want them to be like you and I. We want them to be able to walk as much as they can. We want them to be able to exercise. So it's basically to build their endurance back up. We also use Bridge-to-Transplant devices in our very large type "O" patients. Type "O" blood type patients are a little harder to transplant. So they're on that transplant list a little longer. Unfortunately, the length of the list also causes them to often become sick or in their heart failure. So we're able to put these devices in, and we're able to give them a better life until their transplant comes. Now, kind of the way the whole bad world and transplant world is going is that most patients who will get a transplant will be on a LVAD before transplant. It's just how it's going. We've noticed that the healthier we can take them into the transplant, the better off they are with their transplant, and their transplant surgeries go a little better. So at Saint Luke's, probably about 75% of our patients who go to transplant have an LVAD prior to it. And again, they can be discharged home. The other indication that we're starting to use now, and it's been approved in the last probably about 10 years, is destination therapy. Destination therapy patients are not transplant candidates. There's many reasons why they may not be transplant candidates. It could be their age. At Saint Luke's, we have a soft cut-off of 70. We do do some patients over 70 if they are very physically active patients, but most of the time our cut-off for transplant is 70. We also-- if they have a lot of health conditions-- we may not be able to transplant them right now whether they have renal failure, whether they have cancer, other things that may cause them to not currently be able to be on the transplant list. Well, we don't want to promise those type of patients a transplant if we can't give it to them. So what we do them is we say-- oh, we can still put this pump and is destination therapy, but we're asking them to bear with us and see if we can fix their health condition. And then when their health condition is fixed or becomes at a point where they can be transplanted, then we move them back over to the bridge to transplant list. Compliance is another huge issue. We are advocates for the donor family. We are not advocates for our patients. So we want to make sure that our patients are a hundred percent compliant, and that they're going to treat their new organ with the respect that it deserves. So if we have any sort of judgmental issues with our patients on their ability to be compliant with medications, alcohol, or drug use, things like that, we may actually say-- you know what, you have to prove to us you're going to be compliant, and then we will give you a heart. So we basically do a social contract with them and say these are the things that you have to do, and when you fulfill that social contract we then will move you back over to Bridge-to-Transplant. The other reason that we may put it in for destination therapy is obesity. If somebody is over a BMI of 40, which is basically a ratio between their height and their weight, if it's over 40 we can't transplant them. It's too hard to find them a healthy organ. So then we say to them-- you know what, we will put this device in you, and we will give you the ability to go out and exercise, we'll educate you on what you need to eat, and you need to come back to us and show us that you're going to lose the weight you need in order to get that transplant. We also are one of the only programs in the nation who actually also has a good relationship with gastric bypass. So a lot of our patients, if they're really obese and they're showing us that they're doing what they need to do, we actually will refer them to our bariatric program to get a lap band, or usually only a lap band because it causes issues later with transplant if they have a full gastric bypass, but we do have a program with that. All of the patients who are destination therapy, they're at high risk of intervention, high risk of death if we don't intervene soon. Usually the protocol is if we don't do something and put a device in them, their life expectancy is about six months is what we're looking at. These patients will live on this device. They are never promised a transplant. They're given basically contracts and say-- if you follow these, we will go ahead and possibly move you over to that transplant list, but you really have to prove it to us. So when they're put in, we do give them a palliative care consult, because we know that they could die on this device that might be there end-all. They could eventually again move to that transplant list if things get fixed, and then they can be discharged home on these devices to live on them. Currently, at Saint Luke's we are about a 50/50 in our Bridge-to-Transplant and our destination therapy list. Now when we talk about these new types of devices, before we get into them I want to just talk about what non-pulsatile devices are. When I first started at Saint Luke's, our devices were about the size of a paint can lid, and they were about two inches thick. So imagine putting that in a patient. That was pretty big. It was all motorized and it would break in about a year and a half. So the companies and the health care world said-- you guys have to do something about this. So in order to make them smaller, we had to make them what we call non-pulsatile. So basically when we talk about non-pulsatile, our devices have no valves in them. So they have no ability to close and shut. It's just one opening that goes through. With that the easiest way to picture it is like water coming out of a garden hose. We call it continuous flow. So whatever the device gets the device is going to spit out. When it comes out of the end of our device,