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,

or what we call our outlet, it is also

going to have no pulsatility to it.

It is, seriously, like water out of a garden hose.

So with that in mind, our patients

will have very, very low blood pressures,

and their difference between their systolic

and their diastolic pressure is pretty small.

We're looking at about a 5 to 15 millimeter of mercury due.

And that difference, and that-- what we call pulse pressure,

the difference between the systolic and diastolic--

is literally just on their own heart and their contracting.

So that's what causes that difference, but again

we minimize it.

So there is no usually blood pressure of 120 over 80.

We're looking at 90 over 70, 80 over 60, sometimes.

We're looking at much lower blood pressures.

They're typically not palpable at the extremities.

So even though it may have a little bit of pulse pressure

when it leaves our device and hits the aorta, by the time

it gets out to their arms and their legs,

if you try to feel pulses they're

often diminished, or gone.

So it does cause a little bit of problem

for people who meet them in the community

because they're used to feeling a pulse,

and our patients often don't have that.

The patients still do need their native heart.

We did not take it out.

We attach these devices to their native heart,

and for our devices to work and work effectively,

we really that need that native heart to still pump.

So we're really dependent on still that contractility

that that native heart has always had.

And we will try to correct the heart if it's not functioning

right because our device will see

and have problems with that.

Similarities among all of our LVADs that we use,

even the ones that I'm not going to show you today-- we do

have some at the hospital that maybe don't go home

or are a different kind that we rarely use,

but all of our devices will have what we call a driveline.

And this is basically a line that exits their body usually

on the right side, and this is what

delivers all the power to the device

and actually allows the device to communicate back with us.

This driveline is very, very important

that we keep and maintain it.

We don't want any cuts in it.

We don't want any breaks it because if we break things

we break the wires, we break the communication,

or we break the ability to provide power to it.

All of our devices will have a controller, basically

the brains of the system.

It's like a little mini computer.

It's all programmed.

It's what provides-- tells the pump what to do,

and it also is what reads what the pump is doing and gives you

visual and audible alarms if anything is wrong.

It has two batteries.

They will all have a battery charger,

and they will all have some sort of AC power unit for sleeping.

Basically all that is is a unit that plugs up into the wall

and provides the patient continuous power so

that when they're sleeping they don't

have to worry about running out of battery power.

What we do at Saint Luke's, though,

is we encourage our patients only