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  • 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,