The Washington University and Barnes-Jewish Hospital Heart and Vascular Center celebrates its VAD program’s 25th anniversary, maintaining the same goal — offering advanced heart failure patients a chance at a longer, better life.
Across its 25 years, the program has implanted more than 1,100 VADs in patients, placing it among the top 10 programs in volume in the U.S.
The program’s one-year VAD survival rate is comparable to the one-year heart transplant survival rate. Currently, median survival time for patients with the current VAD being used is more than 5 years. Our center’s longest-surviving patient is currently in their 12th year of VAD destination therapy.
“Our center has been successful thanks to a large group of experienced individuals including cardiologists, cardiac surgeons, nurses, and support staff working together with the goal of helping patients with end stage disease and limited options,” says Washington University advanced heart failure specialist Justin Hartupee, MD, PhD. “VADs have continued to improve over time and offer hope for prolonged survival and dramatically improved quality of life to our patients.”
Changing technology
The tick-tick-tick was a dead giveaway.
In the late 1990s, you could tell you were near a ventricular assist device (VAD) patient because you could hear the device clicking inside them, pumping blood through their body. You could also spot the bulky battery pack slung over their shoulder in a canvas bag.
VAD technology was much different when the Washington University and Barnes-Jewish Hospital VAD program started in 1997.
“Initially patients remained hospitalized due to the complexities of the pump, the frequent, required monitoring and size of the equipment,” Christine Huber, VAD coordinator says.
Eventually, pumps became smaller, taking up less space in the chest and allowing for less-invasive surgical approaches. The external controller and batteries also shrunk, while battery life grew. The Washington University and Barnes-Jewish Heart and Vascular Center took part in multiple international clinical trials that helped advance VAD technology. The result of these trials are current devices that are smaller and easier to implant, are more durable with significantly improved safety profiles and battery life. These advances result in improved outcomes and quality of life for VAD recipients.
“This allows the patient to be more mobile for extended periods of time,” Huber says.
Vests, jackets and T-shirts, all customized to fit VAD equipment, has helped patients keep their equipment secure and discrete.
“All of these advancements help with the transition from hospital to home after a life-changing surgery,” says Huber. “Now patients can return to their communities and resume their lives.”
A team approach
Since the beginning, the VAD program has taken a team approach to patient care.
Patients are evaluated and followed by a large team under medical director Greg Ewald, MD, who has been with the VAD program since its inception. The multidisciplinary team includes cardiologists, cardiothoracic surgeons, nurse coordinators, social workers, dieticians, pharmacists, financial specialists and palliative care/hospice services.
“Each patient is assigned to a specific nurse coordinator, which promotes the development of a strong patient-provider relationship and allows us to know the intricacies of our patients and their health, while giving them a partner in care that they can trust and use as a resource,” says Huber.
Coordinators help patients manage their medications, schedule tests and procedures and coordinate with patients’ primary care providers and specialists.
In addition, VAD social worker Mary Beth Fernandez, LCSW, provides psychosocial support to patients and runs the monthly support group where VAD patients can share their successes, discuss new ideas, troubleshoot problems and encourage each other. The group has met virtually since the start of the pandemic.
While celebrating the lives saved and improved throughout the 25 years of the program, the Washington University and Barnes-Jewish Heart and Vascular Center VAD team knows that the program also has deep experience in providing superior patient care to continue as a leader in its field into the future.