Following
the implantation of the first artificial heart, the Jarvik
in October of 1985, mechanical circulatory support (MCS) devices
have been utilized frequently as a bridge to cardiac transplantation
during the past decade. Those suffering from end stage heart
failure that can no longer be managed in the intensive care
units with traditional therapies, such as IV medications,
can receive MCS devices. Surgically implanted, these heart
pumps take over the cardiac function until suitable donor
organs can be located.
Unheard of at the time, the University of Pittsburgh Medical Center discharged the first patient ever on a VAD, and has since upheld a long history as a leader in the field of Mechanical Circulatory Support. UPMC has advanced the field of Mechanical Circulatory Support through clinical innovations achieved in the areas of predictors of cardiac recovery, exit-wound site care, patient discharge, and refinements in patient and device selection criteria to name just a few. Technical innovations continue to occur in the lab as well as at the bedside, and laboratory innovation ranges from new pump designs to improving current designs through fluid flow field visualization. Through the combination of such clinical and technical resourced, UPMC has succeeded at vastly improving both patient survival rates and quality of life.
Upholding such leadership status, the Artificial Heart Program (AHP) at the University of Pittsburgh Medical Center (UPMC), under the direction of Dr. Robert Kormos, is responsible for the selection and management of these patients. Assisting Dr. Kormos is a team comprised of cardiac surgeons, cardiologists, clinical nurses, and a cadre of bioengineers. This group provides both clinical and technical expertise to patients, their families and UPMC staff. To date, 250 patients have undergone mechanical circulatory support at UPMC, of which greater than 75% have been successfully transplanted. The duration of support has increased from an average of 14 days in 1988 to more than 100 days this past year, reflecting the ever-increasing shortage of donor organs. Cumulatively, the Artificial Heart team has provided over 50 years of patient support days, and among the most experienced group throughout the world.
Artificial
Heart staff members participate in every aspect of intra-aortic
balloon pump (IABP) and ventricular assist device (VAD) implementation
within the University of Pittsburgh Medical Center. Team members
interface with the medical staff to assess potential candidates
for MCS, and assist the cardiac surgeons during operative
procedures. Following initiation of IABP or VAD therapy, AHP
staff members render 24-hour system monitoring, and are available
for advanced technical support. Engineers and nurses work
along side of cardiac surgeons, cardiologists, and medical
staff from various clinical disciplines offering a unique,
rounded approach to patient care. Furthermore, this team of
experts plays a vital role in the development of prospective
technology by applying exceptional clinical propensity to
the design of more suitable artificial organs.
We
discovered almost a decade ago that these MCS patients can
be physically rehabilitated to the point that they are well
enough to leave the hospital and return home to near normal
functioning. As a result, the AHP initiated the first MCS
outpatient program in the world in 1990. More than 50 patients
have been discharged since the inception of the program. Three
MCS patients are currently being supported outside of the
hospital, and have contributed to our more than 10 years of
out of hospital experience.
The
impact on quality of life in the outpatient setting is profound.
MCS patients have returned to their careers, attended school,
and lived exceedingly normal lifestyles in the midst of circulatory
support. One young male participated in the birth of his second
child; another patient inherited the responsibility of caring
for his terminally ill wife. Most recent studies show that
this population of patients scored far better in quality of
life measures than the standard transplant candidates, and
about equal to the post transplant population of patients
who have been discharged home.
This innovative program also has a significant impact on health care costs, since it is quite obviously much cheaper for a patient to be well living at home versus an in-patient requiring round-the-clock intensive care, as is customary for patients in end stage cardiac failure. Some patients have been discharged from the hospital in less than three weeks following surgical implantation of an MCS device. As a result, this population spends fewer days in an ICU or on the acute care ward where standard end stage heart failure candidates live for many months. As such lending support to the cost effectiveness of these devices.
The clinical artificial heart staff also serves as the national training center for outside medical centers implementing a Novacor or Thoratec VAD program. To date approximately 60 centers from throughout the country have sent a team of specialists to Pittsburgh for the training exercises. In addition, there is an academic interface with the school of engineering at the University of Pittsburgh and Artificial Heart Program engineers have presented lectures and offered clinical internships in both the graduate and undergraduate programs.