Keeping the Heart Ticking with an LVAD

Diagnostics|Oct.22, 2020

For people who need new hearts, one device could offer a long-term alternative solution.

There are a limited number of hearts available for transplant, but according to India Today, new technology is buying people with heart failure more time while they wait. That technology continues to improve, with recent data from Brigham and Women's Hospital indicating that patients with a left ventricular assist device (LVAD) had survival rates through two years nearly equivalent to those who received a heart transplant. Could machines become the preferred choice for a new heart in the future?

"We're a lot closer to that reality than most people think," said Kevin Bourque, vice president of research and development for the mechanical circulatory support business at Abbott. "Transplants aren't magic. They can create some real complications. The rate of improvements on the pump technology and maintenance means it's not unreasonable to think that patients who have a choice would start picking the device as their 'forever heart' over a spot on the heart transplant wait list."

Better Tech for Better Health

The results of the study on LVADs show encouraging signs for people living with heart failure: improved long-term survival, higher quality of life and lowered chances of strokes and blood clotting.

Having a heart pump today means people living with them must manage some of the technology. Currently, a driveline connected to the internal pump extends outside the body to keep the device powered and running properly but the next iterations of heart pumps are expected to remove that external equipment requirement.

Future heart pumps are likely to be even smaller, lighter and more efficient. Advancements in battery technology, miniaturisation and durability that make everyday devices around us last longer will also help tomorrow's designs, perhaps to a degree where cardiologists may recommend them over transplants.

"It could be as simple as wearing a vest that charges your heart pump like you can wirelessly charge a mobile phone," Bourque said. "We could have a situation where people don't even know you have a device inside you, and that discreetness will add a lot of appeal."

Mimicking Heart Rate Variations

A natural heart responds to our bodies' activities and adjusts how quickly it needs to pump blood. Meanwhile, LVADs have built-in features that enable physicians to adjust pumping speeds based on patient needs. Technology will continue to become more sophisticated, allowing future mechanical pumps even more versatility, according to research published in The New England Journal of Medicine.

The rise of data and devices that measure vital signs could help a heart pump recognise the need to pick up the pace. Measuring factors that affect heart rate, such as respiratory rate, could help us understand where a variable pump speed might improve the device's performance.

Consider a device that measures and collects data on heart performance and wirelessly transmits it to a user's clinic. That data could be looped to a mechanical pump to ensure consistent pressure within the heart, improving quality of life. Software customisation and even learning algorithms could be combined to create a mechanical heart that responds much like a regular heart.

Self-healing hearts: The road ahead

While improving LVAD technology could mean people picking a mechanical device so they are guaranteed decades of reliable pumping, the latest research around heart failure might afford heart pumps a new role, Bourque said. They could be part of a short-term, recovery treatment.

"We need to consider how pumps can be part of a treatment strategy that ends with cardiac remission — strengthening heart performance so people re-grow healthy heart tissue and eventually don't need a pump," he said. Perhaps in the future, a pump won't be a long-term solution but instead a tool that is part of a broader plan to restore heart function.

"What we're focused on with our engineering are human factors around these devices. We want to have a very patient-centric and provider-centric view of how these will evolve," Bourque said. "There's a lot of promise around heart pumps and how they'll appeal to heart patients going forward."


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