Device keeps heart patients alive and active

Bryce Bollum
Bryce Bollum, 63, of Inver Grove Heights, Minn., is able to garden again because of his ventricular assist device.
MPR Photo/Lorna Benson

When former Vice President Dick Cheney got his new heart pump earlier this month, most people had never heard of a ventricular assist device.

But VADs, more commonly known as heart pumps, are being used to keep more and more people with chronic heart failure alive.

Some doctors predict that VADs will become the dominant technology for severe heart failure for the next decade or longer.

Earlier this month, right around the time Cheney received his VAD, Jean Quinlivan, of Edina, woke up from surgery and felt something wonderful.

"Immediately noticed that my feet were warm for the first time in months. It starts working right away," she said.

Quinlivan has been dealing with the effects of chronic heart failure since her first heart attack 12 years ago.

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When her heart function plummeted suddenly this spring, she figured she had reached the end of her treatment options, but her doctor thought she might be a good candidate for a heart pump.

Smaller new devices
On the left, a first-generation ventricular assist device. On the right, the second generation heart pump.
MPR Photo/Lorna Benson

"I had always thought if I had a terminal illness, that I would just go into hospice and go," she said. "But this seemed a little different. It seemed to offer something more, and I'd love to have some more time with that family."

A few feet away, near the foot of her hospital bed, a cheery get-well sign is plastered with photos of her many grandchildren and great-grandchildren. At age 82, Quinlivan is the oldest person to receive a ventricular assist device from the University of Minnesota Medical Center, Fairview.

Her cardiologist, Peter Eckman, says she is doing remarkably well.

"These are people who are often looking at survival that's measured in weeks to months," he said. "And when they have an opportunity to live for another few years with an improved quality of life, they're very often incredibly grateful for that opportunity."

AS DEVICES IMPROVE, SO DO LIFE SPANS

Patients who receive VADS today typically live with the devices from 2 to 5 years -- sometimes longer. The pumps help many patients buy extra time while they await a heart transplant. Others like Quinlivan, who are too frail to qualify for a heart transplant, use the devices to extend the life of their heart for as long as they can.

The devices have improved significantly from just a few years ago, when the internal pump was the size of a grapefruit. The early version also had bearings that started wearing out around 15 months.

Dr. Ranjit John and the VAD
University of Minnesota cardiovascular surgeon Ranjit John demonstrates how the ventricular assist device, or VAD, is positioned in the chest.
MPR Photo/Lorna Benson

"In the past the results were bleak," said Ranjit John, a University of Minnesota cardiovascular surgeon. "But clearly in the last five years we are seeing a new era in which the survival rates are huge."

John said 65 percent to 85 percent of patients who receive the new devices are alive after a year or two, depending on whether they are awaiting a heart transplant or using the device to extend their life.

Patients can often resume most of their pre-implant activities, except for swimming and other water-related sports which would short circuit the external batteries need to run the pump.

KEEP IT CLEAN

There are other medical risks.

"The biggest thing you have to worry about, I think, is you have to be careful not to get an infection," said Bryce Bollum, who received a VAD two years ago.

The device has enabled the 63-year-old Inver Grove Heights retiree to resume golfing, gardening and traveling with his wife.

But he says it's critical that he keeps the small electrical wire, that pokes out of his side, very clean so he doesn't get an infection.

Bryce Bollum's VAD line
Bryce Bollum points to the area on his stomach where his VAD drive line exits his body. He must change his bandage every day to prevent infection.
MPR Photo/Lorna Benson

"They're pretty tough if you happen to get one because everything is hooked right to your heart," he said. "So if it starts following things in, why, it goes pretty quick."

VADs don't appeal to everyone with advanced heart failure. Dr. Eckman estimates that 10 percent to 20 percent of his advanced heart failure patients decide that they do not want one.

But, he said, VADs will become the dominant technology for severe heart failure over the next 15 years, while researchers try to figure out the potential of stem cell therapies that would enable heart muscle to regenerate.

"They're amazing and they're here today," Eckman said, "which is a marked contrast to the cell therapies that rightly have a lot of enthusiasm and a lot of interest. I think it's important that the scientific community continue to study this."

Along with the university's Fairview hospital, the Mayo Clinic in Rochester and Abbott Northwestern Hospital in Minneapolis also implant VADs.

The cost of receiving a VAD typically ranges from $150,000 to $200,000, including hospitalization. Most insurance companies cover the procedure.