Heart failure is a condition in which the heart is not strong enough to pump enough blood to meet your body's needs. It is classified from Class 1 (mild symptoms controlled with medication) to Class 4 (severe symptoms despite maximal medical treatment). Heart transplantation is the gold standard treatment for Class 4 heart failure, but is limited because of a shortage of donors and concomitant patient features such as significant kidney disease or history of cancer. The left ventricular assist device (LVAD) was developed initially as a "bridge" to help patients accepted for transplant survive until they received a new heart. Now, appropriate patients with Class 4 heart failure, who are ineligible for a transplant, can be supported indefinitely by the newly developed LVAD called HeartMate II.
What Is the Ventricular Assist Device (VAD) Program?
The multidisciplinary ventricular assist device (VAD) program of the Stony Brook Heart Institute is the first and only VAD program of its kind on Long Island. Our VAD program provides "destination therapy" using the latest VAD technology to treat eligible patients with advanced heart failure, and give them a new lease on life. This program has been accredited by the Joint Commission, which further distinguishes it and the quality of care we provide here at Stony Brook.
The left ventricular assist device (LVAD) called HeartMate II — a new generation of "artificial heart" technology approved by the FDA in 2010 — is a surgically implanted, battery-powered pump that helps the left ventricle pump adequate amounts of blood to the body.
The LVAD is implanted in your upper abdomen and connected to a power supply located outside your body. Blood is sent through a tube in your left ventricle into the LVAD, which pumps the blood through another tube into your aorta and throughout your body.
An LVAD can be implanted in people who are candidates for a heart transplant as a "bridge" to transplant. Some patients may experience improved heart function while the LVAD is in place, which may make the transplant unnecessary. In patients who are ineligible for a heart transplant, the LVAD can be destination therapy; that is, the LVAD is implanted permanently. Click here for more information about LVAD destination therapy.
Earning National Accreditation
In February 2013, our VAD program earned reaccreditation from the Joint Commission after an intensive two-day review. The two-year reaccreditation extends from January 31, 2013, through January 31, 2015. Ours became the first accredited VAD program on Long Island in 2011.
"Accreditation signifies that our program provides safe, high-quality care for patients with heart failure," said Kenneth Kaushansky, MD, Senior Vice President, Health Sciences, and Dean, Stony Brook University School of Medicine. "It is a seal of approval that signals to patients that they are in capable hands when they come to Stony Brook Medicine."
Arthur Plowden, 42, of Amityville, calls himself "half man, half amazing." He invented the phrase a few weeks after he became the first patient ever at a Long Island hospital to receive VAD destination therapy. With Plowden are members of the SBU Heart Institute team, from left: Hal Skopicki, MD, Director, Heart Failure Program; Kathleen Newton, RN; Allison McLarty, MD, cardiothoracic surgeon, and Karen Garland-Smrek, RN.
Destination therapy uses VAD technology as the final treatment option for select patients whose hearts require mechanical assistance to pump blood. Once used as a temporary device for heart failure patients awaiting transplants, new VAD technology now helps more patients extend and improve their quality of life.
To achieve accreditation, VAD programs are evaluated on standards in the Joint Commission's Disease-Specific Care Certification Manual. Programs must demonstrate conformity with clinical practice guidelines or evidence-based practices. They are also required to collect and analyze data on at least four performance measures related to clinical practice guidelines until more standardized performance measures are identified.
Accredited programs must also:
- Provide VAD destination therapy to an adult population;
- Have facilities with the infrastructure to support VAD placement, including adequate staffing and facilities to perform and recover patients after cardiac surgery;
- Be an active continuous member of a national, audited registry for mechanically-assisted circulatory support devices that requires submission of health data on ventricular assist device destination therapy patients from the date of implantation throughout the remainder of their lives; and,
- Include a board-certified cardiac surgeon who has placed 10 VADs in the last 36 months with current activity in the last 12 months.
Providing Destination Therapy
Allison J. McLarty, MD, associate professor of surgery, leads Stony Brook's program in destination therapy, which provides an alternative to heart transplant. She is now treating a growing number of patients who have congestive heart failure with implantation of the HeartMate II.
In April 2010, Dr. McLarty accomplished the first permanent LVAD implantation on Long Island, making headlines for her success with this important new advance in patient care.
The HeartMate II, which had just been approved by the FDA as a permanent implant, consists of a surgically implanted pump attached to an external power source that can be portable and worn on a shoulder strap or belt. The pump takes over the work of the heart's left chamber that's become severely weakened as a result of congestive heart failure.
Unlike earlier LVADs that were designed for temporary use, the HeartMate II is for permanent use. This LVAD engineering represents a new generation of "artificial heart" technology that provides end-stage heart failure patients with access to an important new treatment option.
Studies show a significant improvement in quality of life with the HeartMate II compared to conventional medical treatment.
Dr. McLarty co-directs Stony Brook's VAD program with cardiologist Hal Skopicki, MD, assistant professor of medicine, who serves as medical director.
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