Q: What are the indications for referral for LVAD implantation?
A: The indications for referral for LVAD implantation are as follows:
- Two or more hospitalizations for heart failure in the past six months
- Intolerance of heart failure medications
- No benefit from cardiac resynchronization via a biventricular pacemaker
- On, or being considered for, inotropic support
- Class 4 heart failure and ineligibility for transplant
- Cardiac cachexia
Q: What is the timeline after referral?
A: When we first see a patient referred for LVAD implantation, a comprehensive review is initiated. Multiple baseline tests are obtained, and patients are evaluated by all specialty services including renal, gastroenterology, pulmonary, psychiatry, nutrition, and social services, in order to ensure there are no contraindications to implant. A decision is made regarding implant as a "bridge to transplant" (BTT) versus "destination therapy" (DT). For outpatients, this process may take weeks to months. For patients who are unstable or clinically deteriorating, the process is fast tracked. Some patients require inotropic support or an intra-aortic balloon pump (IABP) prior to VAD implantation.
Q: What do I look for in my LVAD patients during their office visit?
A: Patients are seen initially weekly, then monthly, in our LVAD outpatient clinic. However, we ask that they also follow up with you. During the office visit with you:
- When obtaining vital signs, remember your patient may not have a palpable pulse; mean blood pressure (BP) may be obtained with a Doppler. Goal mean arterial pressure (MAP) ranges from 65 to 85.
- Patients can develop aortic insufficiency with long-term VAD support, so onset of a new diastolic murmur would be a concern, and should prompt an echocardiogram and communication with our VAD team.
- Gastrointestinal bleed can also occur in up to 15-20% of patients on long-term VAD support. Reports of tarry stools or signs of anemia would be a concern, and should prompt communication with our VAD team.
Our VAD coordinators are available 24/7. Please call (631) 444-LVAD (5823) with any questions or concerns.
Q: What kind of routine post-operative testing should I do for my LVAD patient?
A: A baseline EKG and echocardiogram are performed prior to the patient's discharge from the hospital. These should be repeated annually, or if clinically indicated. In addition, at Stony Brook, we perform the "6-minute walk test" at several intervals postoperatively to assess functionality and quality of life. Patients with an automatic implanted cardiac defibrillator (AICD) should have their device interrogated at regular intervals.
Q: How does Stony Brook's LVAD program interface with heart transplant programs?
A: We have excellent relationships with all of the major transplant programs within our area: Columbia University Irving Medical Center, Mount Sinai Health System, NewYork-Presbyterian/Montefiore Medical Center, NYU Langone Health, Westchester Medical Center and Yale New Haven Health System.
Q: What types of device do you implant?
A: We implant the HeartMate III LVAD, manufactured by Thoratec. This was the first FDA-approved device for both "bridge to transplant" (BTT) and "destination therapy" (DT).
Q: How do I make a referral?
A: Referrals may be made by calling our VAD coordinator at (631) 444-LVAD (5823).
Q: How do I contact the LVAD service with urgent concerns?
A: The LVAD phone is staffed 24 hours a day, 7 days a week, and we are happy to take your calls at any time. The LVAD phone number is (631) 444-LVAD (5823).