Dr. Miller: You have advanced heart failure. Would you ever need an artificial heart? This is Dr. Tom Miller on The Scope Radio. We will talk about that next.
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Heart Failure Treatment
Dr. Miller: I am here with Dr. Craig Selzman. He is an associate professor of cardiothoracic surgery in the department of surgery. He is also an expert in heart surgery and implantation of artificial hearts.
Craig, what types of patients that have heart failure might merit a discussion about having an artificial heart implanted?
Dr. Selzman: It's actually lower than you think. The reality of it, there is probably about five to six million folks out there, many of those that might be listening that have the diagnosis attached to them of heart failure. But of that group, the folks that have really advanced disease, it's much smaller. Not that much smaller but probably anywhere between two and 800,000 people.
Dr. Miller: Nationally, that's a big number.
Dr. Selzman: It's a big number. It's a big number. And then the folks that really have really bad stuff, it's probably about 80,000 a year. But the important thing to know about that is that everybody thinks, "Well, if my heart goes bad, I'll just get a heart transplant. That's what they do, right?"
The only problem with that is there is only about 2,000 to 2,500 hearts a year. So you can see the disparity right off the bat that if there are only 2,500 hearts that are available for transplant for the entire country, and there are 80,000 to 150,000 patients that could potentially benefit, we got a real problem there.
Dr. Miller: Well, we see that with all type of organ transplants now. Whether it's liver or kidney or pancreas or lung, there are not enough donors. But it sounds like the artificial heart is a way for people to have advanced therapy who might not be able to get to a heart transplant right away.
Dr. Selzman: Yeah, that's true and that's how we use not just the artificial heart. Artificial heart is often used to symbolize a lot of things. There are heart pumps or internal or external pumps that support your circulation is used. The artificial heart, the original one, the ones that we associate with Barney Clark and others, actually you remove your existing heart and you put in two ventricles, two pumping chambers that are combined to make a total artificial heart.
The way the majority of patients use . . . about 95% of the folks that need assistance, we use devices that support a single ventricle. And the most damaged ventricle, typically, is the left ventricle. So that's why we developed these devices called LVADs or left ventricular assist devices. That's what we most commonly use.
Dr. Miller: How does a patient with advanced heart failure and the need for surgical treatment make their way to you or a specialist?
Heart Failure Stages
Dr. Selzman: There are fantastic doctors in the community that can manage the early stages of heart failure. Early stages are folks that might just be on some blood pressure medicines and they get some shortness of breath, maybe they're put on a water pill that help them deal with that.
But what we find is that when patients get a little bit sicker and they're going up on some of these medicines and then even worse, when they are unable to tolerate some of these medicines because their blood pressure is a little bit low or they're still fatigued, these are kinds of patients that we would recommend to be seen by someone with some experience at advanced levels of heart failures.
Dr. Miller: I'm assuming that would include a team perhaps, maybe a cardiologist who specializes in heart failure as well as a surgeon and some others. Is that right?
Dr. Selzman: Absolutely, and the Ï㽶ÊÓƵ Utah, we have a team of almost 70 people that are involved in the care of various patients with heart failures, from the not so sick to the very, very sick. But it does require a team to care of all this and dedicated to understanding the particular needs of this group of patients
Dr. Miller: So how would a patient advocate to see someone or a group that specializes in this type of advanced care? They are under the care of their internist or family practitioner. At some point, they may need this specialized care.
Dr. Selzman: Yeah, it's a good question because most people that have various mid-level staging of heart failures, they are not the ones that aren't that sick or the very, very sick-they are kind of that gray zone in the middle-don't really appreciate how bad their heart failure is. And maybe their primary care provider is not maybe fully appreciating the scope of how much disease they have.
As such, you are potentially missing some therapies that might otherwise not be offered to you. So, we need to have people to recognize that this disease is rampant and recognize that there are more than one or two medicines that can be used for it.
Dr. Miller: Well, it also seems to me that the earlier the patient would get into a specialist group, the better chance they would have of designing the optimal therapy over time for that particular patient. So it would be better to get them mid-way through the process then later on when things are really going south.
Dr. Selzman: Yeah, I think that's a great point because the way that our group looks at it is we are partners to the providers and the community and the patient, most importantly the patient. So we try to team up with the patient and what the best thing is.
At the Ï㽶ÊÓƵ of Utah in particular, our scope is 14, 15 states of people coming in. So we have some unique challenges. We cannot be everyone's heart failure doctor. So we work with the group, wherever they are coming from, to try to help that patient to find what the best pathway is.
But I totally agree with you that we'd love to see these patients early on, and we've followed the patients for decades before their heart has actually progressed to the point where it needed something in an advanced therapy fashion.
LVADs/Left Ventricular Assist Device
Dr. Miller: And so these patients, when they do end up with a left ventricular assist device, tend to do quite well over time and the technology now allows these patients to do better, be healthier and people shouldn't really think about the old days. The technology is very different now than it used to be.
Dr. Selzman: We'd love to put on our little quarterly newsletter showing all the pictures of people doing their fly fishing, they're playing golfs, some of these got some moose hanging over them. You name it, you can do it. You can live life and mind you, that by the time we are seeing these patients, most of the people are not living life. They are basically struggling to go from the couch to get to the restroom or couch to get to the refrigerator, and these kinds of therapies give back life.
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