Former Vice President Dick Cheney is recuperating from surgery to implant the kind of mechanical pump now being given to a small but growing number of people with heart failure so severe that they would most likely die within a few months without it.
Former Vice President Dick Cheney is recuperating from surgery to implant the kind of mechanical pump now being given to a small but growing number of people with heart failure so severe that they would most likely die within a few months without it.
The pumps are partial artificial hearts known as ventricular assist devices. Cheney’s kind is about the size of a D-Cell battery and leaves most recipients without a pulse because it pushes blood continuously instead of mimicking the heart’s own pulsatile beat.
The pumps are not cures and do not replace the heart. They pose significant risks and are implanted as a last resort either for permanent use or as a bridge to transplant until a donor heart can be found.
An estimated 5 million people in the United States are in various stages of heart failure. Patients in end-stage heart failure are severely short of breath, able to walk only a few yards at a time, or confined to a chair or bed.
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As a small number of published studies have shown increasing success with the devices — which are powered by batteries that are about 4-by-6 inches and are connected by a wire that goes through the skin — leaders in the field are trying to increase public and physician awareness that such therapy is available and relatively safe if the patients are carefully chosen. Current belief is that the best time to refer patients for such therapy is before kidney, liver and lung damage develops.
By supplementing the amount of blood pumped through the body, the devices allow many recipients to lead active lives. Patients need to take an anticoagulant, like Coumadin (warfarin) and have blood tests to monitor the amount.
“It is a big operation with risks because we are operating on mortally ill patients,” said Dr. O.H. Frazier of the Texas Heart Institute at St. Luke’s Episcopal Hospital in Houston. Cheney, 69, had a quadruple bypass operation in 1988.
The most recently licensed pumps are smaller, quieter, easier to implant, allow quicker recovery time and last longer than earlier models. Recent reports show improvement over the earlier model mechanical hearts that carried a high rate of complications and death.
Cheney has not said whether he intends to live with the device until his death or to sign up as a candidate for a human heart transplant. Inova Fairfax Hospital in Virginia, where a very ill Cheney with worsening heart failure received his pump earlier this month, performs heart transplants.
Cheney’s heart has been severely damaged from five heart attacks, starting at age 37, with the most recent in February. Over the years, Cheney has had angioplasty to unblock coronary arteries and stents to keep them open; an implanted pacemaker and defibrillator; surgery to repair aneurysms, or ballooning of arteries, behind both knees; and a number of visits to George Washington University Hospital for monitoring and observation, the last in June.
In a statement issued July 14, Cheney said he “was entering a new phase of the disease” with “increasing congestive heart failure” and chose a pump to “enable me to resume an active life.”
After heart transplants were first performed in 1967, they became the only treatment for end-stage heart disease. But with donor hearts in very short supply, and with improved drugs and other therapies allowing more people to live longer with chronic heart failure, the disparity between demand and supply has accelerated the need for safe and effective mechanical heart replacements.
Cheney received a HeartMate II device, according to a health-care worker who did not want to be identified because he was not authorized to speak for Cheney. Thoratec of Pleasanton, Calif., sells the device and did not respond to inquiries.
The Food and Drug Administration has licensed two ventricular assist devices for both permanent and bridge-to-transplant use — Thoratec Heartmate XVE and Heartmate II. The agency has licensed four additional devices as “bridges” to transplant: WorldHeart Novacor, Thoratec PVAD, Thoratec IVAD and MicroMed Heartassist V (for pediatric use).
Frazier said he had implanted a total of 170 such pumps as of June 1. Of those, 24 were in patients 65 and older. Nine of the 24 have died. Six of the 15 survivors received heart transplants. The remaining nine are living with the pump.