Baystate Brings VAD Technology to Cardiac Patients in the Region

For Ernest Scruse, Jr. the ventricular assist device (VAD) is much more than a medical device he must wear every day; it is truly a lifesaver.

Although he never experienced chest pains or a heart attack, Scruse first experienced the potential signs of a heart condition only four years ago. Shortness of breath and extreme sweating sent Scruse to his primary care physician and ultimately to Baystate Medical Center, where the doctors implanted a pacemaker and implemented a prescription drug regimen. Unfortunately, his worsening condition led to a difficult discussion with his doctor.

“I was told by my doctor that the left side of my heart was taking in 100% of the blood but only pumping out 10%,” said Scruse. “He sat me down and told me that I was in heart failure and that the pacemaker and medicine were not working. He then told me that I was a prime candidate for the VAD.”

What is a VAD and how does it work?

 A ventricular assist device (VAD) is a mechanical pump that is used for patients who have reached advanced heart failure. The LVAD is surgically implanted in a sac around the heart known as the pericardial space and helps the left ventricle pump blood to the rest of the body. The pump is connected directly to the heart at the bottom left ventricle where it draws blood through the aorta and allows it to flow throughout the rest of the body. A driveline, connected to the pump, exits the body through an opening in the abdomen and is connected to the controller. The device needs to be connected to a power source at all times, whether that is plugged into an outlet or relying on its battery packs that allow the patient more mobility.

“It's a lot like a hybrid car in that it is an electric assist for the heart,” said Dr. David Deaton, thoracic and cardiac surgeon at Baystate Medical Center. “Ventricular assist devices are blood pumps that move the blood to some extent instead of the heart; however, the heart also can move some of the blood as well. It is somewhat like a hybrid car where you have both the electric off engine and the gasoline engine and they work together to power the car.”

Having a VAD allows most patients with advanced heart failure to return to a fuller life and increases their life expectancy.

Who qualifies for a VAD?

 There are specific characteristics that a patient must possess to qualify for a ventricular assist device. They need to exhibit advanced heart failure symptoms including their left heart being significantly dilated and severely weak but also need the right heart to function well enough to support the device. Candidates also need to be extremely limited in regards to quality of life and tend to be housebound or minimally active outside the home. It’s a fine line between being sick enough to need the device and healthy enough to withstand the surgery.

A patient’s other organ functions also need to be adequate in order to support the device and get through and recover from major surgery. Social and psychological support is also key and plays a big role in qualifying individuals for the VAD.

Lucky for Scruse, his case was a perfect fit for the program.

“His condition had deteriorated over about a year or two and resulted in his having severe limitations of function and then eventually he had advanced heart failure symptoms. He couldn’t get around much,” said Dr. Gregory Valania, Scruse’s cardiologist.

Facing his fears

 Although he was extremely grateful to have another option in terms of treatment, Scruse had to come to terms with his feelings on the pending procedure.

“I was scared. I was really scared and even thought about backing out of the surgery. But I had to think about my parents, my siblings, my kids. I had to say to myself, ‘Ernest, it’s going to end up hurting them more than you if you don’t go through with it,’” Scruse said.

A lifesaving procedure

 After completing two weeks of pre-op appointments and bloodwork in the hospital, Scruse returned home for one week and was then admitted to the hospital on October 24th, the day before his procedure.

Scruse’s VAD implantation was the first of its kind to be performed at Baystate Medical Center and also the first to be done in the region.

“There are really only three main centers that do this procedure and we feel really great about being one of them. We are the only center outside of the Boston area that does this. I think it’s something to be proud of in the region.” said Dr. Gregory Valania, cardiologist.

Although the procedure went well, Scruse did face some complications, including bleeding and blood clots, both common side effects for patients going through this type of surgery. After his condition stabilized and he overcame some expected setbacks in the cardiac intensive care unit, he was discharged on December 20th after spending 51 days at Baystate Medical Center.

Returning home

Initially, patients like Scruse are monitored bi-weekly by the VAD coordinator and see a member of their physician team once per week. As they recover, those visits become less frequent as time passes unless the patient faces any additional medical issues.

Since returning home, Scruse says he has much more energy and stamina and enjoys getting outside to walk as much as possible.

“I just can’t wait for the weather to break and then I can really get out there and do what I want like going to ball games with my son, fishing with my dad and things like that,” he said.

Scruse attributes his new found stamina to the work he has been putting in at Baystate’s Cardiovascular Rehabilitation program, one of the largest and most comprehensive programs in New England. For over 30 years, this program has helped patients recover from heart and vascular problems and return to their optimal health.

Thanks to the VAD and its ability to function on battery power, Scruse, an avid fisherman, is looking forward to heading out on the water with his father. “We go on a nice big boat and head out on the ocean. We usually start up in New Bedford and then go to Niantic or the Cape and catch sea bass, porgy, blues and stripers,” said Scruse. “It’s a great getaway and helps you get away from all of the stress and clear your mind.”

Teamwork

 According to both Valania and Deaton, in order to have a successful program like this you need to take a team approach and have a strong infrastructure. The heart failure team meets weekly to go over the status of patients who have been implanted, being considered for implantation or are currently hospitalized with devices that were recently implanted. The team at Baystate consists of four physicians, two nurse practitioners, two dedicated heart failure nurses, social workers, psychiatrists, a heart failure coordinator and a VAD coordinator who is the main contact for the patients and manages their care.

A look ahead

 Fifteen potential candidates, who are on the cusp of needing the procedure, are currently having their cases evaluated by the hospital’s heart failure team. In the future, Baystate looks forward to qualifying additional cardiac surgeons to perform this procedure along with Dr. Deaton. The team anticipates performing at least ten to twenty of these procedures per year moving forward.

With his VAD procedure behind him and Baystate’s heart failure team by his side, Ernest Scruse, Jr. has a new lease on life.

“I am very grateful that I had the procedure done. I really don’t think I would be here right now without it,” he said.