Physicians deactivate heart pump with catheter-based approach
A mechanical pump supported a failing heart, but did the job so well it eventually was no longer needed. Turning it off safely was the challenge.
Donna Jackson’s heart, on the verge of failing two years earlier, had made a strong recovery. By spring 2013, she no longer needed the left ventricular assist device, or LVAD, that had been implanted in her chest almost three years earlier. It got in the way of things she wanted to do, like swim with her grandchildren. But her doctors at Stanford Hospital & Clinics believed the 70-year-old resident of the Central Valley would have trouble surviving the surgery to remove the mechanical heart pump. So they decided to find another way.
Their solution — a minimally invasive, catheter-based procedure unlike any previously reported that allows Jackson to live free of the LVAD’s batteries, controller and external driveline — is described in a paper published in the August issue of the Annals of Thoracic Surgery.
Other minimally invasive techniques to deactivate the LVAD already existed, but they would require small incisions in the chest and the abdomen — more than the Stanford team wanted. “We decided the best thing to do was to use a catheter-based approach because it would involve only a small incision in her groin and the smallest amount of anesthesia possible,” said the study’s senior author, Richard Ha, MD, clinical assistant professor of cardiothoracic surgery at the Stanford School of Medicine and surgical director of the hospital’s Mechanical Circulatory Support Program. The lead author of the paper is Sanford Zeigler, MD, a cardiothoracic surgery resident.
Jackson’s doctors threaded a slim plastic tube through a small incision to her femoral artery in the groin and up to her aorta, allowed them to plug the flow of blood to the LVAD. Then, they cut, cleaned and capped the wiring powering the LVAD so it no longer emerged from an opening in her abdomen. (The LVAD remains inside Jackson’s chest.)
Jackson returned home from Stanford Hospital five days after the procedure.