For Area Heart Failure Patients, VAD Therapy Is Now Close To Home

Surgically implanted heart pumps have been saving lives for more than a decade, but until seven years ago, heart failure patients living near North Carolina’s third-largest city had to travel more than an hour to receive one.

Now, an innovative program has established the Cone Health Heart and Vascular Center at The Moses H. Cone Memorial Hospital in Greensboro as the first hospital in the state without a heart transplant center to offer ventricular assist device (VAD) therapy. Since the VAS program began in 2013, 80 heart failure patients have received the advanced, life-extending procedure close to home and in the care of surgeons trained at some of the country’s top heart care centers.

State-of-the-art program earns award for doctors

In recognition of their work in building the state-of-the-art program, Cone Health Medical Group HeartCare and the American Heart Association awarded cardiovascular and thoracic surgeon Peter Van Trigt, MD, and cardiologist Daniel Bensimhon, MD, with the 2016 LeBauer Visionary Award.

Peter Van Trigt, MD

The doctors say the program further secures the Cone Health Heart and Vascular Center’s reputation as one of the nation’s best cardiac surgery centers. And patients of the program say it has transformed their lives. At a recent event celebrating the program’s third anniversary, Michael Ledford said he can now walk two miles without any problem and that he feels better than he has in the 14 prior years dealing with congestive heart failure.

The open-heart operation to install the VAD is a four- to six-hour procedure during which a surgeon inserts the pump next to the patient’s heart. Patients typically require two weeks of in-hospital recovery time; within three to six months, they’re able to enjoy activities—like jogging, hiking, ice hockey and even skydiving—that their condition had previously prohibited.

Treatment meets high standards

Even before it offered VAD therapy, the Cone Health Advanced Heart Failure Clinic saw about 5,000 office visits per year and admitted 125 patients per month. For an already bustling center, establishing a new program brought several challenges. Assembling the team was perhaps the greatest.

Daniel Bensimhon, MD

“The number of people involved in taking care of a VAD patient correctly is a lot,” Bensimhon says. “The operation is one small part of the program. We become the primary medical provider for these patients.”

Dr. Dalton McLean, Advanced Heart Failure Cardiologist, joined the program shortly after it began.

To meet the stringent criteria of the Centers for Medicare & Medicaid Services, which maintains regulatory oversight of VAD programs, Dr. Van Trigt spent several weeks at Duke University Hospital, where he performed at least 10 VAD implant procedures, before offering the first VAD surgery at Moses Cone Hospital. Dr Bryan Bartle joined the program in 2014. He completed his VAD surgical training with Dr. Van Trigt here at Moses Cone Hospital.

And, because some patients receive the VAD pump as a bridge to heart transplant surgery, Cone Health needed to cement a partnership with the Duke Cardiac Transplant Clinic.

The hard work has paid off. In 2018, we screened 50 patients, and implanted 24 pumps.

VAD candidates are carefully selected. “We look for patients who have heart failure and are struggling with everyday activities such as walking to the mailbox,” Bensimhon says. “We also look for patients who are not responding to medications, or who have had frequent hospitalizations for heart failure.”

Timing is critical for VAD surgery

Once seen as an interim solution that could keep patients alive until a donor organ became available, a VAD can now extend a patient’s life for up to eight years and potentially longer.

“For every heart failure patient who gets a heart transplant, 100 will die waiting, because the supply of hearts hasn’t changed,” Van Trigt says. “But the biomedical engineering of heart pumps has significantly advanced.”

But timing is everything.

“For a patient to benefit, the pump has to be applied at the right time and in the right place,” Van Trigt adds.

Those who are already in cardiogenic shock when they arrive at the hospital, he says, are in no shape to be transported somewhere else for VAD surgery. For that reason, Cone Health’s VAD program not only benefits patients by treating them close to home, but it also increases the chance of identifying candidates for the procedure before it is too late.

“The important thing is that patients have to be referred when they’re sick enough to get a pump but not too sick to get one,” says Bensimhon in explaining that prolonged heart failure causes irreparable damage to other organs in the body, creating problems that a pump cannot solve.

“There are a lot more candidates for VAD surgery if we could just get to them in a timely fashion,” he adds. “The worst thing to us is to see someone who would have benefited six months ago but now it is too late.”

Van Trigt is happy to work with referring doctors.

“We encourage doctors: If you’re concerned about your patient and just want to know if they’re a candidate, send them for an evaluation to at least see if we can help them,” he says.

For referring physicians

Patients with more than one of the following risk factors and who are New York Heart Association Class III or IV should be considered for referral for advanced heart failure therapies:

• Inability to walk one block without shortness of breath
• Intolerant or refractory to ACE inhibitors, angiotensin receptor blockers or beta-blockers
• More than two heart failure–related hospital admissions in the past six months
• BUN greater than 40mg/dL or serum creatinine greater than 1.8 mg/dL
• CRT nonresponder
• High diuretic dose
• Serum sodium less than 136 mmol/L