On January 24, PPMD hosted the third in our series of four cardiac webinars. This webinar was dedicated to the subject of Ventricular assist device (VAD) use in patients with Duchenne. We were pleased to be joined by a panel of four outstanding surgeons who are all experts in the field of cardiothoracic surgery.
The four members of the panel included:
The topics they covered included:
There were some great questions asked, but unfortunately we were not able to get to all of them during the webinar. The remaining questions have been addressed below!
As we began to answer these 3 questions, I noticed that we were saying the same things each time. I am, therefore, going to answer all three questions at once.
Those of you who might prefer a shorter answer:
For patients who have developed heart failure that is not improving, and which has developed as a result of Duchenne, the option of placing a ventricular assist device may be worthy of discussion. This option should be discussed with a cardiologist who is familiar with heart failure, ventricular assist device (VAD) placement and Duchenne. Placing a VAD is a complicated decision that should be made for each individual patient and situation, after very careful consideration of both the risks and benefits. Not all patients are candidates for a VAD and this is not a decision that should be taken lightly. This determination should be a process which includes consideration of all therapeutic strategies, a thorough evaluation of the patient and family, and a thorough discussion of all aspects of informed consent/assent. It should not be rushed, and should be done over a period of time (few months), if possible, to get the best outcome.
Those of you who might want more detail:
There are two considerations regarding the VAD itself: 1) the size of the VAD that can be implanted and 2) the speed at which the VAD is set to pump. It is safe to say that most surgeons feel comfortable placing a VAD in patients weighing greater than 85 pounds (1.2 m2 body surface area (BSA) and running the pump at a speed appropriate for a person of that size. Some of the guess work of deciding the appropriate size VAD for a patient has been eliminated by the ability to do 3-D reconstruction of the chest and of the VAD. This allows surgeons to do "virtual surgery" and determine if the VAD will safely fit. If it is determined that a VAD will indeed fit into a smaller patient, there is then the decision of how fast to run the pump. Some surgeons feel that a pump placed into a smaller patient should be run at a slower speed, while other surgeons prefer to run the pump at higher speeds. Again, this is very patient, surgeon and center specific decision and warrants a very thorough discussion.
While placing the VAD can be technically challenging, the pre-operative and post-operative care are also extremely important. Having a full multi-disciplinary team in place (cardiologist, neurologist, respiratory therapy, nursing, social work, pulmonologist, ect.) that is familiar with Duchenne care is very important; having a competent team will maximize the chances of obtaining a good surgical outcome. Because many patients travel great distances to have their surgeries, it is also critical to have a cardiologist or primary care provider who lives near the patient involved in their care. Having the surgeon and cardiologist communicate with the local cardiologist or primary care provider before the patient is discharged, and maintaining communication after the patient has gone home, will help to minimize postoperative issues.
Without knowing anymore about your sons', or any patients' conditions, it is difficult to know what therapies might be best. The important of discussing all of the risks and benefits of placing the VAD with your cardiologist and cardiovascular surgeon cannot be overemphasized.
The surgeons who participated in this webinar have graciously offered to list their contact information below should patients, cardiologist or surgeons have further questions or concerns.
David Luís Simón Morales, MD
Office number: 513-636-4770
Pirooz Eghtesady, MD
Office number: 314-454-6165
Robert "Jake" Jaquiss, MD
Office number: 919-681-2343
Voice mail: 919-681-2344
Patrick McConnell, MD
Office number: (614) 722-3102 (Enjoli Bova)
Kathi Kinnett, MSN, CNP
Vice President, Clinical Care
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