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Webinar Q&A: Ventricular assist device (VAD) use in Duchenne

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:

  • Dr. Pirooz Eghtesady - cardiothoracic surgery, St. Louis Children’s Hospital
  • Dr. David Morales - Chief of Cardiovascular surgery, executive co-director of the Heart Institute, Cincinnati Children's Hosptial Medical Center
  • Dr. Robert “Jake” Jaquiss  - Chief of Pediatric Cardiothoracic Surgery, Duke University
  • Dr. Patrick McConnell  - Cardiothoracic Surgery, Nationwide Children’s Hospital

 

The topics they covered included:

  • What is a VAD/LVAD?
  • When might a VAD be considered?
  • Who might be considered as a candidate?
  • Pros and cons of VAD implantation
  • Post-VAD life; lessons learned from the first 3 recipients

 

Webinar Recording

Additional Questions

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!

  1. My son has been in the hospital for 10 weeks now, his heart function ranging from 33.3 to as low as 11; would my approach be to discuss this with his cardiologist?

  2. Regarding the size of the patient, please elaborate in the case of adult with DMD who are smaller because of steroids

  3. Is there a minimal age/weight, I have a DMD boy who is still walking short household distances. He has minimal external symptoms, 5% ejection refraction, and significant hypertrophy and somewhat stable and weighs 85 pounds

 

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

E-mail: david.morales@cchmc.org

 

Pirooz Eghtesady, MD

Office number: 314-454-6165

E-mail: eghtesadyp@wudosis.wustl.edu

 

Robert "Jake" Jaquiss, MD

Office number: 919-681-2343

Voice mail: 919-681-2344

Email: Robert.jaquiss@duke.edu

 

Patrick McConnell, MD

Office number: (614) 722-3102 (Enjoli Bova)

E-mail: Patrick.mcconnell@nationwidechildrens.org

 

 


Kathi Kinnett, MSN, CNP
Vice President, Clinical Care
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Tags: PPMD Blog, Staff, cardiac, care, lvad, vad

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