Mechanical heart program leads the way
CLINICAL MILESTONES PUT CENTRE AT THE FOREFRONT

Dr.Vivek Rao believes the Centre will play a major role in perfecting new ventricular assistive devices – or mechanical hearts as they are commonly known.

For patients awaiting a heart transplant, life can seem precarious, with long waiting lists and limited medical resources. “Waits can be as long as two years for some blood types,” notes Dr.Vivek Rao. “We still lose one in five patients waiting for transplants, even with vastly improved
clinical care. Unfortunately, many of these patients die suddenly, without any chance of medical intervention.”

Dr. Rao believes recent developments in technology – specifically the new generation of ventricular assistive devices (VADs) – could play a major role in reducing these deaths by
helping to keep patients on waiting lists alive longer, and even providing an alternative to transplants.

As Surgical Director, Heart Transplant Program, Dr. Rao, along with his colleagues at the Peter Munk Cardiac Centre, is playing a major role in advancing the frontiers of this exciting area of medicine.

“These devices are often referred to as mechanical hearts,” explains Dr. Rao. “They are essentially introduced to support circulation in patients whose hearts are failing for various reasons until a new heart can be found and transplanted. But we are now seeing some patients who are doing so well on VADs that the possibility of not transplanting them becomes an option.”

The Peter Munk Cardiac Centre is one of the busiest VAD implant facilities in Canada, and current work is helping to identify the best applications of emerging technologies.

“We have already done some very important work on VADs,” Dr. Rao says. “We were one of the first centres in Canada to implant the Heart- MateR II, and we were the first to have a patient successfully transplanted form this device, after an impressive 134 days of cardiac support.”

However, Dr. Rao believes that it is pending advances that will really establish the Centre’s leadership in the use of VADs.

Taking a leadership role
“This fall we hope to be the first to implant the new, state-of-the-art WorldHeart LevacorR Rotary Ventricular Assist Device,” he notes. “This really represents the latest advance in VAD technology. It’s a device that theoretically has an infinite lifespan, so it could change how we approach treatment. Successful implantation of this device would be the biggest clinical milestone not only in the recent past, but for the next few years. It would really put the Peter Munk Cardiac Centre on the world VAD map.”

Of course, there are still many challenges to overcome.

“While early results are promising, we still need to look at long-term results, with five to 10 years of data, to really see how effective these devices are, “ Dr. Rao explains.

“Also, there are still many more requests for procedures and transplant patient care than the hospital can currently support,” he adds. “The Heart Transplant Program really needs the resources to develop a standalone heart failure unit. This would allow us to manage patients more efficiently and improve outcomes.”

With this in mind, however, Dr. Rao is enthusiastic about the potential of new generation ventricular assistive devices to positively impact the treatment of patients awaiting heart transplants, and about the contribution of the Peter Munk Cardiac Centre. “Other cardiac care institutions around the world will be closely watching what we are doing,” he concludes.

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