End Stage Heart Failure
End Stage Heart Failure
Dr. Nikolas Krishna, cardiologist and medical director for the Advanced Heart Failure Clinic at Chippenham Hospital, explains how patients who have end stage heart failure have options to have the best life possible.
Content
3 -> - [End Stage Heart Failure, Nikolas
Krishna, MD, Director of The
Advanced Heart Failure Clinic]Folks
with End-Stage Heart Failure.
4.53 -> These are sick patients.
5.88 -> They have a very high mortality.
7.02 -> Now they have the,
7.853 -> what we call, the cancer and cardiology.
9.42 -> They have End-Stage
Heart Failure or Stage D.
11.82 -> So if we can catch them in time
13.5 -> and they don't have what we call,
14.67 -> End Organ dysfunction,
15.69 -> the kidneys are still healthy,
17.13 -> the metabolically they're intact,
19.8 -> they have options to bridge an IV medicine
24.45 -> or just as they are to advance therapies,
28.2 -> a heart pump or a transplant.
30.12 -> Those are the how the,
32.04 -> how the roads diverge.
33.57 -> So some patients get an LVAD
35.97 -> or Left Ventricular Assist Device,
37.62 -> as a bridge to a transplant.
39.69 -> They're so sick, they need this pump, now.
41.82 -> Maybe they don't qualify
43.2 -> for the transplant, just yet.
44.52 -> And there are some disqualifiers,
45.78 -> for transplant, but not to say,
47.55 -> they can't get one in the future.
48.75 -> Cuz transplant is still
49.92 -> the best thing out there.
52.077 -> What we called First Line Therapy.
55.47 -> So they get their heart pump
56.7 -> and years later, months later,
58.2 -> they can get their transplant.
59.94 -> The new allocation system
61.14 -> for transplant has changed
that, a little bit,
62.97 -> but in theory, it's still the same.
65.94 -> For some patients, age 70
68.13 -> typically being cut off for transplant
69.81 -> or for other contraindications,
71.55 -> they can't get a transplant.
72.9 -> So they go directly to the LVAD
74.52 -> and they will have that, as we call,
75.75 -> Destination Therapy.
76.71 -> They will have that pump
78 -> for the rest of their life.
79.71 -> And they're our patients
80.64 -> for the rest of their life.
81.57 -> And after about the first few months,
83.55 -> when potential complications can happen,
85.71 -> after the first year especially,
87.57 -> many of them do wonderfully.
89.52 -> We have patients who go fishing with it,
91.662 -> go on long road trips,
93.63 -> they travel.
94.68 -> A patient who traveled
96.06 -> on his motorcycle down to Florida in it.
97.493 -> So people can do whatever they like to do.
101.16 -> One thing you can't do with a heart pump,
103.89 -> that you can do with a transplant,
105.66 -> is completely submerge underwater
108.24 -> and go swimming underwater,
go scuba diving.
110.88 -> And it is primarily because,
112.65 -> this electrical device needs to be powered
114.99 -> by batteries, that are external
116.64 -> and the driveline is connecting it.
118.59 -> So you can have anything
happening to that driveline.
121.98 -> That driveline, as we tell our patients,
123.75 -> is their lifeline.
125.13 -> So you don't wanna get it wet
126.51 -> and you don't wanna
have any issues with it.
127.92 -> And you certainly don't wanna have it
128.76 -> ever severed, which has
been known to happen.
132.06 -> And now that is an emergency.
134.04 -> 'Cause these patients,
134.873 -> by the time that they have their VAD,
138.09 -> they're already in stage.
139.05 -> Their own heart's not doing much,
140.64 -> their native contractility.
142.44 -> Years afterwards, their heart's likely,
144.63 -> still not doing very much and they
145.8 -> become more and more dependent on the VAD.
147.87 -> So at that point, if
anything happens to it,
150.18 -> then that's not good.
151.013 -> Now these batteries,
151.846 -> the hallmark is like a laptop battery.
153.69 -> It should last all day and often they do.
156.03 -> They last for 10 hours
157.92 -> and then they go back home
159.51 -> and they recharge the batteries.
160.92 -> They can be out all day,
161.94 -> during the day and the evening.
163.567 -> And at night when they're sleeping,
165.09 -> they plug into the module
166.83 -> and they don't need to be on batteries.
Source: https://www.youtube.com/watch?v=xAweKB4qNhM