Ventricular assist devices (VADs) are known to deliver rapid relief of the symptoms of heart failure. Most patients report a significant improvement to their quality of life within two weeks of the implantation of an assist device. A quality-of-life study reported that “one to 2 weeks after LVAD implantation, patients were quite satisfied with their lives, experienced moderately low amounts of stress, coped well, and perceived themselves as having good health and quality of life, low symptom distress, and moderately low functional disability.”
Jarvik Heart takes improved quality of life – not simply prolonged life – as its objective. And the Jarvik 2000 FlowMaker® has been very successful at meeting that objective. The pump’s small size, adjustable speed, and silent operation provide important advantages in comfort, control, and convenience. A few of the possible quality-of-life changes effected by the device are outlined here:
Within hours of implantation, the Jarvik 2000 FlowMaker® typically improves a patient’s circulation and relieves many of the symptoms associated with heart failure. Studies have shown improved heart function within 48 hours, sometimes even with the pump turned off. As blood flow is restored to normal, swelling in the limbs and abdomen subsides. Most patients feel better soon after the procedure, though the incision may cause pain.
There is trauma associated with surgery of any kind. Still, with the assist device implanted and operational, patients breathe easier and feel less fatigue as oxygenated blood returns to the tissues and muscles. They can often expect to improve from NYHA Class IV to Class I. That is to say that they improve from the worst class of heart failure, with symptoms at rest, to the best class of heart failure, with symptoms only upon considerable exertion.
Patients who undergo treatment with VADs know that a pronounced and immediate improvement in blood flow changes how they feel. After a period of initial recovery from the surgery, most patients experience less of the swelling, fatigue, and shortness of breath associated with heart failure. Patients successfully supported by VADs simply feel better.
But some VADs introduce “symptoms” of their own, such as restlessness and discomfort due to a pump’s noise or level of output. Patients may also feel a sense of powerlessness when they lack control over the mechanical heart.
The Jarvik 2000 FlowMaker® puts control of the pump into the hands of patients. By adjusting the pump speed, a patient can match its output to his or her own physiology and level of activity. The control system uses a simple dial with five numbered speed settings. A patient might keep the controller on setting 3 for most of the day, turn it up to speed 4 or 5 to go for a brisk walk, and turn it down to 2 to go to sleep.
The Jarvik 2000’s speed-adjustability and silent operation support patients comfortably at rest, during vigorous activity, or while sleeping. Although patients cannot hear or feel it, they report sensations in their own bodies that tell them when they should adjust the pump speed. When exercising, they may become short of breath, an indication that they need to turn the pump speed up. Returning to rest, patients know to turn it down, or they are reminded by monitoring their own bodies. Some patients, for example, can’t fall asleep unless they turn the pump speed down, so they remember.
We use patient-adjusted control with the Jarvik 2000 rather than automatic control because we believe that it is better to trust the way a patient feels than to trust a microcomputer. Patients appreciate this, and many are comforted to know that they are in control.
Living with the Jarvik 2000
Doctors at all Jarvik 2000 implantation centers provide patients and their caretakers with guidelines for living with the Jarvik 2000 FlowMaker® and using its external equipment. Regular follow-up consultations with a trained physician are necessary, usually monthly, to ensure the best care for the patient’s heart, to answer the patient’s questions, and to monitor the patient’s progress.
In general, Jarvik 2000 patients participate in the following kinds of care:
Exercise: To maximize the patient’s recovery, exercise — including walking up to several miles per day — may be recommended to recondition a patient’s cardiovascular system and increase muscle strength. In various clinical studies, heart failure patients who were supported by LVADs did markedly better with exercise than heart failure patients who were treated with optimal drug therapy.³
Medication: While supported by the Jarvik 2000, patients routinely take anticoagulant and other medications used to treat heart failure, such as diuretics, beta blockers, and oral inotropes.
Outpatient care: Depending on their clinical condition and other factors, patients may be able to return home with the Jarvik 2000 within a month of implantation. As their recovery progresses, patients find they are quite mobile and can make day trips outside the hospital. Home visits during that time may help them to gain experience caring for themselves and managing their batteries and controller.
Extra attention: The pump, battery and controller of the Jarvik 2000 FlowMaker® are user-friendly and unobtrusive, affording patients independence and mobility. While activities like bathing or travel require a bit of extra attention, the Jarvik 2000 enables patients to do most normal, daily activities without restriction. Patients who have been severely debilitated by years of progressive heart failure often continue to gain strength and feel better as the months pass. Many return to work and to the lives they led before.