Pam Golden remembers when even a simple trip to the grocery store was exhausting.
She couldn't walk through the aisles and had to drive a motorized scooter.
Golden, 67, had significant heart problems. The left side of her heart was pumping at 5 percent of capacity.
“I was desperate for help that I couldn't find,” she said.
In August 2011, Golden got the help she was looking for when doctors in Oklahoma City implanted her with what's known as a left ventricular assist device.
The device takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would, according to the National Heart, Lung and Blood Institute.
A small tube carries blood out of a patient's heart into a pump. Another tube carries blood from the pump to the patient's blood vessels, which deliver blood to the body.
Golden wears a vest that carries the power source and control unit. She cannot take baths or go swimming, as she has a port in her chest with a wire that runs into the unit.
Infection is one of the biggest risks. Golden has a hole in her side with a cord coming out. If the area became infected, she could face serious complications. Other risks include blood clots, bleeding and device malfunction.
Golden is aware of the risks but thinks the surgery was worth it.
About 10 years ago, she had cancer and underwent chemotherapy treatment. The chemotherapy damaged her heart.
She didn't know there was a problem until a few years ago when she went on vacation to Lake Tahoe. The elevation change made it more difficult to breathe, and Golden's problems became more evident.
Early one morning, Golden couldn't breathe. She was taken to the hospital and doctors thought she might have had a heart attack.
“I said, ‘I haven't missed a day of work. How have I had a heart attack?'” Golden said.
All indicators pointed to a heart attack, and it was determined Golden would need open heart surgery. But when doctors opened her chest they found no clogged arteries or damage.
Finding an answer
Cardiologist Dr. Douglas Horstmanshof finally determined what was wrong.
Horstmanshof is the Heart Failure Institute program director at Integris Baptist Medical Center. Since March 2008, he and his colleagues have implanted about 180 left ventricular assist devices in patients from Oklahoma, Arkansas, Texas and Kansas.
Horstmanshof said at least 30 percent of the people who are offered the device by Integris doctors would die with their current hearts.
“And in Pam's case, she had reached the point where she probably had less than a 20 percent chance that she was going to survive the year with the heart she had,” he said.
Horstmanshof said Integris' one-year survival rate is about 90 percent after a left ventricular assist device is implanted. The program's two- and three-year survival rate is about 80 percent.
“That means the vast majority of patients who receive these devices are still alive and well two and three years later,” he said. “The longest-living LVAD patient in our program is approaching five years as of this March.”
Device is last resort
Many patients would be candidates for heart transplants, but about 3,000 Americans are on the waiting list for a heart transplant on any given day, according to the National Heart, Lung and Blood Institute. About 2,000 donor hearts are available every year.
About 5.8 million people in the United States suffer from heart failure, according to the institute.
Patients who receive ventricular assist devices are generally some of the sickest people in the hospital and have no more last resorts, said Dr. Edward Kasper, director of clinical cardiology at Johns Hopkins Hospital in Maryland.
Kasper said for that reason, the mortality rate among left ventricular assist device patients remains high.
“This is a person who has received pretty much everything else that they could possibly get in terms of medications and reparative surgery, and it has failed,” Kasper said. “They're still horribly limited by heart failure symptoms, and that's when you start thinking about left ventricular assistance.”
Research shows that the survival rate can range greatly, depending on the age and health of the patient.
A study published in the New England Journal of Medicine in 2009 showed that two years after surgery, there was a 58 percent survival rate. The Mayo Clinic reports a survival rate of 74 percent.
The device costs about $70,000. Medicare will reimburse hospitals somewhere between $100,000 and $110,000 for the procedure, Horstmanshof said.
Kasper, who has served on Hopkins' ethics board, is aware of the debate about whether people who are as sick as LVAD patients should get a costly procedure.
“The fact of the matter is that when I'm in the room with the patient, I have to think about what's best for the patient, not what's best for society,” Kasper said.
“I don't actually think about the cost of it, unless the patient doesn't have insurance, but then I'm trying to figure out, ‘How can I get this patient insured?' And not, ‘Is putting in an LVAD the best thing for society?' It puts us, as physicians, in a very conflicted role if we're supposed to be thinking about what's best for the patient and what's best for society.”