Mechanical Circulatory Support
Within the field of cardiovascular disease, congestive heart failure (CHF) has become a growing epidemic, with an ever-increasing incidence and a projected estimate of 8 million people who will be diagnosed with CHF in the United States by 2030 (Benjamin et al, Circulation, 2019). Amongst the CHF population, approximately 250,000-300,000 patients are estimated to have advanced heart failure refractory to maximized medical therapy (Norton et al, Prog Cardiovasc Dis, 2011). For these patients with advanced heart failure, cardiac transplantation represents the definitive treatment option. However, there is a widening gap between the number of patients in need of transplant and the limited supply of donor hearts. Furthermore, there is an expanding population of patients who are ineligible for transplant due to advanced age or other comorbid conditions. As such, durable mechanical circulatory support in the form of the implantable ventricular assist device (VAD) has emerged as an excellent option in the armamentarium of HF therapy.
What Is the Ventricular Assist Device (VAD)?
The VAD is a form of durable mechanical circulatory support designed for ambulatory long-term use by patients with advanced heart failure. It is a surgically implanted pump that offloads a failing ventricle and delivers adequate cardiac output. VAD technology has three basic components:
-
An inflow cannula drawing blood and thus decompressing the left and/or right ventricle
- The pump
- An outflow graft delivering blood to the arterial circulation
The pump is powered via a tunneled driveline that connects to an external controller device and power source. Durable VAD technology is almost exclusively utilized to support the left ventricle, often termed LVAD, while a durable VAD supporting the right ventricle, termed RVAD, is rarely implanted worldwide. On this webpage, the term ‘VAD’ refers to an LVAD unless otherwise specified.
A Legacy Dating to 2009
The first VAD was implanted at Westchester Medical Center (WMC) in 2009. Since then, 163 patients have received a VAD at Westchester Medical Center with excellent outcomes. VAD technology is a central part of our mission is to offer comprehensive medical, surgical, and device therapies to patients in the Hudson Valley and New York Tri-State region with advanced heart disease, ensuring both longevity and quality of life through high quality care. We utilize the VAD device to provide cardiac support for patients with a failing heart refractory to guideline-directed medical therapy. These devices can be used as a bridge to recovery, a bridge to cardiac transplantation, or as destination therapy. Our commitment extends from excellence in direct patient care to education and translational research.
The WMC VAD Program complies with all current regulatory, certification, and accreditation requirements as defined by the Joint Commission, New York State, and the Centers for Medicare and Medicaid Services (CMS).
Are You a Candidate for a VAD Implantation?
There are four indications for implantation of a ventricular assist device:
- Bridge to Transplant: For patients who are candidates for heart transplant, and will be supported by a VAD until the time of transplant
- Bridge to Recovery: For patients with the potential for myocardial recovery, enabling eventual removal of the VAD support device.
- Destination Therapy: For patients who are not candidates for heart transplant, and will be supported on a VAD indefinitely.
- Bridge to Decision: For those patients whose candidacy for transplant is unknown but require VAD implantation, which allows for an eventual decision to be made regarding transplant candidacy.
Our program can enroll eligible patients in clinical trials. We are currently participating in the following clinical trial: Destination Therapy Post Approval Study (DT PAS).
Why Choose Westchester Medical Center for VAD Implantation?
Patients with an LVAD are able to return home with more energy, less shortness of breath, and greater quality of life. At the forefront of LVAD technology, our program is a specialized center for utilizing the newest generation LVADs, including the HeartMate 2, HeartWare HVAD, and HeartMate 3. These new LVADs have superior outcomes to previous generations of LVADs.
The multidisciplinary VAD team consists of members from the following departments: Cardiothoracic Surgery, Cardiology, Nursing, Infectious Disease, Psychiatry, Palliative Care, Social Work, Nutrition, Finance, and Administration. All members of the VAD multidisciplinary team have active roles in individual patient evaluation and care, as well as the overall performance of the VAD team. This team meets on a weekly basis to discuss all patients being evaluated for VAD support and those currently on support, either inpatient or outpatient. The multidisciplinary VAD team is also involved in regularly reviewing and evaluating performance data.
Temporary (Short-Term) Pumps
Temporary pumps are used to stabilize critically ill patients, such as patients with a severe heart attack or severe heart failure. These pumps are often used as a "bridge-to-recovery," in situations when the heart recovers after a short term of support, and the device can be removed.
We specialize in the use of a variety of temporary pumps that support heart function. Two such devices are the intra-aortic balloon pump and the Impella device, which are generally placed by minimally invasive approaches. We are one of the few centers where these devices are placed so as to allow patients to sit up and walk.
Westchester Medical Center also has one of the most robust experiences in the nation with the next level of support: extracorporeal membrane oxygenation (ECMO), which is a technology capable of supporting both heart and lung function. Our expertise with this technology has merited multiple publications in prestigious medical journals.
The Future of the VAD Program
The VAD Program is continually striving for excellence in the field of durable mechanical circulatory support. The field is rapidly evolving in its technological advancements, and Westchester Medical Center remains at the forefront of these advancements, with members of the VAD team attending national conferences and with the program participating in research projects and utilizing the most up-to-date technology.
The VAD Program also continues to adapt to the changing healthcare landscape with expansion of the WMCHealth Network. The WMC VAD Program already participates in shared care management with more distant hospitals such as Albany Medical Center and Rochester General. As the hospital network expands further into the Hudson Valley, the VAD Program itself will expand to enable effective follow-up for patients implanted with a VAD.
Contact Us
For additional information please call 914.493.8793.
Our Address
Westchester Medical Center
Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595
Directions
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By Train
Westchester Medical Center is served by Metro North's Harlem line via two stations:
- White Plains - Bus transfer options available
- Hawthorne - Taxi service available
For train fare and schedule information, call 1-800-METRO-INFO or go to www.mta.info
By Bus
There are three bus lines (Westchester Bee Line) you can take to our campus.
Please call 914.813.7777 for bus routes and fares.
Campus Map
The Westchester Medical Center campus includes the Maria Fareri Children's Hospital and the Behavioral Health Center.