Exercise for adults with congenital heart disease poses many unique challenges. In this presentation from August 12, 2021, Sherrin Gallagher, ACNP, AACC, reviews the importance of exercise and current guidelines for adults with congenital heart disease.
The Massachusetts General Hospital Mechanical Circulatory Support Program provides comprehensive evaluation and treatment options to patients who may need devices to help with heart functionality.
What are Mechanical Circulatory Support Devices?
The Mechanical Circulatory Support Program at Massachusetts General Hospital comprises a multidisciplinary team of leading clinicians who carefully consider a wide array of MCS options to meet a patient’s individual needs.
Mechanical circulatory support (MCS) devices are used in circumstances when the heart is not able to pump properly and provide enough nutrients and oxygen to other organs. For patients with heart failure, or who are awaiting heart transplantation, these devices can offer significant support and improve their quality of life.
MCS devices are treatment options for patients:
- In need of temporary support devices after a heart attack or during a high-risk cardiac procedure
- Awaiting heart transplant who require durable MCS devices as a bridge to transplant
- With advanced heart failure who are not eligible for a heart transplant and need durable MCS for destination therapy
MCS as a Temporary Support Device
Temporary support devices are options for patients who have had a heart attack or are undergoing a high-risk cardiac procedure. These devices, such as an intra-aortic balloon, can be implanted through a catheter in the groin and positioned in the aorta; by pumping with each heart beat, it can improve the amount of blood that that heart is able to pump. Other forms of surgically implanted pumps, such as the Impella 5.0® and Centrimag®, provide even more support to the heart’s pumping function.
For patients in need of heart and lung support, extra corporeal membrane oxygenation (ECMO) can fully support the circulatory needs of critically ill heart failure patients while also performing the work of the lungs as necessary.
MCS as a Bridge to Transplantation
Heart transplantation is the only curative treatment for end-stage heart failure. However, the number of people who need new hearts greatly exceeds the number of heart donors—a gap that continues to grow. As demand increases and donor hearts remain in short supply, average waiting times for new hearts may lengthen from months to a year or more.
The left ventricle is the heart chamber responsible for pumping oxygen-rich blood to other organs. Left ventricular assist devices (LVADS) help to reduce the workload of the ventricle and assist in delivering adequate blood supply to all organ systems. Surgically implanted durable mechanical pumps can help to improve functional capacity, quality of life and survival in patients awaiting heart transplantation.
In 2013, the majority of our patients undergoing transplantation were successfully bridged to transplantation with an LVAD. The Mass General MCS Program currently uses HeartWare® and Heartmate II® LVADs as durable support devices and recently added Syncardia Total Artificial Heart. Patients are able to await transplantation outside of the hospital with these devices, and many of our patients are able to return to work and engage in exercise programs. We are also investigating minimally invasive implantation techniques, in an effort to reduce recovery time and return to activity.
MCS as Destination Therapy
Advanced heart failure frequently arises in patients with advanced age or other medical conditions that do not allow heart transplantation. As a result, many heart failure patients will need a long-term or permanent treatment option other than transplant surgery. This option is known as destination therapy.
Mass General has extensive experience with implanting the Heartmate II LVAD, which is the only FDA-approved option for destination therapy at present. To determine whether or not a destination therapy LVAD (DT LVAD) is appropriate for a particular patient, our team conducts a comprehensive evaluation to understand the factors contributing to a patient’s symptoms, while offering state-of-the-art heart failure interventions customized to that patient’s needs as he/she undergoes assessment. Patients with DT LVADs benefit from the collective expertise of our MCS team in caring for patients after their procedure, including an LVAD coordinator who is available 24 hours a day, seven days a week to provide support and education to patients and their family members.
Innovative Approaches to MCS Evaluation
The Mass General MCS Program offers comprehensive evaluation to patients who may require MCS.
For critically ill patients experiencing heart failure and in need of immediate care, Mass General has a dedicated Cardiogenic Shock Team. This team is staffed by cardiologists and cardiac surgeons who provide urgent evaluation and multidisciplinary decision-making regarding MCS options. Cardiogenic shock evaluation and management is provided for inpatients at Mass General, as well as outside hospital referrals by calling 617-726-2241 and requesting the Cardiogenic Shock Team.
For outpatients with severe heart failure symptoms, Mass General offers a comprehensive evaluation and education system. Mass General is a national referral center for advanced physiologic evaluation through a sophisticated form of exercise-based evaluation that carefully defines the degree of reserve capacity of the heart and other organ systems. This form of testing can help to predict who will stand to gain the most from MCS while also opening the door to other potential interventions to maximize functional capacity. To schedule an appointment or learn more, contact the Mass General MCS Program at 866-644-8910.
The Mass General Difference
The Mechanical Circulatory Support Team at Mass General comprises highly experienced surgeons, cardiologists, respiratory therapists and nurses. Our doctors are internationally recognized leaders within their respective fields and collaborate with colleagues in various departments across the hospital to share expertise and lead innovative research to improve patient care.
Mass General is consistently ranked among the best hospitals in the country by U.S. News & World Report. Our ranking is based on our quality of care, patient safety and reputation in clinical specialties. Our commitment to excellence means that we work to ensure that our patients receive the best care at all points during their visit.
Request a Consultation
To request a consultation or refer a patient, call 866-644-8910 or request an appointment online.
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