Destination therapy offers a treatment pathway for individuals facing advanced heart failure, a severe condition where the heart cannot pump enough blood to meet the body’s needs. This approach provides long-term mechanical support for patients who are not suitable candidates for a heart transplant. It represents a significant advancement in managing end-stage heart failure, aiming to improve both the length and quality of life for those with limited options.
What is Destination Therapy?
Destination therapy is a long-term treatment strategy for patients with advanced heart failure who are not eligible for a heart transplant. The primary device used in this therapy is a Left Ventricular Assist Device (LVAD). An LVAD is a mechanical pump surgically implanted to help the weakened left ventricle of the heart circulate blood to the rest of the body.
The device works by taking blood from the left ventricle and pumping it into the aorta, the body’s largest artery, which then distributes oxygen-rich blood throughout the body. This continuous blood flow helps to reduce the workload on the failing heart, allowing it to rest and potentially recover some function, though the device is generally intended for permanent support. Its purpose is to improve quality of life by alleviating severe heart failure symptoms like fatigue and shortness of breath, and extending survival.
Who is a Candidate for Destination Therapy?
Candidates for destination therapy have end-stage heart failure, classified as New York Heart Association (NYHA) Class IV, meaning they experience severe symptoms even at rest. These individuals have exhausted other medical therapies, such as medications and lifestyle changes, without sufficient improvement. A patient is considered for destination therapy if they are deemed ineligible for a heart transplant due to factors like advanced age, other serious medical conditions (comorbidities) such as irreversible kidney failure, severe liver disease, or severe lung disease, or personal preference.
A comprehensive evaluation by a multidisciplinary medical team is necessary to determine suitability for destination therapy. This evaluation assesses the patient’s overall health, including their heart function, the presence of other medical conditions, and their body size to ensure proper LVAD implantation. Patients should be stable enough to undergo the open-heart surgery required for LVAD implantation, falling into Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Levels 2-3. This careful selection process aims to identify individuals who are most likely to benefit from the therapy and tolerate the procedure.
Living with a Destination Therapy Device
Living with a destination therapy device involves daily management routines and lifestyle adjustments. Patients learn to manage the external components of the Left Ventricular Assist Device (LVAD), which include a controller and battery packs connected to the internal pump via a driveline that passes through the skin. Regular battery changes are necessary, with batteries providing up to 14 hours of power, and patients must ensure they have a continuous power supply, often through rechargeable batteries or by plugging into an electrical outlet.
Care of the driveline site is also important to prevent infection, which is a common complication. Patients receive alarms from the controller that indicate system status or potential issues, and they are trained to respond appropriately. Despite these management tasks, many patients experience an improvement in their quality of life, reporting increased energy, reduced symptoms of heart failure, and the ability to resume some activities they could not perform before the device. Ongoing medical follow-up with a specialized team is part of long-term care to monitor the device, manage any complications, and support the patient’s overall well-being.
Understanding Destination Therapy in Context
Destination therapy plays a distinct role within the broader landscape of heart failure treatments, differing from “bridge to transplant” Left Ventricular Assist Device (LVAD) use. While both approaches utilize similar mechanical circulatory support devices, their long-term goals are different. “Bridge to transplant” LVADs are implanted temporarily to support the heart and improve a patient’s condition while they await a heart transplant. This allows patients to remain stable and healthy enough to undergo the transplant procedure, and the LVAD is removed at the time of transplantation.