Typically, in the past, if we were trying to support a patient with congestive heart

failure, we didn't have that many options. Only a small minority of patients can get

transplant. It became apparent to us that there needed to be an intermediary step, or

another treatment to address these patients who are suffering with heart failure.

Here at Stanford, Dr. Philip Oyer in 1984 implanted the first left ventricular assist

device as a bridge to transplant, it's still a major surgery, just like a transplant, and

you do have to open the chest and place this metal pump. But, instead of replacing the

heart with someone else's heart, you retain your own heart. The LVAD is there to support

your heart, and actually, let it relax.

The kinds of heart problems that an LVAD, is fashioned for are, essentially, when the

heart muscle is very weak.

The question about whether patients would benefit who are currently on the transplant

list in getting left ventricular assist device therapy is a very difficult one. We had always

thought the best case scenario would be for our patients to get one surgery. Why put them

through two surgeries, getting the left ventricular assist device and then transplant. Then we

started seeing how good our outcomes were in terms of our patients who were waiting

on the transplant list and got the left ventricular assist device and went on to transplant.

Now we have patients coming to us who say, "I had this left ventricular assist device

therapy, my quality of life is so good, I'm not sure I want a transplant at this point

in time." Or even, in extreme cases, "I want to be off the transplant list because I'm

doing so well."

In the year 2011, we did more left ventricular assist devices than transplants.

What makes us feel good about this program is our patients and, and how they responded

to the therapy. I think that no one would be as happy as we are now with our program

if our patients weren't doing so well.

Our cardiologists were convinced, when our patients started coming back to clinic after

the LVAD was placed, and they told us, "I wish I'd had this placed sooner, I feel so

much better." Now, our longest running patient, has been on the pump for two years. She has

not been admitted to the hospital for more than one-and-a-half years, and her quality

of life is quite good.

Stanford feels privileged to be at the forefront of this technology. There have been great

advancements in the field of left ventricular assist device therapy. What we hope over the

next ten to fifteen years, is that the technology will get to the point where patients won't

even notice that they have an LVAD in place.

But, more importantly, I think, we'd like to see this technology become more durable.

We also hope that these pumps will be smaller, because a smaller pump means a smaller dissection

in the heart. And, it hopefully means a quicker recovery.