November 18, 2009
Marilynn Marchione, AP
For the first time, a miniature heart pump shows the potential to become a widely used, permanent treatment for many older people with severe heart failure. But can we afford it?
In a study of 200 patients, the new device increased by four times the number who survived at least two years compared with an older pump that had drawbacks limiting its use, doctors reported Tuesday.
However, the HeartMate II costs $80,000 plus $45,000 or so for the surgery and the hospital stay necessary to implant it. “It will allow older people who are not heart transplant patients to stay alive, but at a higher cost. It's all about who's going to pay,” said Cleveland Clinic heart chief Dr. Steven Nissen, who had no role in the research.
About 5 million Americans have heart failure, but few patients find a donor and many are too old or sick for a transplant. Left ventricular assist devices, or LVADs, can be implanted next to the heart to help it pump. However, current ones wear out too fast to be long-term solutions, and survival remains dismal — only half of patients live a year and only one-quarter live two years.
The HeartMate II, made by Thoratec Corp. of Pleasanton, Calif., is the first of a new generation of smaller pumps that push blood continuously rather than simulating a heartbeat as older pumps do. A wire from the patient's abdomen connects the pump to equipment outside the body — a small computer and batteries that the patient wears in a belt pack or harness.
The device was approved last year for short-term use in people awaiting a transplant. A cost-effectiveness study has not been done, but doctors hope the new device will prove cheaper by preventing the many complications and hospitalizations these patients endure now, said Duke's Dr. Joseph Rogers, a study co-leader.