Mechanical Heart and Lung Support Team
A successful mechanical heart and lung support program, also referred to as the mechanical circulatory support device (MCSD) program, requires medical professionals with different expertise. While some aspects of device implant surgery have become routine, other aspects require innovation as we seek to make improvements in machines and in the way we manage patients who have one. This is where the experience of the team can make the difference between success and failure for an individual patient, particularly if the problem is unusual or serious.
Our multidisciplinary MCSD team includes cardiologists, transplant surgeons, nurse practitioners, a nurse, and social workers. Each member of the team will want to get to know the candidate and their family, and will play different roles in your care. Below you'll find more information on our MCSD team and the critical role they play in this process.
Role of the Nurse Practitioner: Nurse practitioners coordinate care throughout the evaluation, implantation, and long-term follow-up by maintaining open communication between all team members. They accept new patient referrals, and provide care for candidates on the waiting list for a new heart, as well as for patients supported with "bridge" or "destination therapy" devices.
Our nurses have advanced practice degrees and extensive experience in the management of heart failure, heart transplant, and anticoagulation. They are able to perform history and physical examinations, order tests, make diagnoses, and write prescriptions. In consultation with the cardiologists and surgeons, they screen medical records of patients referred for consideration of transplant or device implant, and coordinate the evaluation process.
After surgery they coordinate care, including adjustment of immunosuppressive blood thinning medications, ordering and following-up on scheduled tests, and keeping the patient and referring physicians informed about the progress of their patient. They are usually the primary point of contact for referring physicians, team physicians and patients alike.
Role of the Social Worker: The social worker helps the patient and family to marshal the personal and financial resources necessary to have a successful procedure and to manage the often-complicated logistics of living with a mechanical assist device. She can help the patient meet other device recipients or those waiting for transplantation. She will also help the patient and family better cope with the expected emotional stress of making a decision that is best for that patient and his or her particular circumstances. Bernice runs a very popular monthly support group for pre- and post-transplant patients, to which device recipients are welcome to come. The support group meets on the second Wednesday of each month.
Role of the LVAD Engineers: The LVAD engineers maintain the devices and related equipment, assuring reliable safe function of the blood pump components. They participate in the evaluation, implantation, and long-term follow-up, and take an active role in patient education, data collection and analysis, and protocol development. They are available to answer patient questions about mechanical device issues, and to make recommendations about safe home discharge during device support, whether for "bridge-to-transplant" or "destination therapy".
Role of the Cardiologist: The cardiology heart failure specialist directs evaluation as to the cause of patient symptoms, and develops a list of treatment alternatives. Typically, a MCSD is recommended after other treatment options have been exhausted. The cardiology team has helped pioneer many new and innovative approaches to the care of patients with heart failure.
Transplant/heart failure cardiologists participate in the pre-implant evaluation, in management around implant surgery, and with the long-term care of mechanical blood pump recipients. The cardiology team includes experts in the evaluation and management of patients with heart failure, heart echocardiograms, and other heart procedures. In addition to transplantation, they will consider or provide other options for heart failure treatment, including changes in the drugs used or their doses, or clinical trials of new medicines or approaches.
Once a mechanical device is being considered as the best option for a given patient, the transplant cardiologists may continue to direct medical heart failure management in conjunction with the referring cardiologist and the transplant nurse practitioners to help the patient be in the best possible condition when the device is implanted.
After device implant, a cardiologist performs regularly scheduled ultrasound ("echo") tests. In addition, the cardiology team follows patients closely along with the surgeons and nurses, helps to adjust blood thinner ("anticoagulant"), blood pressure, and other medications, institutes and monitors preventive medical strategies (lipid lowering, exercise regimen), and treats other medical problems (diabetes, hypertension) that may arise.
Role of the Transplant Surgeon: The surgeons actively participate in the process of evaluating each patient who is identified as a possible candidate for a MCSD. Surgical alternatives other than MCSD will also be considered, including surgery for atrial fibrillation, and surgery to remodel a damaged left ventricle or repair or replace a leaky mitral or aortic valve. Sometimes one of these options will be recommended with the expectation that, if a conventional or alternative surgical technique proves unsuccessful, a MCSD option will be available.
If a MCSD is recommended and the patient agrees to proceed, the surgeons work together to direct and supervise the team of doctors, nurses, and allied health care providers who perform your device implant. Typically one surgeon will direct the surgical team, and then perform the actual transplant procedure and associated peri-operative care.
Once the evaluation is complete, the team will decide if medicines, conventional heart surgery, transplant, an alternative device or a MCSD, is the best option for each individual patient. The risks, benefits, and treatment options/alternatives will be discussed with each patient in detail. If the patient and the medical team agree that a MCSD is the best available choice, the patient is prepared for surgery at the University of Maryland.
This page was last updated: June 19, 2013