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To Infinity and Beyond: What Does Destination Therapy Mean to Me?

Gustav Stiehl
Linda Staley, MSN-NP

Mayo Clinic Hospital - Arizona
Phoenix, AZ, USA

Destination therapy is a permanent, advanced heart failure therapy that involves a surgically implanted mechanical heart pump used to support a patient's failing left heart ventricle. This therapy is intended for patients who are not candidates for heart transplantation.

For a patient, this means that he or she will live the remainder of their life mechanically supported with a left ventricular assist device (LVAD), a mechanical therapy to to manage their end-stage heart failure.

Living with the LVAD becomes a way of life for the patient and caregiver, usually a family member. They both learn to manage the equipment, such as batteries and the controller, and at-home procedures, such as dressing changes, that are part of their everyday life.

Most patients choose LVAD therapy to improve their quality of life and to experience fewer heart failure symptoms, allowing them to spend more time with their family and loved ones. Living with an LVAD is not without risk, and often complications can occur while on the mechanical support that can reduce the patient's quality of life and can cause time spent in the hospital. Patients and their caregivers are educated about the potential risks and complications prior to the surgery to ensure they are fully informed about life on the LVAD and the dedicated roles and responsibilities that must be undertaken by the caregiver.

It is important that the LVAD team carefully discusses with the patient what level of quality of life is acceptable, should complications occur -- a decision that is different for each patient and caregiver to consider.

Gustav Stiehl is an almost nine-year veteran on the HeartMate II that was implanted in him during a clinical trial in January 2008. He recently agreed to candidly discuss what it is like to live his daily life with an LVAD. When asked about his first thoughts when told about the prospect of receiving an LVAD to manage his end-stage heart failure, he said, "I don't remember too much about that time. I was so sick and in the ICU. But I do remember that my wife and I had a discussion about how the LVAD would give me the chance of a few more years in this world." Stiehl's wife recalls being told that her husband could go into hospice, or could receive an LVAD that could give him three-to-five more years of life, with hope for an improved quality of life.

Stiehl also went on to note that because he is only given so much time on this earth, that if his life could be extended for only one year, it was worth it.

He admits that the initial recovery after receiving his LVAD was very difficult. "I was so debilitated when the initial recovery was slow and challenging, but I kept telling myself that it was better than the alternative."

The LVAD, attests Stiehl, has provided him the ability to continue the activities he loves, such as playing golf, traveling around the world and singing in a choir.

The most important thing of all for Stiehl is spending time with his family and friends.

Stiehl has met with and advised many patients over the years who were considering an LVAD. He tells them that the choice is difficult, and that they would have to make some significant lifestyle changes. But to Stiehl, those changes are minor, and he says that he functions pretty normally.

Life on the LVAD has not been without some complications for Stiehl, including a stroke that happened during his sixth year on the device. Also, he required a pump exchange for a thrombus that he says hasn't slowed him down "as much as growing nine years older has."

When asked what advice he has for those considering an LVAD, he counsels, "Get the LVAD early, before you get too sick. And always keep a positive attitude and live every day as fully as possible."

He says it sincerely when he considers his nearly nine years on his mechanical device: "I am blessed to be living 3,180 more days longer -- and counting -- than I would have without my LVAD." ■

Disclosure Statement: The authors have no conflicts of interest to disclose.

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