Treatment of Advanced Heart Failure, Advanced Arrhythmias, and Cardiac Transplantation

My name is Paraq Patel. I'm the Medical Director of Advanced Heart Failure and Cardiac Transplantation. I primarily treat advanced heart failure and advanced arrhythmias for patients with cardiomyopathy, ventricular tachycardia, and atrial fibrillation. Basically a patient when they've had more than two admissions for heart failure in the last year. Patients who are unable to walk a block due to heart failure, patients who are unable to up titrate medications because of hypotension, patients with recurrent ventricular arrhythmias are patients we typically will consider for advanced therapies. And it's important to note that we do two things. Number one, we'll evaluate them for advanced therapies which include heart transplant as well as left ventricular assist device therapy. But we also work together closely with the referring physician to optimize medical care.

Because this is our subspecialty, we have some tricks up our sleeves in terms of optimizing medical care. And we work closely with our referring to find a way to get our patients better so that sometimes they can even avoid transplantation or even a ventricular assist device. Our specialty is definitely transformative, to say the least. There are multiple technologies that are going to revolutionize the way we manage patients, both in the acute setting all the way to the chronic setting. In terms of managing patients from an acute setting, temporary mechanical circulatory support has significantly changed over the last ten years and revolutionize the way we manage patients with advanced cardiac disease. In the past, patients with a large myocardial infarction may not survive when they're in cardiogenic shock to the point where they can receive advanced care. Now with the implementation of temporary mechanical circulatory support, whether impellers or tandems or balloon pumps, or ecmo, patients who originally did not have a chance for survival are able to survive to the point where they can at least receive consideration for advanced care.

That technology has changed the forefront of acute care. Now in terms of chronic care, left ventricular assist device therapies definitely have improved in terms of their versatility, the technology, and the implementation of the devices to the point where we're actually, even to date, able to alter the trajectory of patients with advanced heart failure. Now we have the opportunity to utilize the left ventricular assist device to keep them alive until a heart becomes available. I think specifically within the field of heart transplant, we have excellent outcomes as well. We have excellent survival on the transplant wait list. Our survival after heart transplantation is very good. We actually work closely with our referring cardiologists even after transplantation, to provide excellent care for our patients. It's important for referring providers to understand that this is a teamwork approach for all of us. That when somebody is sent to the Mayo Clinic for advanced care, that working together in a collaborative fashion is key to our success.

The other thing I'd like to make sure that referring providers know is it's always better to refer earlier rather than later. Within the spectrum of advanced heart failure, there are people who have years to live or months to live and we'd much rather see them in a controlled setting than the patients who have days to live because we're able to sometimes provide therapies to allow them to avoid transplantation or avoid a ventricular assist device. But also to make sure that they're ready and understand what the complications and challenges of transplantation are. As well as ventricular assist device therapies. If we have time to make sure the families involved to make sure that their insurance is going to cover their immunosuppressive meds afterwards to make sure that if they were maybe a little too obese for transplant or maybe they were smoking, that maybe we can work with them on those relative contraindications. If we have time for that, we have a better opportunity to serve our patients by giving them options in the future. Early referral is absolutely key to the success of our advanced heart failure patients.