Connections: Patients with advanced heart failure benefit from a new allocations system and better tech and tools | Fall 2019

Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.

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From the OHSU Knight Cardiovascular Institute

HCM Connections Magazine Frederick Tibayan headshot

Frederick A. Tibayan, M.D.

Dr. Tibayan is a cardiothoracic surgeon and the surgery director for heart failure and transplant. His clinical interests include heart transplantation, mechanical circulatory assist devices, valvular heart disease and aortic disease.

It’s an exciting time in cardiovascular medicine. There are many new techniques, medications, technologies and mechanical circulatory support options to help people with heart failure feel better and live longer. We can do so much now to optimize heart failure patients. However, timely referral is the cornerstone of effective patient care for heart failure. If patients come to us at the end stage of disease, that limits the options.

Revived heart transplantation program and new allocation system

With the successful recruitment of cardiologists from some of the best programs in the country, OHSU is pleased to resume heart transplant care for Oregonians with advanced heart failure. To date, we have hired three advanced heart failure specialists to join our existing multidisciplinary team.

Johannes Steiner, M.D., is our primary UNOS (United Network for Organ Sharing) physician. OHSU performed Oregon’s first heart transplant in 1985.

In October last year, UNOS changed the allocation system for donor hearts, so that the people who need organs most urgent can get them faster. They replaced the three-tiered system with a six-tiered one, with more specific guidelines for each tier.

Patients requiring extracorporeal membrane oxygenation, and other mechanical support, for both left and right sides of the heart will receive top priority.

Changes that allocate donor hearts from a wider area to the sickest patients are balanced by efforts to keep organ preservation time as short as possible.

Better mechanical support devices and surgical approaches

The technical and clinical improvements in mechanical devices have enhanced the efficiency, durability and size of the pumps, leading to better outcomes and quality of life for patients.

OHSU was part of the Momentum 3 clinical trial for HeartMate 3 LVAD (left ventricular assist device), which had excellent patient outcomes and decreased adverse events like clotting in the pump.

In addition to new pumps, new approaches in surgery for some patients can speed healing and recovery. Our OHSU team has expertise in the lateral thoracotomy approach to inserting a pump, and we are educating other centers and surgeons in the technique.

When to refer

Again, earlier is better. If patients are having increasing symptoms of heart failure, please refer them for evaluation for interventions that could enhance their quality of life. Signals for referral can include:

  • Failing success with medical management.
  • Multi-organ end-stage complications (kidney, liver, etc.)
  • Suffering complications from medical therapy.

Patient-friendly resources for heart failure

OHSU and the American Heart Association have teamed up to bring patients tools to help them manage heart failure.

Explore the Oregon Guide to Heart Failure

The site has videos and downloadable PDFs. Topics include managing medicines, questions for the doctor, selfmonitoring and more.

Organ transplantation expertise

OHSU is the only health system in Oregon with comprehensive support services for heart transplants, including:

  • Multi-organ failure services: On-site access to the skills and expertise offered by other organ transplant programs, including liver and kidney, to ensure effective outcomes.
  • Immunogenetics and Transplantation Lab: A lab that performs tissue compatibility testing for kidney, pancreas, heart, lung, liver and bone marrow transplant.
  • Cardiovascular Intensive Care Unit: A 24/7 intensive care unit that manages only the sickest cardiovascular patients.
  • Level 1 Trauma Center: The highest-level of 24/7 lifesaving trauma care for patients in urgent need of highly specialized cardiovascular care, including those with heart failure.
  • ECMO (extracorporeal membrane oxygenation): Cardiac life support for patients with potentially reversible respiratory and/or cardiac failure; OHSU is the only health system in the Pacific Northwest offering air and ground transport for both pulmonary and cardiac adult ECMO patients.
  • Multi-disciplinary expertise: Transplant surgeons, critical care specialists and advanced heart failure transplant cardiologists experienced in pre- and postoperative care.

Contact us

The OHSU Knight Cardiovascular Institute has the full spectrum of care for heart failure patients. We are available to answer questions about all treatment options for heart failure disease.

Please call the OHSU Physician Advice and Referral Service at 5034944567.

To refer a patient, please fax to 5033466854.