Dick Cheney: Turning Off LVAD?

[Michael Scally MD]

According to Mayo Clinic researchers, in cases where patients who are very sick and are being kept alive by the left ventricular assist device (LVAD), it is ethically and legally permissible to turn off the device in the US. In a study published online in Mayo Clinic Proceedings, researchers cited more than a dozen cases where patients or their representatives wanted the device to be turned off. The study authors said turning off LVAD cannot be equated to euthanasia as there is no new pathology introduced to cause death.

Dick Cheney was out of the ICU, but still hospitalized after receiving a LVAD. Cheney Still in Hospital After Surgery
http://www.nytimes.com/2010/08/02/us/politics/02cheney.html This is not an easy course for anyone, especially the critically ill.


Mayo Study: Withdrawing LVAD Support Is Ethical
Mayo Study: Withdrawing LVAD Support Is Ethical - Health Blog - WSJ

August 2, 2010
By Katherine Hobson

High-tech medical devices can raise tricky ethical questions — just consider the left ventricular assist device (LVAD). The pricey device essentially takes over the function of the left ventricle, helping a heart to continue beating when it would otherwise fail. But what happens when patients become very, very sick and are essentially being kept alive by the LVAD? Is turning off the device more akin to euthanasia or taking someone off a ventilator?

In a study published online in Mayo Clinic Proceedings, Mayo researchers come down firmly on the side of the latter, describing 14 cases where patients or their health-care surrogates requested the assist device be turned off.

The researchers write that in the U.S. “it is ethically and legally permissible” for physicians to comply with requests by patients (or their representatives) to “refuse or to request withdrawal of life-sustaining treatments” such as hemodialysis or artificial nutrition. But LVADs make some clinicians uncomfortable for several reasons, they write — the device seems almost like a replacement part than outside assistance, for example.

Researchers write, though, that withdrawing LVAD support isn’t the same as assisted suicide or euthanasia because there’s no “new pathology” introduced to cause death. Death, when it comes (all 14 patients died within a day of turning off the device), is due to the underlying heart failure, they write. So assuming patients or their representative know the consequences of deactivating the device, clinicians should honor their wishes.

Since January 2009, patients at Mayo who are weighing an LVAD as a life-long solution, not just a way to stay alive while waiting for a heart transplant, specifically discuss what they want to happen to their device under certain circumstances. Generally, the policy “has been well received by patients, their loved ones, and the health-care team,” the authors write.


Mueller PS, Swetz KM, Freeman MR, et al. Ethical Analysis of Withdrawing Ventricular Assist Device Support. Mayo Clinic Proceedings. http://www.mayoclinicproceedings.com/content/early/2010/06/28/mcp.2010.0113.abstract

OBJECTIVE: To describe a series of patients with heart failure supported with a ventricular assist device (VAD) who requested (or whose surrogates requested) withdrawal of VAD support and the legal and ethical aspects pertaining to these requests.

PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients at Mayo Clinic, Rochester, MN, from March 1, 2003, through January 31, 2009, who requested (or whose surrogates requested) withdrawal of VAD support and for whom the requests were fulfilled. We then explored the legal and ethical permissibility of carrying out such requests.

RESULTS: The median age of the 14 patients identified (13 men, 1 woman) was 57 years. Requests were made by 2 patients and 12 surrogates. None of the patients' available advance directives mentioned the VAD. For 11 patients, multidisciplinary care conferences were held before withdrawal of VAD support. Only 1 patient had an ethics consultation. All 14 patients died within 1 day of withdrawal of VAD support.

CONCLUSION: Patients have the right to refuse or request the withdrawal of any unwanted treatment, and we argue that this right extends to VAD support. We also argue that the cause of death in these cases is the underlying heart disease, not assisted suicide or euthanasia. Therefore, patients with heart failure supported with VADs or their surrogates may request withdrawal of this treatment. In our view, carrying out such requests is permissible in accordance with the principles that apply to withdrawing other life-sustaining treatments.

 

[d5332]

The LVAD is to new to the market and it is being marketed in a misleading way.

Yes, the LVAD can be turned off if the person has a living will or if the family moves forward with disconnecting their loved one off life support.

When you “qualify” for the LVAD, the hospital is basically saying you need a heart transplant. Instead of rushing to evaluate if the person is a good candidate for a heart transplant and keep them in the hospital, they instead are pushing the LVAD on the family and the patient if conscious as the latest and safest life saving miracle.

Hospitals claim a person can live 10 years on that machine without needing a replacement til then. Hospital claims person gets their life back while waiting for the transplant.

I wont ramble on….the LVAD is too new and should not have been approved by the FDA. Most patients that get the LVAD die from LVAD complications shortly after, complications such as strokes. The percentage, the risk of a stroke is extremely high.

The LVAD is made of artificial materials no where similar to the texture of heart tissue and arteries. It does not matter how thin the hospital makes the patients blood, the patient is at risk of stroke, a really high risk. The blood begins to form a film on the inner walls of the LVAD and it does it very quickly, that accumulation turns to clots, clots that dislodge very easily because the blood is so much thinner than normal.

In conclusion, the medical industry is misleading the public with the LVAD, it saves you from left ventricular failure and moves you to a super high risk for stroke, a risk that is very real, if you don’t believe me start doing searches for mourning families whose loved one died from a stroke shortly after getting the LVAD.

The LVAD is being used on real human unsuspecting participants. I was present at the hospital meetings during which the family is introduced to the LVAD. The hospital is selling it in the same way that a car sales person sales you a car, in the same manner that the Kirby Vaccumm cleaner sales people sale you a $1800.00 Vaccumm cleaner. Very very misleading.

I will not post statistics of how dangerous the LVAD still is, look them up and you too will say, WHAT THE HELL IS THE POINT OF SAVING SOMEONE FROM HEART FAILURE IF YOU ARE GOING TO EXPOSE THEM TO SUCH A HIGH PROBABILITY OF STROKE.

In conclusion, yes, the LVAD can be disconnected without any issues, I witnessed it, I lived it.

The industry is still learning about the LVAD and it should be pulled from the market and used and perfected using farm animals and the testing should last another 10 to 15 years.

If you don’t believe me, find out how many times LVAD manufacturers have changed the texture and design of the inner walls of the LVAD to no avail, the blood keeps on sticking causing strokes within weeks after the patient is “saved”!!!! The patient has not even healed yet from their open heart implantation of the LVAD and they die from stroke.

 

[Michael Scally MD]

Cheney Is Back, With Heart Pump and New Outlook
http://www.nytimes.com/2011/01/05/us/politics/05cheney.html

By LAWRENCE K. ALTMAN, HELENE COOPER and MICHAEL D. SHEAR
Published: January 4, 2011

WASHINGTON — A few days before Christmas, former Vice President Dick Cheney emerged from several months of a self-imposed political sabbatical to headline a fund-raiser for Maria Cino, a party operative and Bush administration official who is running to replace Michael Steele as head of the Republican National Committee.

The fund-raiser for Ms. Cino, held at the Alexandria, Va., home of Mr. Cheney’s former aide Mary Matalin, was his first major foray into partisan Washington political theater since receiving a mechanical heart pump in July that has, most doctors say, saved Mr. Cheney’s life by taking on the task of helping to push blood through his arteries.

Mr. Cheney, as he did at several holiday receptions in Washington, chatted about his new pump. At one cocktail party, the former vice president even opened his coat jacket to show it off. While Mr. Cheney is noticeably thinner — his trademark stiff, one-sided grin now shows up on a markedly leaner face — he is returning, associates say, to his old life, including hunting and socializing.

But for the most part, Mr. Cheney has put aside his public role as the fiery, combative political figure of the last two years, who seemed to relish every opportunity to engage in verbal jousting with President Obama.

With George W. Bush having decided to stay largely silent during Mr. Obama’s tenure, Mr. Cheney embraced the role of public critic, accusing the new, young president of rolling back Bush-era policies and undermining the nation’s security. In 2009, Mr. Cheney and Mr. Obama gave dueling speeches on the same day.

Now, however, family members and friends paint a portrait of a man less focused on the day-to-day back-and-forth in Washington and one more interested in documenting his years of service in a memoir and navigating life with his new pump.

At 69, Mr. Cheney’s heart will never beat at full strength again, doctors say. His new mechanical pump — a partial artificial heart known as a ventricular assist device — leaves patients without a pulse because it pushes blood continuously instead of mimicking the heart’s own beat. Most pulse-less patients feel nothing unusual, but the devices do pose significant risks of infection. They are implanted as a last resort either for permanent use or as a bridge to transplant until a donor heart can be found. Mr. Cheney, who has participated in some of the nation’s toughest decisions for decades, now faces a crucial one of his own: whether to seek a full heart transplant.

It is a decision he will most likely be forced to make within months. He is old enough that soon he will no longer qualify for a transplant, doctors say. And while it is possible for some patients with Mr. Cheney’s device to live for years, the long-term prospects remain unknown.

His family and friends will not talk publicly with any specificity about the former vice president’s heart condition or the steps he might be taking to confront it.

But in the meantime, Mr. Cheney has begun resuming his old activities. Besides the Cino fund-raiser, he attended a round of holiday parties in Washington — leaving whispers in his trail about his weight loss. “For all of the caricatures of him, he never lets it get under his skin,” said Ms. Matalin, a close friend.

Mr. Cheney, who spent the holidays at his ranch in Wyoming, recently had a class of West Point cadets over to his house in McLean, Va., to talk about his experiences working for four of the last five Republican presidents and what it was like to work at the White House. In Wyoming, he has been spotted in local grocery stores, stocking up to make chili and spaghetti sauce, “as well as walking me through how to cook Christmas dinner,” his daughter Liz Cheney said in an e-mail.

But most of all, Ms. Cheney said, her father has been working on his book, which is scheduled to come out this fall. “He still prefers to write in longhand on yellow legal pads despite my efforts to introduce a laptop into his process,” Ms. Cheney said.

By supplementing the amount of blood pumped through the body, Mr. Cheney’s pump allows him to do many things he would do with a working heart. Such patients can bicycle, golf, play tennis, drive, shop and generally do what they did before they developed severe heart failure. They need to take an anticoagulant, like warfarin (sold under the brand name Coumadin), and have blood tests to monitor the amount.

Mr. Cheney’s pump was placed near his heart. With most patients, a power line emerges about waist level and connects to a controller, a minicomputer that plugs into a pair of one-and-a-half-pound, 12-volt batteries. Patients wear a black mesh vest over their clothing that holds the controller and batteries. They usually cannot shower and have to be satisfied with sponge baths.

Mr. Cheney’s friends and family say that he is making plans to get out in 2011 and give more speeches. On Jan. 20, he is to fly to Texas for the 20th anniversary of the Persian Gulf war with the first President Bush, the emir of Kuwait and a host of alumni of that administration, including former National Security Adviser Brent Scowcroft and Colin L. Powell, who was chairman of theJoint Chiefs of Staff at the time, when Mr. Cheney was defense secretary.

On Tuesday night, Mr. Cheney was the host of a fund-raiser at the home of some friends in Jackson, Wyo.,, for a scholarship program that he and his wife, Lynne, have begun at the University of Wyoming. They donated $4.5 million to help create scholarships for students to study overseas. During his remarks, Mr. Cheney said that after getting kicked out of Yale twice, he owed getting his life back on track to the University of Wyoming.

Mr. Cheney’s heart pump is also allowing him to go to the movies. “He and my mom went to see ‘True Grit’ at the Teton Theater here in Jackson a few days ago,” Ms. Cheney said. Her parents, she said, gave it “two thumbs up.”