51˶

Randy Travis Gets an LVAD, Future Uncertain

MedpageToday
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Grammy award-winning country music star Randy Travis has received the Impella pump, a percutaneous left ventricular assist device (LVAD), to help him as he battles viral cardiomyopathy, according to his publicist.

Earlier reports said Travis had undergone heart surgery, but his publicist issued a statement Tuesday emphasizing that he did not have surgery, but rather had the LVAD placed.

The Impella comes in several models, all of which are inserted percutaneously or minimally invasively through various arteries into the left ventricle.

The device is temporary, however, and is meant to allow the heart to rest and recover.

As of Tuesday evening, Travis was still in critical condition in an undisclosed Texas hospital, according to reports.

Theoretically, if the heart continues to worsen, the next step would be to receive a larger LV pump, which can be permanent or temporary, serving as a bridge to heart transplantation.

Viral cardiomyopathy is an episode of heart failure caused by the same viruses responsible for upper respiratory tract infection, gastrointestinal distress, and other common conditions.

"The diagnosis is one of exclusion and usually made retrospectively," Cam Patterson, MD, physician-in-chief at the UNC Center for Heart and Vascular Care in Chapel Hill N.C., told 51˶.

The Coxsackie B virus is notorious for causing viral cardiomyopathy, and the adenovirus also has been associated with the disease, he noted.

A virus is not the most common cause of cardiomyopathy, though, Patterson said. It's third, preceded by ischemia and alcohol-related cardiomyopathy.

Travis has spent time in an alcohol treatment center as part of a sentence following several alcohol-fueled run-ins with the law.

"The real challenge for people who have a history of alcohol abuse is whether they could still be considered candidates for some therapies such as a heart transplant," Patterson said.

About 40% of people with viral cardiomyopathy will experience spontaneous recovery," said Clyde Yancy, MD, chief of cardiology at Northwestern University in Chicago and a former president of the American Heart Association.

"But that also means more than half of these patients are left with residual damage to the heart," he told 51˶.

Patients can present with current (or have had prior) symptoms that are characteristic of a viral illness. When shortness of breath sets in, the diagnosis is often made from inference.

Yancy noted that many patients come in dramatically ill, but without a dilated heart. These patients have a better chance of recovery. "Once the heart dilates, there is reason for pause."

He said it's important for people to recognize that viral cardiomyopathy is just one type of heart failure. The larger picture is that heart failure happens over a million times each year and merits more public awareness and attention, he said.