Patients who are suffering from heart failure now have a new treatment option that will give them a new lease of life.

Shortness of breath. Fatigue. Edema, or excessive fluid build-up in the body. Heart palpitations.

These are just some of the symptoms that patients with heart failure have to battle everyday.

Traditional treatments for heart failure can include daily medication, while more serious cases may require surgery like angioplasty or even a heart transplant, if doctors find that the patient's heart is damaged beyond repair.

But now, doctors are turning to a Left Ventricular Assist Device, or LVAD, as a long-term treatment option for patients. One such doctor is cardiologist Dr Kenneth Ng from the Novena Heart Centre at Mount Elizabeth Novena Hospital, who specialises in taking care of patients with heart failure.

So what is an LVAD? It is basically a pump that is placed in the left ventricle of the heart and connects with the aorta, one of the heart's main blood vessels, with the aim of assisting a heart that is too weak to fulfil its function of pumping blood to the rest of the body. In the past, the LVAD was used as a "bridge to transplant" - a device to help keep a weak heart pumping until a suitable organ was found to allow the patient to undergo a heart transplant; or as a "bridge to recovery", to give the organ a chance to recover or grow stronger without putting too much stress on it.

New Hope for the Future

Early last year, the LVAD was approved by the Food and Drug Administration (FDA) in the United States as a destination therapy, which meant that doctors were allowed to use the device as permanent treatment for patients whose only option used to be a heart transplant. "Only two or three heart transplants are performed each year, and donor organs are few and far between," reveals Dr Ng. This is part of the reason why the use of LVAD as a destination therapy is growing in popularity. "Cumulative research evidence about the LVAD strongly supports the safety and benefits of the device," he adds.

To date, Dr Ng and his partners at Novena Heart Centre have performed over 10 cases of this surgery, and he believes that it is a very viable treatment option because it allows patients to return to their "normal" life post-surgery. "Most patients do very well after the surgery, and are able to return to the kind of lifestyle they enjoyed before they fell ill, allowing them to continue to be productive members of society," he states.

The Journey to Singapore

One patient who has experienced the life-changing effects of having the LVAD procedure is Mr Tin Win from Myanmar. The 71-year-old had his first bypass surgery in London in 1961, and led a full and active lifestyle until 2004, when he was diagnosed with dilated cardiomyopathy, a condition where the heart is weakened and unable to pump blood through the body efficiently. Last year, he started suffering from episodes of breathlessness and fatigue. "I felt very tired very easily, and my feet would swell. I would be admitted to hospital, the doctors would give me injections, and I would feel better and get discharged. But then the same symptoms would come back and I would have to go through the whole cycle of treatment again," explains Mr Tin. "My doctor in Myanmar tried to treat the condition with medication, but every time I went home I would start feeling tired again - I had no idea I was suffering from heart failure. Finally, when we asked her if there was a more effective treatment, she told me about the LVAD as an option and put me in touch with Dr Lim Chong Hee, a cardiothoracic surgeon in Singapore."

"Honestly, when I first came to Singapore for my appointment with Dr Lim, I was still hoping that he would be able to find some medicine to help me. I arrived on 21 March, 2013 and was admitted directly into the ICU from the airport," he recalls.

Partners in Novena Heart Centre, Dr Lim and Dr Ng worked together from the start to find a way to help Mr Tin, but found that medication was just not working for him. "When I met him, Mr Tin had advance heart failure, which was evidenced by the poor left ventricle ejection fraction, recurrent admissions for heart failure, and inotrope dependence," recalls Dr Ng. While there was the option of continuing with long-term inotropic therapy (medication) as a treatment to keep him out of heart failure, this would also shorten his lifespan. "We then considered him for the LVAD treatment. And because he was classified as INTERMACS category 3 [stable but dependent on inotropes], all other organ function was normal, and he had not had any prior stroke, I felt that he was a very good candidate for this treatment."

Life Changing Experience

The LVAD procedure was carried out on 29 March with the assistance of Dr Lim Chong Hee and Dr Lim Yeong Phang, another cardiothoracic surgeon. "Our biggest concerns about the surgery were actually during the peri-operative period, where there is a possibility that the patient can go into multi-organ failure, bleeding or severe infections. We tried to prevent them by optimising the patient before surgery by making sure that all the organs were functioning well, and improving the patient's nutritional status," shares Dr Ng.

Another concern for this procedure was the everyday use of the device in Myanmar. "We were worried about the reliability of the electricity supply because the batteries of the device need to be kept charged, and that the patient lives very far from our facility," says Dr Ng. To ensure that they have a constant supply of electricity, Mr Tin's family bought a generator for his home. The vendor will also be flying to Myanmar to have a look at the home facilities and layout, and to make the necessary changes before Mr Tin is due to return home. "To help with the use of the device, our team has taught not just Mr Tin but his family members to recognise the various alarms for the machine. We invited a cardiologist from Myanmar to Singapore to learn how to manage the device. The mobile phone and internet will also help us keep the lines of communication open."

Looking Ahead

Speaking to us a month after the procedure, Mr Tin was happy to be out and about. "Everyone tells me that considering that I had major open-heart surgery, my recovery has been spectacular. And I think Dr Ng and all the medical staff at the hospital had a big role to play in this. They took very good care of me and paid attention to everything I said - if I had a complaint or felt funny, they didn't ignore me and checked to make sure I would feel better," he shares.

Dr Ng is also very happy with Mr Tin's recovery. "I am very happy with the results - Mr Tin is well and able to move around independently without any symptoms, and his progress has been smooth," he smiles. "And the benefit of this surgery is that the major complication rate for the device is less than five per cent. The LVAD doesn't put many limitations on the patient - aside from having to be mindful of the life span of each battery charge, and not being able to immerse themselves in water, patients are able to go back to their original lifestyle."

Now that he is on his feet again, Mr Tin is looking forward to going back home to Yangon. "I can't wait to go back and spend time with my friends, exploring all the best restaurants in the city," he smiles. "And I'm looking forward to spending some time just relaxing on the beach!"

Kidney transplants offer patients a new lease of life.

Since the first standard living donor kidney transplant was performed in Singapore in 1976, advances in medication and transplant procedures, particularly ABO incompatible kidney transplants, have created more opportunities for end-stage kidney failure patients to enjoy a dialysis-free life.

In standard kidney transplants, both the donor and recipient must belong to a common blood group identified through tissue-typing and good matching. If not, the recipient's body will reject the donor's kidney. However, in the case of an ABO incompatible kidney transplant, the recipient's body is able to accept a kidney even when the blood types do not match. Although the surgical procedure is the same for both, patients undergoing ABO incompatible kidney transplants need to undergo a series of pre-transplant procedures, the most important of which is immunoadsorption or plasmapheresis, which \91washes out' the antibodies that would typically work against the donor's incompatible blood group.

One of the pioneers of ABO incompatible kidney transplants in Singapore, Dr Lye Wai Choong, nephrologist at Mount Elizabeth Hospital, shares that kidney transplants have been known to provide patients with a better quality of life compared to dialysis. This is particularly so for patients who undergo pre-emptive kidney transplants, that is they undergo kidney transplants even before their failing kidneys require dialysis. Not only would the patient be free from the inconveniences, pain and suffering brought about by dialysis, but studies have shown that such patients have better survival rates. "Patients on dialysis live seven years on average, whereas those who have undergone kidney transplants often live twice as long," reveals Dr Lye.

Transplant Over Dialysis

These were the reasons that prompted Mr Nguyen Huu Phuoc, 55, from Ho Chi Minh, Vietnam, to consider a standard kidney transplant rather than dialysis. Diagnosed with kidney disease two years ago, Mr Nguyen was initially treated with traditional herbal remedies by his attending doctor. However, as he progressed towards kidney failure five months ago, his doctor advised him to undergo dialysis thrice weekly instead. "During the two-week stay in the hospital, I saw the pain and suffering patients experience during dialysis. I felt that I would not be able to endure it. Hence, I felt depressed and lost confidence as I thought I would die soon without dialysis. A long-time regular customer shared that I should consider a kidney transplant and recommended Parkway Hospitals in Singapore. I'm glad I made the choice to come as the service and assistance rendered so far have exceeded my expectations," he shares.

In Good Hands

Mr Nguyen attributes the success of his operation to a few factors. First of all, the turnaround time for receiving a transplant at Mount Elizabeth Hospital was short. Secondly, the friendly staff at the Patient Assistant Centre in Ho Chi Minh City were very helpful in providing a detailed explanation as to how the kidney transplant process would take place. He was briefed on the procedures, treatment duration and post treatment care and on the transplant ethics process in Singapore, which helped to mentally prepare him for the procedure. The nurses and doctors also took good care of him and ensured that he took his medicines punctually.

"As long as kidney transplant patients observe good hygiene, eat cooked food, drink boiled water and take their medications, they will enjoy a quality of life similar to that of healthy people,"explains Dr Lye. With these advantages, it is little wonder that more people today opt for kidney transplants over dialysis.

He adds that the option of pre-emptive kidney transplant might be more popular with future advances in medical science aiming to prolong the lifespan of the kidney and the need for less medication.

Bright Future

Mr Nguyen now looks forward to upgrading his bakery business of 30 years, so that he is better able to provide for his family and support his 19-year-old son through university. He also dreams of being able to travel to different countries. With increasing advances in kidney transplantation technology, new life and hope springs forth for end-stage kidney failure patients such as Mr Nguyen.

Scaling New Heights

In May 2008, Dr Lye performed the first ABO incompatible kidney transplant in South-East Asia. His patient, Mr Khairul Anwar Ibni, was the first Singaporean to receive a kidney donation from his wife, Madam Radiyah Mohamad Som, who has a different blood type from his \96 hers is A+, whilst his is O+.

Khairul had uraemic cardiomyopathy (his heart was failing) with only 15 per cent heart function then. His heart disease was caused by his poor kidney function. As he was wheelchair bound and was looked after by his wife and eldest daughter, he felt as if he was a burden to his family. "I was counting down the days; each day my body was deteriorating further," shares Khairul.

Five Years On

Although the thought of undergoing an unorthodox transplant was daunting, Khairul is happy with the decision he made, as he is able to lead a more fulfilling life now. Not only did he complete his Diploma in Travel and Tourism upon continuation of his studies one year after his transplant, he is also proud to be able to work to support his family. He also treasures the simple act of being able to drink water after meals or when thirsty. "I was like a kid who was given sweets," says Khairul. "Back when I was on dialysis, this was something that I couldn't do."

However, Khairul feels that kidney transplant patients still face some difficulties finding employment. He recalls that he was once offered a job and the employer called to turn him down without citing any reason after he declared that he was a kidney transplant recipient.

Khairul perceives himself as being every bit as capable as his colleagues at work. Indeed, he has not taken a single day of medical leave during his three years working post-transplant. "To all the employers out there, we kidney transplant patients lead a normal life, we can work hard and we get on with our lives. That's our goal," says Khairul.

Despite the difficulties faced, Khairul hopes the awareness of ABO incompatible transplants will increase. He adds, "The waitlist for a kidney is too long. A life can be saved with ABO incompatible transplants".