More than 6 million U.S. adults have heart failure, meaning their heart can’t pump enough blood and oxygen for their body’s needs.
Many will live years with the condition, but it’s a wide spectrum, said cardiothoracic surgeon Dr. Jesse Madden of Novant Health Cardiothoracic Surgeons in Winston-Salem.
Doctors classify heart failure by “stages” and “classes” indicating the severity and types of symptoms.
Madden works with patients in advanced or end-stage heart failure, who typically have only months to live — and often don’t know it.
Expert care for heart failure in Winston-Salem.
Across Novant Health: Empathetic, expert care for individuals with heart failure.
What end-stage heart failure means
By the time Madden and his team meet with a patient, they typically feel terrible, he said.
“They can't breathe. They're weak. They’re anxious. They’re depressed,” Madden said. “Many can't eat because digestion is too much work for their body.” Most are on an IV medication 24 hours a day, and lying in bed feels like a workout, he added.
Some have declined slowly over time as their body failed to respond to medications. Others were fine a week ago until they had a heart attack and wound up in the ICU.
“Most know they have heart failure,” Madden said. “But almost no one has told them what end-stage heart failure means for their life.”
The first person to have such a frank conversation about their diagnosis is typically a heart failure cardiologist or heart failure surgeon, like Madden.
Patients in end-stage heart failure have an average life expectancy of six months, and almost no chance of being alive within two years — similar to the worst metastatic (spreading) cancers. Madden ensures patients understand: “They will die soon if we don't do something significant.”
A few patients will be eligible to go on the heart transplant list, he explains, and a few may be candidates for bypass surgery.
And Madden can offer another possible form of hope: An implanted device called an LVAD. (Pronounced L-vad, which stands for left ventricular assist device.) Forsyth Medical Center is one of eight LVAD programs in North Carolina. Novant Health New Hanover Regional Medical Center in Wilmington also offers this technology.
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Technology expands options
Most of us have heard of a pacemaker, which tells the heart when to beat.
End-stage heart failure patients need a different technology: a pump that takes over the function of the heart by pumping blood from the left ventricle of the heart to the rest of the body.
Similar to a pacemaker, an LVAD is implanted in the chest. Unlike a pacemaker — which runs on internal batteries — the LVAD connects to outside power through a small tube that goes through an opening in the patient’s skin, and the LVAD actually pumps blood for the heart.
When Madden first encountered the technology as a medical student almost 20 years ago, LVADs were powered by an external machine the size of a mini refrigerator, and patients had to be hospitalized to use them. Over time, Madden said, he “saw devices get better and better, and saw patients get better and better.”
Today, patients can plug their LVAD into an outlet when at home. When out and about, their LVAD is powered by a portable battery pack they slip into a fanny pack or cross-body bag.
For those who are curious, the LVAD inside the chest is the size of a computer mouse, and the battery pack is the size of a small book. (“Like those pocket Bibles,” Madden said.)
About half of patients with advanced heart failure are eligible for LVAD therapy. For others, severe organ failure, such as end-stage lung, liver or kidney disease, may make them ineligible for this life-saving therapy.
A longer life expectancy — and better quality of life
An LVAD doesn’t cure end-stage heart failure, but it extends the average life expectancy from six months to an estimated five to seven years.
Put another way: Only one in 10 patients identified as having end-stage heart failure is alive two years later. But if they get an LVAD, seven to eight of these patients are alive two years later.
For many patients, that extra time is long enough to watch a daughter get married, meet a long-awaited grandbaby, or do that traveling they always wanted to do. It’s time they wouldn’t have had otherwise — and the LVAD improves their symptoms so much, they can enjoy the time, too.
“It’s a dramatic improvement in the length of life and also an improvement in quality of life,” Madden said.
How does the LVAD work?
A treatment for those who aren’t heart transplant candidates
The first left ventricular assist devices, or LVADs, were tested in the 1960s. For decades, an LVAD was only available to a small number of hospitalized patients as a “bridge-to-transplant” treatment to keep them alive as they waited for a new heart.
Starting in 2003, however, the FDA approved LVAD as a long-term treatment for patients who aren’t heart transplant candidates.
While a heart transplant is a solution for some patients, most end-stage heart failure patients don’t qualify for transplants due to medical issues or age.
Others opt out due to personal concerns.
“You’re basically waiting around for another family to have a tragedy in their life, and then you're taking someone’s organs. That's an amazing gift, but a lot for some patients to unpack,” Madden said. “Especially for some who are in their 60s and are like, ‘I've lived a good life. Do I want to take that heart away from a 30-year-old?’”
The LVAD is implanted during a four-hour surgery. Under anesthesia, the patient is connected to a ventilator and a heart-lung bypass machine. Madden opens the chest, sews the pump into the patient’s heart, connects the pump to the tube that will connect it to a power source and closes the incision.
After that, most patients spend about a week in the ICU, followed by another week or so in the hospital. Many then go to an inpatient rehabilitation facility. Within a month, most patients are home and have started outpatient cardiac rehabilitation.
“Usually by three months after surgery, they’re feeling good,” Madden said, adding that patients who were most incapacitated usually feel much better within two weeks.
Patients who complete rehabilitation have a lot to look forward to. “They feel better, breathe better and can get back to walking, shopping, driving, traveling — all the things that are very hard to do with end-stage heart failure,” Madden said.
As they go about their daily lives, he said, the LVAD does what the heart used to do.
A change in lifestyle
An LVAD does require some lifestyle changes. “You’ll have a power cord coming out of your side that is a lifeline and you have to protect it,” Madden said.
Patients can no longer submerge themselves in water, so tub bathing, hot tubs, swimming and surfing are all off-limits. (Showering is OK.) They’ll have to carry a device and will take a blood thinner for the rest of their lives.
Otherwise, most patients get back to their lives in short order. Madden has had LVAD patients compete in bike races, cycle across the country and travel internationally, all without issue.
From hospice care to new horizons
Before LVAD, patients who weren’t transplant candidates would typically go into hospice care. “We had nothing to offer them,” Madden said.
And now? New horizons await.
Surgeon brings ‘hope to hopeless’ at new specialty heart tower
Cardiothoracic surgeon Dr. Jesse Madden likes statistics. It’s part of why he likes being a heart surgeon.
“It’s like sports, where you know what your players’ stats are,” Madden said. "I know what my outcomes are — I know what my stroke rate is, I know what my infection rate is, and I can compare that to every other heart surgeon in the country. I get a lot of satisfaction and enjoyment out of improving outcomes and moving that needle.”
One of Madden’s stats: He’s completed 150 left ventricular assist device (LVAD) procedures, described above.
Another statistic he can’t quite calculate is: If the average life expectancy for each LVAD patient is an additional five to seven years — and they would otherwise live six months — “that's a lot of additional years that people are alive,” Madden said.
For six years, Madden was the only doctor in Western North Carolina offering LVAD. He built a program there offering hope to patients with end-stage heart failure.
In January 2025, he’s bringing his same expertise to the new five-story south tower at Novant Health Forsyth Medical Center in Winston-Salem. This team of specialists already offers diagnostic and multispecialty care to patients with heart failure. Now, they’ll be able to offer LVAD, too. It’s part of Novant Health’s commitment to bringing the latest in advanced surgical, heart and critical-care services to the growing population in and around Forsyth County.
Madden is excited to work with heart failure cardiologists, physical therapists, nutritionists, pharmacists, palliative care physicians and social workers to provide LVAD procedures to patients. He’ll also provide video-assisted thoracoscopic surgery (VATS) and surgical treatment for atrial fibrillation, or A-fib.
