Re: New treatment?

Posted By CCF CARDIO MD - MTR on June 20, 1998 at 23:27:53:

In Reply to: New treatment? posted by J. Gray on June 16, 1998 at 12:59:27:






A friend told me today of a new treatment or procedure for treating people with damaged hearts.
My brother-in-law had a serious heart attack two weeks ago, and has told me that the upper left portion of his heart was severely damaged and is not working.  I'm sorry I don't know the medical terminology to use, but can you tell me if there is a new treatment where patients are put on a heart pump and damaged tissue is repaired?  That was the gist of what my friend told me he had heard, that it was still experimental.
If there is any new treatment available to help my brother-in-law, I am confident he would like to know about it.
Thank you in advance for your help. This is a wonderful, wonderful place.



  ______
Dear J. Gray, thank you for your question.  I believe your friend heard
about information released last week by Temple University regarding left
ventricular assist devices (LVADs).  LVADs were developed after the total
artificial heart programs of the 1980's failed.  For patients with severe
congestive heart failure from a cardiomyopathy (damaged heart muscle), LVADs
offer a mechanical way to restore cardiac function while awaiting a heart
transplant.  Cardiomyopathy can be caused by heart attacks which scar
portions of the heart muscle or processes that cause the heart to dilate
and weaken that are not related to coronary artery disease (viral infections,
certain drugs, diseases like Lupus, etc.).  The first type of cardiomyopathy
is called ischemic cardiomyopathy (ICM) while the second type is called
dilated CM (DCM).  LVADs work in both types of cardiomyopathies.  The device
is implanted in the tissue between the skin and the abdominal cavity and
consists of a hydraulic pump, an inflow cannula that is sutured to the apex
of the left ventricle, an outflow cannula that is sutured to the ascending
aorta after the aortic valve, and an external drive line that leaves the
body to power the device.  Patients with LVADs often show dramatic improvement
in heart function and are strengthened for a planned heart transplant.  
However, organs are scarce so many patients wait months on LVADs for a donor
heart and are exposed to the risks of the device which include infection,
clots that could cause a stroke, and bleeding.  There is a current research
trial evaluating permanent LVAD implantation for patients who are not
transplant candidates, but results are not yet available.  For someone who
has had a recent heart attack to require a LVAD, they would have to be
critically ill in cardiogenic shock.  Most patients with heart attack
do not become that sick.  Only after repeated heart attacks and damage to
the heart does ICM usually become severe enough to require a LVAD.  At
our institution, LVADs are commonly used because we have very sick patients
referred from all over the country for this procedure.  Our cardiac surgeons
are pioneers in the use of LVADs.  Occassionally, a patient with an LVAD
may have enough recovery of their left ventricular function, that the device
can be explanted.  I must emphasize, however, that this involves only a
handful of patients and is rarely done. When this happens, the patient usually has DCM
and the process that caused the cardiomyopathy reverses.  When the LVAD
is explanted, a portion of the heart muscle has to be removed and a modified
Batista procedure is the end result.  As you may recall, the Batista procedure
was touted as a surgical way to cure heart failure by removing a portion of
the left ventricle and sewing the heart back together.  However, the results
have not been promising so this procedure is not being performed anymore.
The difference between the Batista and LVAD explantation is that the LVAD
took over cardiac function for a period of time to allow the heart to rest
and recover.  Thus, your brother-in-law sounds like he had a major heart
attack, but it's doesn't seem that he needs an LVAD at this time.  If he
develops severe congestive heart failure, then you may want to discuss with
his cardiologist about being evaluated at a tertiary hospital with the
capabilities to implant a LVAD.  Otherwise, I hope this information helps.
Information provided in the heart forum is for general purposes only.  
Specific diagnoses and therapies can only be provided by your physician.