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Newswise — James Casey was on the brink of death. His heart was failing fast, and the lack of blood flow from his heart was killing his kidneys and other organs, making him too sick to withstand surgery that might save his life. The situation was desperate.
But Casey is alive today because doctors at the University of Michigan Cardiovascular Center tried a new option: an advanced heart-assisting technology that pumped his blood, fed his organs, and got him through his crisis — without an operation. That made him strong enough to receive an implanted heart-assisting device, and to return home to wait for a heart transplant.
The U-M is one of a handful of medical centers nationwide that can save patients like Casey, who until recently would have faced certain death because they didn't have the strength for heart surgery or couldn't tolerate anesthesia.
These dramatic rescues are made possible by a device called the TandemHeart PTVA System, the first in a new generation of heart devices that can take over for the heart's pumping function but don't require surgery. U-M teams have helped more than a dozen patients already with the TandemHeart, and hope to help many more with this device and other, more experimental technologies now being tested.
"These devices can be used to buy time, and bridge those patients to some level of recovery, so they may be able to tolerate a more invasive procedure such as the implantation of another device," says Mauro Moscucci, M.D., who treated Casey using the TandemHeart and is helping test other devices for patients with acute heart failure caused by a heart attack, heart muscle infection, trauma or other damage.
Moscucci directs the cardiac catheterization laboratory at the U-M Cardiovascular Center, where he routinely uses non-surgical techniques to diagnose and open clogged arteries. The TandemHeart device connects with the body in much the same way as artery-opening technology. In addition to keeping desperately ill patients alive, it also makes it possible to help sustain high-risk patients through artery-opening procedures that they otherwise couldn't withstand.
Moscucci explains that devices such as the TandemHeart attach to the bloodstream and the heart using long, thin tubes that doctors insert into the body though small "keyhole" cuts in the thigh and thread carefully through the blood vessels and up into the heart itself. One tube is gently poked through the wall that divides the two sides of the heart. The tubes, called cannulae, are then attached to a small pump outside the body that pushes blood forward at a precise rate.
The device takes over for the left side of the heart — the side that usually takes in oxygen-rich blood from the lungs and then uses sheer heart-muscle power to send it out to the body. For that reason, devices like TandemHeart are called ventricular assist devices, or VADs. And because the device is attached through the body through the skin, it's called a percutaneous VAD.
Instead of muscle power, the TandemHeart and devices like it use electrical power to push the blood out. And that creates a sort of "vacation" for sick hearts, which means that patients like Casey can recover enough to have surgery or heart procedures — or even to go home without any other invasive treatment.
It also ensures a good flow of blood to the brain, kidneys, liver and other organs, which are often starting to die for lack of oxygen in critically ill heart patients. If blood flow can be restored before too much harm is done to those organs, a patient can often go on to recover.
"I'm able to get out and do things around the house and out in the yard," says Casey, who is 62 years old and suffered a slow decline in heart function before his sudden crisis early this year. "I'm walking a whole lot better. My strength is every day increasing, and getting better."
His dramatic improvement since his near-death crisis earlier this year is being helped by a second heart-assisting device, called a HeartMate, which was implanted in his body as soon as the TandemHeart had allowed him to recover enough to endure surgery.
Implanted by U-M cardiac surgeon Francis Pagani, M.D., Ph.D., who works closely with Moscucci on TandemHeart patients, the HeartMate does the same job as the TandemHeart, taking over for the pumping action of the left side of the heart. But it sits entirely inside the body, with only a thin cable emerging from the body to connect to a battery pack worn on a belt.
"TandemHeart and HeartMate are both VAD devices, working in concert with the heart to improve its pumping function," says Pagani. "One is for temporary use, the other for longer-term use."
Ultimately, Moscucci notes, Casey and some patients like him will need a heart transplant to sustain his life for years to come. But with donor hearts in short supply because not enough Americans communicate their wish to donate before they die, high-tech solutions like TandemHeart and HeartMate are saving more lives each year.
"In 2004 in the United States, 457 people died while waiting for a heart transplant, including 13 in Michigan," he says. "The introduction of devices like TandemHeart and HeartMate allow us now to take care of patients who need a heart while they're waiting for a heart transplant."
The U-M has built up a special expertise in the use of heart-assisting devices, and in fact U-M doctors were some of the earliest users of TandemHeart and HeartMate when those devices were still being tested. Now, they're testing other new devices that are still in experimental stages, including a device called the Orqis Cancion that doesn't require doctors to tap into the heart but rather pushes blood to the body from a spot in the body's largest blood vessel, just above the heart.
"In terms of what we can offer to patients with heart failure or circulatory failure, we at the University of Michigan have pretty much every possible device that is going to be available," says Moscucci. "We have a top VAD program, a top heart transplant program, and really we can provide what no other institution in the state of Michigan can provide." Earlier this year, all of those resources were united under a new Center for Circulatory Support, as part of the U-M Cardiovascular Center.
It's not just technology, he adds — it's teamwork that makes U-M a destination for patients like Casey. Heart specialists, surgeons, nurses, technicians, transplant coordinators and many others cooperate to help each patient get the best care for their unique situation, from crisis to recovery.
As for James Casey, he's just happy to be alive — and patiently waiting for a suitable donor's heart to become available. "I'm thinking how nice that would be, to be able to have some years ahead to spend more time with my wife and family, and meet people and make new friends," he says. "And that's my hope. And I have hope now — I didn't before."
About heart failure and heart-assisting devices:
"¢ Nearly five million Americans have the chronic form of heart failure, a progressive condition that weakens the heart muscle and diminishes its ability to pump blood to the body. "¢ About 550,000 new cases of heart failure are diagnosed each year, and 52,828 people die from the condition each year. Many heart failure patients have a history of heart attack, uncontrolled high blood pressure, or both. They often have health crises or are disabled by their condition, and account for almost a million hospital visits each year, and $27.9 billion in health care costs."¢ Medications can help control chronic heart failure symptoms and support the heart's function. But each year, some patients enter the last stage of heart failure, in which death is certain unless technology or a transplant can take over the heart's pumping ability."¢ Hearts can also fail suddenly, due to an infection of the heart muscle (myocarditis), lack of blood flow to the heart muscle caused by a heart attack brought on by a clogged heart artery (myocardial infarction), or sudden severe heart-rhythm problems. If enough heart muscle is damaged, the heart's pumping ability can fail suddenly — a state called cardiogenic shock. "¢ Whether due to long-term or sudden heart failure, any loss of blood flow to the body from the heart can result in serious damage to the brain, kidneys, liver and other organs, which can make a patient even more seriously ill. "¢ Heart surgery can help some patients, especially to restore blood flow to the heart muscle. But many patients are too sick to withstand surgery and general anesthesia. Some patients can be helped by angioplasty, which opens clogged arteries without surgery. But some patients can't even tolerate that procedure. "¢ Devices like the TandemHeart can help get patients through a heart failure crisis, allowing them to recover enough to go home, have surgery or sustain an angioplasty procedure. "¢ The University of Michigan offers advanced care for heart patients who have no other options, using a variety of technologies, procedures and operations. The TandemHeart, currently approved for short-term use, is the first of a new generation of heart-assisting devices that don't require surgery for use.
For more information on all forms of heart failure treatment at the University of Michigan Cardiovascular center, call toll-free, 1-888-287-1082.
Find out more on the web at:
U-M Cardiovascular Center: General heart failure informationhttp://www.med.umich.edu/1libr/guides/heartfal.htm
U-M Cardiovascular Center: Heart Failure Programhttp://www.med.umich.edu/cvc/lead/index.html
U-M Cardiovascular Center " Center for Circulatory Supporthttp://www.med.umich.edu/cvc/lead/devices.htm
TandemHeart information from manufacturer CardiacAssist, Inc.http://www.tandemheart.com
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