Health - SynCardia

Health
Heart Helpers
R
From pacemakers to artificial hearts, high-tech implants give
cardiac patients a second chance at life. by Janine S. Pouliot
Ray Harmon was dying of a
broken heart. Literally. Only in his late
30s, the special projects manager for Gov.
Jim Doyle suffered from a serious heart
disease that was killing him. Born with the
congenital heart defect called cardiomyopathy, or an enlarged heart, he’d suffered
the consequences his entire life.
“As I kid I became fatigued earlier than
my counterparts because my heart had to
work harder,” explains Harmon. He was
still able to play high school sports, but
he was barely 30 when his heart began to
show the real effects of his condition.
“I was working out in the gym, and suddenly my blood pressure dropped,” he recalls. “I was taken to the hospital where I
received a defibrillator implant [for] my
heart and ended up staying three months.”
After that, things more or less returned
to normal until one day in 2003, when his
condition went into a downward spiral.
This time, he ended up in the hospital
permanently, a heart transplant his only
chance of survival. Yet there was no telling
when a heart would be available.
Then Harmon was offered something
that had been inconceivable only a few
years ago – a totally artificial heart. His
own failing organ would be removed and
replaced by something completely manmade, buying time until a donated human
heart was offered.
On Aug. 8, 2006, Harmon underwent
the surgery. Recovery was not a picnic,
and he had to remain tethered to the machine that provided the pumping power to
his heart. But it was all worth it when, on
Feb. 6, 2007, a human heart for transplant
was finally available. Harmon successfully underwent transplant surgery, waking
up just before Valentine’s Day with, fittingly enough, a new heart. And he’s been improving ever since.
Harmon’s chances for survival would
54 | Milwaukee Magazine | December 2007 » milwaukeemagazine.com
have been dim had it not been for his
transition on an artificial heart. But this
astounding device is hardly the only implant giving seriously ill heart patients a
second chance at life. From defibrillators
to implants called LVADs, there are a variety of tiny machines that click, whirl and
pump inside the heart. Some devices help
regulate chronic conditions, while others give patients – like Harmon – a crucial
bridge to the time when a heart transplant
will be available, literally meaning the difference between life and death.
Implants fall into two categories and are
administered by physicians specializing in
distinctly different disciplines. An analogy helps explain the difference: “There
is the plumbing part of the heart, and
there is the electrical part,” says Dr. Tanvir
Bajwa, an interventional cardiologist and
a partner in Comprehensive Cardiovascular Care Group with privileges at Aurora
Heath Care sites.
“Plumbing” refers to the heart’s ability
to pump blood through the veins, just as
a water pump might move water through
the pipes of a house. “When a patient
comes to us with chest pain or shortness
of breath, we’re usually seeing a plumbing
problem,” notes Bajwa. “We look at what’s
called the ejection fraction, or how much
blood the left chamber is able to pump.”
The left ventricle is the stronger of the
two ventricles and is assigned the responsibility of getting blood coursing. “A poor
ejection fraction means a shorter lifespan.”
The other side of the equation is “electrical,” the “juice” that provides the power for the heart to beat steadily. “This has
to do with a patient having rhythm problems,” notes Bajwa. “The problem may be
that the patient’s heart beats too fast or
too slow.”
When a patient experiences symptoms,
the first line of defense is usually an appointment with an interventional cardiologist for a diagnosis. “There is a stress
test, an echocardiogram, catheterization
to check for a blockage in the artery,” says
Bajwa. Interventional cardiologists perform heart surgeries such as angioplasty
and the placement of stents or tiny tubes
that hold open an artery or blood vessel.
If it’s determined that the problem lies
within the electrical system, the patient is
referred to a cardiac electrophysiologist.
Illustration by Christiane Grauert
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Health
“First the patient is put on heart medication for three to nine months,” says Dr.
Atul Bhatia, an electrophysiologist with
Comprehensive Cardiovascular Care
Group practicing at Aurora Health Care.
“If their condition remains unchanged,
then they are a candidate for an implant.”
Traditionally, there have been two types
of electrical implants. “Pacemakers are
meant for patients who have a slow heartbeat, a dysfunction of the body’s own pacemaker,” notes Bhatia. The small device is
implanted below the collarbone and connected to the heart by pacing wires that
monitor the beating action. It delivers an
electrical impulse when necessary.
The other electrical gadget is the defibrillator. “This was developed for a fast
heartbeat and prevents what’s called sudden death,” Bhatia says. In cases where the
heartbeat is excessive but unproductive, the
defibrillator administers a shock, which
calms down the wild, fruitless beats and
returns the heart to a normal rhythm.
Still another electrical heart implant, cardiac resynchronization therapy (CRT), is a specialized pacing unit.
The CRT unit re-coordinates the action
of the right ventricle with the left ventricle when the two beat slightly out of sequence. The unit can also come with a
backup defibrillator, increasing the benefits for extremely ill patients. “CRT received FDA approval in 2000,” says Bhatia. “But now it’s gotten approval for
expanded indications.” As a result, it’s accessible to an even wider population.
As for the pumping side, there’s another
miraculous appliance called LVAD (Left
Ventricular Assist Device). “Two groups of
patients qualify for this implant,” says Dr.
Alfred C. Nicolosi, a cardiothoracic surgeon and director of heart transplantation and mechanical circulatory support at
Froedtert Hospital. “One group consists of
those awaiting a heart transplant who are
getting sicker and probably won’t survive
until a heart comes. We put this device in
as a bridge to transplant. The second group
is just as sick as the first, but for various
reasons aren’t candidates for a transplant.
These people get the device as a permanent treatment, called destination therapy.”
LVAD works by assisting the heart
thrust blood through the body. “During
surgery, an incision is made down the middle of the body and space is created in the
❙ continued on page 58
56 | Milwaukee Magazine | December 2007 » milwaukeemagazine.com
health tips
Mom and Dad, I’m bulimic and I need
your help. Adolescents with bulimia are more likely to
improve when their parents are involved in their treatment.
A new study in the Archives of General Psychiatry found 39
percent of patients involved in family therapy had stopped
binging and purging after six months of treatment. But in
individual supportive therapy, a more common treatment
focusing on the underlying emotional causes of the eating
disorder, only 18 percent had the same result. Another form
of psychotherapy, cognitive behavioral therapy, has been
shown to be as effective as focused family therapy.
What you don’t know could kill you. A
computed tomography (CT or CAT scan) to view arteries of the
heart may help determine which patients experiencing chest
pain are at higher risk of dying in the next 15 months. A study
of 1,127 patients was published online in the Journal of the
American College of Cardiology. It found that a key predictor
of death was having a 50 percent or higher blockage of any
coronary artery, or a highly visible narrowing of the proximal
left anterior descending artery or left main coronary artery.
Shooting from the hip. Older patients with
osteoporosis who receive a 15-minute intravenous infusion of
A roundup of the latest health wisdom
Reclast (zoledronic acid) after a hip fracture may significantly
reduce their risk of subsequent fractures and death. A study
involving 2,111 patients ages 50 and over reported these
findings online in the New England Journal of Medicine. The
risk for subsequent fractures of any kind was reduced by 35
percent and the risk of death by 28 percent with a Reclast
infusion within 90 days of the initial fracture and once per
year thereafter.
Another reason to “Just Say No.” A new
study shows substance abuse may lead to heart attacks in
adolescents. While acute myocardial infarction (heart attack
caused by blood clot) is rare in teens, a study in the Journal
of Pediatrics reviewed 123 patients and found 23 percent
had a history of substance abuse and 12 percent had a
history of smoking tobacco.
“Bad” breath may mean lung cancer.
As reported in Cancer, Chinese researchers tested breath
samples for volatile organic compounds (VOCs) of 29 lung
cancer patients and 13 healthy individuals. Using advanced
gas-analysis technologies, investigators found 11 VOCs in the
breath samples of lung cancer patients that were rarely found
in the healthy individuals.
– Scott R. Weinberger
» milwaukeemagazine.com December 2007 | Milwaukee Magazine | 57
Health
❙ continued from page 56
abdomen, where the pump will lie,” says
Nicolosi. Then an arm of the device is
placed in the left ventricle so blood can be
drained into the artificial chamber. Another arm goes from the chamber back to the
aorta so blood is redirected to the body. A
wire extrudes through the skin to attach to
a minicomputer worn on a belt that controls the whole process.
A new and better generation of LVAD is
on the way. “This model has been in trials
for about 10 years,” says Nicolosi. “Instead
of working as a chamber that intermittently fills up with blood and then suddenly empties in a repetitive cycle like the action of the heart, the unit will have axial
flow pumps with a continuously spinning
impeller. The smaller, simpler mechanism
is thought to supply a more constant blood
flow. FDA approval is expected soon.”
No guarantees come with any implants,
yet research suggests they may improve
survival rates. “There was a landmark study
a few years ago looking at very sick patients who were kept on medication only,
while others received the LVAD,” says
Nicolosi. “The survival rate of patients on
just meds was dismal, only 8 percent. The
survival rate of the LVAD group was 24
percent after two years.” And there have
been upgrades in the device since the study
was published.
Finally, there is the pinnacle of all implants, the temporary artificial heart. This
is what saved Ray Harmon’s life. “The first
artificial heart was implanted in 1982, and
it made news around the world,” says Dr.
Alfred J. Tector, the cardiothoracic surgeon
who installed Harmon’s unit. He is director of the transplant program and medical director of clinical research at Aurora Health Care. Aurora St. Luke’s Medical
Center is one of less than a dozen certified
artificial heart placement centers in the
United States. But like all gadgets positioned in end-stage heart patients, longevity isn’t assured.
“You can run into problems with infections and blood clots,” notes Tector. “But
over time, we’ve learned more about [the
artificial heart], and techniques are getting
better. Since the early days, we’ve learned
that if you increase the heart rate or the
number of beats with the pump, it makes
all the difference in terms of clots.”
And although patients in the U.S. currently must remain tethered to a washing
machine-sized power unit, severely limiting their mobility, a new portable driver has been developed in Europe. “It works
very well,” says Tector. “One patient traveled all over Germany with it.” It’s gotten
FDA approval, so look for the device in
the U.S. soon.
However, no amount of high-tech innovation can replace the importance of a
human heart transplant for end-stage patients, something the Harmon family
knows only too well. The problem is that
the list of patients is long and the number
of donors few. When Harmon’s mother
passed away, she was aware of the importance of being a donor. “Her liver,” Harmon says proudly, “was able to give life to
someone else.” n
Janine S. Pouliot is a frequent Milwaukee
Magazine contributor.
58 | Milwaukee Magazine | December 2007 » milwaukeemagazine.com