Change of Heart

Change of Heart

Incredible new technologies keep the heart pumping

On a multiple-choice quiz, a fair amount of people would be able to correctly select Christiaan Barnard as the first doctor to perform a human heart transplant in 1967. That milestone in cardiac surgery is now a commonplace procedure that no longer makes the headlines. But it doesn’t commonly take place as often as needed.

Dr. Valluvan Jeevanandam, chief of cardiac and thoracic surgery at the University of Chicago Medical Center, estimates that over 50,000 people in the United States could benefit from a heart transplant, but the number of donors is far too small to meet that demand. Only approximately 2,000 of those patients undergo the procedure every year.

A number of significant advances, however, now offer new maximally and minimally invasive options to patients with damaged hearts. Dr. Jeevanandam, who performs heart transplant procedures, says that alternate surgery can also repair this fist-sized organ.

“We can carve out the areas of the heart that are damaged, and we have started a program to inject stem cells into the bad areas of the heart to rejuvenate them,” he says.

He adds that even more significant (namely, for patients suffering from congestive heart failure) is the development of the left ventricular assist device (LVAD). This system, powered by an external battery pack, is surgically implanted in the patient and helps the heart pump blood. “These devices have revolutionized the way we’re able to take care of very sick patients. We used to do about 10 assist-device surgeries a year. Last year we did close to 70,” Jeevanandam says.

Dr. Pat Pappas, cardiothoracic surgeon and director of the adult surgical heart unit at Advocate Christ Medical Center, started participating in FDA studies of LVADs over seven years ago. His hospital has implanted LVADs in more than 100 people, most of whom are now living a normal life. “These are people whose life expectancy was much less than one year at the time of implant, so this is a major advancement,” Pappas says.

Johnny McCann is living proof of the success of the LVAD. He was diagnosed with congestive heart failure 12 years ago. He had difficulty breathing, found it hard to walk and was in and out of the hospital. At one point, he was on the list for a heart transplant. Thanks to medications and physical therapy, his health improved for a short time. But it soon deteriorated so quickly that he became permanently disabled and had to retire from his job as a machinist in a steel mill. Then, his life changed again after he had an LVAD implanted five years ago. “It saved my life,” McCann says.

“I feel so much better. I can now socialize with friends and enjoy my four grandkids.” He is also taking classes to improve the tailoring skills he learned when he was younger. “I want to design a better vest to carry the LVAD’s battery pack, because no one likes the vest I have now,” he says.

As part of a trial, during the past two years, Advocate Christ Medical Center has been implanting the next generation of ventricular assist devices, which are smaller, use lighter-weight batteries and require a shorter hospital stay after the procedure. Pappas says the medical center is evaluating smaller devices that may be used in the future.

Advocate Medical Center is also part of a study aimed to assess the effectiveness of a minimally invasive percutaneous aortic valve replacement. This procedure, which is ideal for patients who are too sick for open heart surgery, simply requires a small incision in the groin to have access to the diseased valve.

While new techniques and technologies are being developed to avoid open heart surgery, which requires cutting open the sternum (commonly known as the breastbone) and putting the heart and lungs on a cardio-pulmonary bypass machine, Jeevanandam points out that great advances have been made that reduce some of the risks.

“The bypass machines used for the procedure have been greatly improved, so the rate of complication is much lower than it was five or ten years ago,” Jeevandam says. “Titanium plates have been developed to fuse the bones of the sternum faster after the surgery and thus dramatically decrease the pain and reduce the length of time a patient must remain inactive from six weeks to three weeks.”

At the same time, minimally invasive techniques have been perfected that make it possible to do coronary bypass surgery without opening the sternum using the heart-lung bypass machine. Jeevanandam says surgeons can do these procedures through small incisions between the ribs. They can insert an endoscope, a long, flexible instrument with a light and fiber optic camera attached to the tip, so they can see the site of the surgery. Or, they can use robot-assisted technology. Instead of moving the instruments, the surgeons manipulate long, thin robotic arms equipped with surgical instruments and a 3-D lighted camera, which transmits an image to a monitor.

“Both decrease the length of [a hospital stay] and the length of inactivity after surgery compared with open heart surgery,” Jeevanandam says.

Treatment for atrial fibrillation has also made great strides. In the past, patients who suffered from this disorder, which causes irregular heart rhythms, were treated with medications that have unpleasant side effects, or the blood thinner Coumadin, which carries risks. Jeevanandam says surgeons can now use ablation therapy, which uses radiofrequency waves to burn the areas of the heart that are causing the arrhythmia. The minimally invasive procedure is carried out through two small incisions in the chest.

The wide array of cutting-edge advancements in cardiac care recently developed, and the new ones on the horizon that expand the limits of treatment, provide every reason for people with a wide variety of heart problems to look forward to a healthier life.

Above photo by James Foster. Published in Chicago Health Summer 2011