Study suggests long-term use of heart pump

Device can be permanent, not temporary, it says

November 14, 2001|By NEWSDAY

Terminally ill heart patients have been rescued from the brink of death with a permanent artificial device that assumes the organ's pumping functions and could save thousands of lives annually, a landmark study has found.

The analysis, led by medical researchers at Columbia Presbyterian Medical Center in Manhattan, revealed that dying patients implanted with a left-ventricular assist device, or LVAD, lived twice as long as their counterparts on medications, the standard therapy. The study calls for a sweeping new use for the device, now only a temporary solution until a heart for transplant is found.

"These are patients with severe forms of heart failure. Their prognosis is obvious. This is a terminal illness, and this is a new treatment for a terminal illness," Dr. Eric Rose, a professor of heart surgery at Columbia Presbyterian, said this week. Rose, who pioneered the nation's first successful pediatric heart transplant in 1984, reported details of the study to fellow heart specialists at the annual scientific meeting of the American Heart Association in Anaheim, Calif. Results of the investigation will be published tomorrow in The New England Journal of Medicine.

All of the patients in the study, whether implanted with an LVAD or taking medications, had end-stage congestive heart failure, a condition in which the heart is weakened by multiple heart attacks or valvular problems, for example. In time, blood backs into the lungs, and ultimately the liver and kidneys fail.

Congestive heart failure afflicts about 5 million people in the United States, and about 100,000 new cases are reported annually. A heart transplant is the best alternative. However, people in the condition Rose and his colleagues treated were considered either too sick or too old to be candidates for transplant.

Doctors estimate the cost of LVAD implantation to be $160,000, equal to the cost of a transplant.

Rose and his colleagues at 22 participating hospitals nationwide tested the HeartMate, the most widely used LVAD in the country. LVADs are generally implanted as a short-term solution, until a suitable donor heart is found. Using an LVAD as a permanent implant breaks new ground.

"This is an important study because we are seeing more and more patients with congestive heart failure, and this shows a doubling of survivorship," said Dr. Valentin Fuster, chief of the Cardiovascular Institute at Mount Sinai Hospital in Manhattan. Fuster said researchers envision further developments for otherwise terminal patients. "One is staging, starting with the device then moving to transplants of cells that grow new muscle," he said.

In the study, 129 patients in medical centers around the country were assigned to be implanted with the HeartMate or to receive standard drug therapy. Within a year, half of those with the device were still alive, compared with 25 percent of patients on medications. By the second year, 23 percent of those with the device were still alive compared with 8 percent of patients on drug therapy. One patient has reached the three-year mark with the device.

Left-ventricular assist devices work by assuming the pumping functions of the heart's left ventricle, the organ's main pumping chamber. The HeartMate is about the size of a wallet with a wire connected to an external battery pack.

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