New Treatment Available in Northwest for Patients with Congestive Heart Failure
04/04/03 Portland, Ore.Patch made from cow heart tissue used to reshape and restore enlarged left ventricles weakened by heart attacks
Jerry Westling used to get winded walking up a flight of stairs. Now, thanks to a new surgical procedure using a patch in his heart made from cow heart tissue, the 56-year-old man is helping build a concession stand for his son's high school baseball team in Eugene, Ore.
Surgeons at Oregon Health & Science University and the Portland Veterans Affairs Medical Center (VAMC) have become the first in the Pacific Northwest to perform a new procedure using an implant made from cow heart tissue for patients like Jerry who have certain types of severe congestive heart failure (CHF). Five million people in the United States have severe heart failure, and 550,000 new cases are diagnosed each year.
The new procedure, called surgical ventricular restoration (SVR), uses a patch made of cow heart tissue to repair an enlarged and poorly functioning left ventricle damaged by heart attacks. The soft and flexible oval-shaped patch is part of the CorRestore System made by Somanetics. A healthy ventricle looks like a football, elliptical in shape, while a damaged ventricle expands to look like a round basketball. The patch helps to reshape the ventricle from the basketball back to the football shape.
"Medication and cardiac-assist devices might alleviate symptoms of heart failure, but these treatments do not address the underlying cause of the disease, which is weakening and enlargement of the heart's main pumping chamber. These treatments are also riskier. SVR with the CorRestore System approaches CHF from the perspective of the illness itself, not only restoring the diseased heart, but, by extension, improving the performance of other organs and the patient's quality of life," said Pasala S. Ravichandran, M.D., associate professor of surgery (cardiothoracic surgery) in the OHSU School of Medicine and chief of cardiothoracic surgery at the VAMC.
A team consisting of OHSU cardiothoracic surgeons Ravichandran, Matt Slater, M.D., and H. Storm Floten, M.D., performed the procedure at OHSU in November 2002 on a 63-year-old man from Seaview, Wash. Before the surgery, the man felt chest pain while resting as his heart failed and required continuous intravenous medical support while in the OHSU intensive care unit. In addition, his kidneys were failing as a result of his poorly functioning heart. Following surgery, the man's heart function improved significantly, and he was discharged just 10 days later.
In December the OHSU/VAMC team performed a similar procedure on Jerry with national cardiothoracic surgery expert Gerald Buckberg, M.D., on Jerry. A heart attack damaged Jerry's heart seven years ago. His heart failure was so severe he was put on a heart transplant waiting list, but was removed after a mild recovery. In addition, shortness of breath and tightness in his chest has prevented him from working. Jerry was excited about the opportunity to have surgery without having his heart removed. Five days after surgery Jerry was back at home in Eugene with his wife and three sons.
"Our group has consistently focused on new trends in cardiothoracic medicine and surgery, especially those toward treatment of patients with advanced heart disease and heart failure with high mortality. This new surgical ventricular restoration procedure illustrates our commitment to this state-of-the-art level of care and is one of four procedures we perform that are only available in the Northwest at OHSU," said Ravichandran, surgical director of OHSU's heart transplant program.
CHF occurs when the heart is unable to pump enough blood to meet the body's demand for oxygen and other nutrients. This problem often results from the body's effort to compensate for heart muscle damage caused by a heart attack. To compensate for the damage, the heart gradually enlarges, eventually causing inefficient heart function and failure.
CHF and related causes result in about 250,000 deaths annually and is one of the most common reasons people older than 65 are admitted to hospitals' intensive care units. In Oregon, cardiovascular disease killed 10,800 people in 2000, making it the state's leading cause of death, according to the American Heart Association.
Despite available therapies, the prognosis for patients with shortness of breath at rest and with minimal exertion is poor: nearly 40 percent of these patients die within 12 months following their initial hospital admission for heart failure. Lack of physical strength and stamina, shortness of breath, and fluid retention plague many of those who survive.
"Although heart transplantation is an option, there is a limited availability of donor hearts, and the sheer number of patients with heart failure is enormous. Many of these patients can benefit from alternative treatments for heart failure," Ravichandran said. SVR with the CorRestore System offers patients the ability to return to a more active lifestyle. As we have seen in the two cases we have already performed, the procedure has resulted in a substantive improvement in quality of life. OHSUs' heart surgery team expects to perform this new surgical procedure on about 10 patients each year.