Science of Healing the Heart
A mechanical pump that was invented as a temporary life support for patients with advanced heart failure is emerging as a potential tool to help hearts heal and function for the long term on their own. The device, called an LVAD, takes over most of the heart's main pumping function and was designed initially to enable patients to survive until a donor heart became available for transplant. But doctors have discovered to their surprise that the heart can get better on the pump. When they remove it later to perform a transplant, the heart is sometimes dramatically improved.
"An LVAD is like putting the heart on the disabled list," says Joseph Woo, surgical director of the heart transplant and LVAD program at the University of Pennsylvania in Philadelphia. As with sidelined athletes, taking the heart out of the game to ease its workload appears to enable it to recover. Now doctors are mounting a multicenter clinical trial to see if using the left-ventricular assist device—the LVAD's full name—as a "bridge to recovery" might eventually become a viable new option for some of the thousands of patients with advanced heart failure, one of medicine's most debilitating ailments.
Congestive heart failure is characterized by an enlarged heart which loses its ability to effectively propel blood to the rest of the body. In advanced disease, fluid collects in the lungs and lower legs, leaving patients so short of breath that walking just a few steps is an ordeal. Among nearly six million Americans with heart failure, an estimated 150,000 have the disease in an advanced stage where a transplant or LVAD become potential options. Most LVAD patients are men, between the ages of 40 and 79.
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For reasons not fully understood, when an LVAD is implanted in a patient with heart failure, the enlarged heart shrinks in a process doctors call reverse remodeling and can regain at least some of its lost function. An aggressive regimen of heart-failure and other drugs contributes to the benefit.
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Not every patient is likely to see the heart recover with an LVAD. Patients whose heart failure is caused by a heart attack—about 60% of all cases—aren't good candidates for the strategy because damage to the heart muscle hinders its ability to regain effective pumping function. And heart failure is often accompanied by kidney problems that could undermine the ability of patients with advanced disease to tolerate the drug regimen that is used in the new LVAD study. For most other patients, heart failure is caused by genetic anomalies, infection of the heart muscle, adverse reaction to drugs such as chemotherapy or unknown reasons. Because these patients' heart muscle haven't been deprived of blood flow—the problem with heart attacks—doctors believe there is greater potential for the underlying tissue to recover.
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