The Penn Heart Failure and Transplantation Program:
Comprehensive Care for Heart Failure Patients
September/October 2007
Heart failure is the leading cause of cardiovascular hospitalizations and deaths in the United States among persons 65 years of age and older. Studies suggest that the mortality and morbidity linked to heart failure in this population can be attributed, in part, to fragmentary management of the disease.
The Heart Failure Program and Heart Transplantation Program have developed a multidisciplinary algorithm for heart failure management that reflects the chronic, progressive nature of the disease. Thus, the programs provide a seamless continuum of care to address heart failure, its effects and comorbidities from its earliest stages onward.
The Heart Failure and Transplantation Program at Penn are comprised of a multidisciplinary team of specialists and clinicians whose experience spans the breadth and depth of heart failure care. The team includes some of the nation's finest cardiologists and cardiovascular surgeons, as well as specialists in cardiac imaging, cardiac anesthesia, pulmonary medicine, infectious disease, immunology and rehabilitation medicine.
“In designing a heart failure management program, it's vitally important to embrace continuity of care, ideally beginning well before the first symptoms appear, to ensure consistent, appropriate treatment
throughout the natural course of the disease.”
-Mariell Jessup, MD,
Director, The Heart Failure and Transplantation Program |
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Multidisciplinary Management of Stage A and Stage B Heart Failure
The management of Stage A and B heart failure at Penn is focused upon the early identification and control of risk factors for patients with coronary heart disease, hypertension, diabetes and other conditions predisposing to heart failure.
Early medical treatment of these conditions, with patient education and risk factor reduction, may delay or prevent the onset of cardiovascular remodeling and other debilitating effects of heart failure.
Stage C and Stage D Heart Failure
Patients with Stage C heart disease are symptomatic and require additional medical management. At Penn, these patients are candidates for innovative surgical interventions and implanted cardiac devices.
Mechanical Circulatory Support Devices for End-Stage Heart Failure
Patients in Stage D (end-stage) heart failure at Penn's Heart Failure and Transplantation Program are offered a full spectrum of care that combines medical management, advanced mechanical circulatory support devices (MCSDs), and for selected patients, heart transplantation.
Long at the forefront of surgical innovation, the Heart Failure and Transplantation Program at HUP has become the region's leading advocate of MCSDs for patients awaiting heart transplantation.
An overview of the devices currently available — or soon to be available — at Penn offers an inventory of the world's most sophisticated MCSDs, and a glimpse of what the future may hold for end-stage heart failure and heart transplantation patients.
Left Ventricular Assist Device
The high-speed axial-flow pump now under investigation by the Heart Failure and Transplantation Program at Penn justifies the term “spaceage technology.” Developed by NASA engineers, the pump is light, small and has just one moving part. An advanced MCSD, the pump augments the left ventricle by propelling up to 10 liters of blood a minute in a continuous stream from the heart. The axial flow pump is considered investigational, and is available from the Heart Failure and Transplantation Program at Penn through its participation in NIH-funded research grants.
Bridging to Transplant
The Hospital of the University of Pennsylvania became the first heart transplant center in the region to be certified for temporary total artificial heart (TAH-t) implantation. The TAH-t replaces the heart completely, and is considered the gold standard for bridge-to-transplantation for patients awaiting a donor heart or at imminent risk of death. Patients receiving the TAH-t are almost twice as likely to survive to transplant as are patients who receive standard MCSDs.
Heart Transplantation
For eligible patients in end-stage heart failure, Penn offers the hope for survival and improved quality of life. Penn's Heart Transplant Program is ranked among the top 10 in the country and is an active center for innovative heart transplant research. The Center's team of cardiovascular and heart transplantation surgeons are internationally recognized for their expertise — gained from performing an average of 50 transplants a year for the last decade.
The Future
Mechanical circulatory support devices have evolved and improved consistently since their introduction in the 1980s. This constant developmental progress offers insight into a future in which the promise of these devices will be fully realized.
Care at Every Stage of Heart Failure
The Penn Heart Failure and Transplantation Program provides comprehensive care for patients with heart failure, offering more treatment options than ever before:
- Drug therapy
- Pacemakers
- Implantable defibrillators
- Coronary artery bypass grafting (CABG)
- Heart valve repair or replacement
- Destination therapy – Mechanical Circulatory Support Devices
- Bridge to transplant – Total artificial heart
- Heart transplantation
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