Translational
Research at Penn: Redefining Endstage Heart Failure
September/October 2008
The translation of research into practice at Penn is perhaps
nowhere more striking than in the approach to endstage heart
failure.
Endstage heart failure is
being redefined at Penn Medicine as an interim in the progress
of the disease—a respite,
rather than a conclusion—for patients who are
ineligible for heart transplant surgery. This is possible because Penn cardiologists,
surgeons and researchers have aggressively pursued partnerships with
scientists and engineers to translate fundamental research in cardiovascular
mechanics and dynamics into instruments that
support or replace heart functions. These life-sustaining
ventricular assist devices, or VADs,
have dramatically altered the prospects for
patients in endstage heart failure.
Between 2006
and 2007, the number of Heart Transplant Patients
who received VADs as Bridge to Transplant increased
by 28% |
|
The Heart Failure
and Transplantation Program is the region’s leading advocate
for the use of VADs for patients in endstage heart failure
and for those patients awaiting heart transplantation. At
Penn, VADs are used to bridge the interim between endstage
heart failure and transplant, and increasingly, as destination
therapy, the permanent implantation of a device to support
or replace the failing heart.
In 2007, 24 heart transplant
patients at Penn received a VAD as a bridge to transplant,
a 28 percent increase over 2006. The advantages of the latest
generation of VADs include a greatly decreased risk of infection,
greater reliability and durability, and smaller sizes to
enhance their suitability for smaller adults and children.
An overview of the devices currently available at Penn offers
an inventory of the world’s most sophisticated VADS,
and a glimpse of what the future may hold for patients with
endstage heart failure, as well as heart transplantation
patients.
Thoratec® Heart Mate® II
Penn was the first center in the
region to implant the Thoratec HeartMate II left ventricular
assist device (LVAD) for destination therapy. Light, small
and powerful, the HeartMate II has a single
moving part that augments the left ventricle by
propelling up to 10 liters of blood per minute in a
continuous stream from the heart. Penn is currently
participating in a study of the HeartMate II for
bridge to transplant therapy.
VentrAssist® Left Ventricular Assist
Device
The VentrAssist® Left
Ventricular Assist Device (LVAD) is designed to be a permanent
alternative to heart transplants for patients suffering from
heart failure, or as a temporary bridge to
transplant. At Penn, the VentrAssist has been
studied for destination therapy and as a bridge
to heart transplantation.
Thoratec® CentriMag
Blood Pumping System
A temporary VAD (up to 14 days), the
Thoratec® CentriMag Blood Pumping System
is a continuous-flow, centrifugal-type rotary
blood pump that is placed extracorporeally.
The CentriMag is used at Penn for bridge to
transplant therapy. The advantages of the
CentriMag include rapid implantation and—because
the pump has no bearings or seals—limited potential
for hemolysis and thrombus formation.
Temporary total artificial
heart (TAH-t) implantation
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
received biventricular mechanical support in the past.
Ventricular Assist Device (VAD)
Certification
In 2007, the destination therapy program at the Hospital of
the University of Pennsylvania received a certification of
distinction
from the Joint Commission, an independent, not-for-profit organization
that accredits and certifies more than 15,000 health care
organizations and programs in the United States. A hospital
must provide destination therapy to an adult population and
place
10 VADs within the previous 36 months to receive VAD certification.
|
