Doctor uses pump to reverse heart failure in patients near death

Tuesday, September 3rd 2002, 12:00 am

By: News On 6

BERLIN (AP) _ Ten patients with end-stage heart failure were successfully treated with implants of mechanical pumps to rest their hearts while drugs helped repair the damaged organs, a renowned heart surgeon said Monday.

It took an average of six months on the pump for the hearts to recover, and the patients _ once near death _ since have returned to work, Sir Magdi Yacoub said at the annual meeting of the European Society of Cardiology.

Their hearts have been functioning normally for an average of a year, with one patient reaching four years, Yacoub said.

``I've been around for 35 years and this is the most exciting thing I've seen in my whole career,'' said Yacoub, a pioneering heart transplant surgeon. ``You have someone who's so sick he is emaciated, then you have him running in the park, playing football, or whatever.''

Colleagues, while impressed, said it was too early to tell whether the patients have been cured.

``It's going to take more than 10 patients to really see where this fits,'' said Dr. Sidney Smith, medical director of the American Heart Association. ``But it is a potential solution to a major problem _ in the United States alone more than 40,000 patients need transplantation and there are only 2,500 donor organs.''

Yacoub reported results on a study of 19 patients with end-stage heart failure, which means their hearts had almost stopped working. Most of them were in their 50s or 60s and had suffered from progressive heart failure for many years.

All the patients had enlarged hearts from their disease _ their hearts bulked up to try to compensate for the damage but only became less efficient. Other organs also deteriorated.

The patients' only hope was a heart transplant, but they were taken off the waiting list because they were too ill.

Three patients were too sick and died early on in the study from multi-organ failure. Another one died from an infection.

Yacoub implanted the heart pumps in the chests of the remaining 15 patients and left them there for as long as it took to reverse the heart damage.

The pump, called the HeartMate, takes over the heart's job of pumping blood around the body, giving the heart a chance to shrink back to its proper size and repair itself. The heart continues beating, it just stops pumping blood.

``Unloading alone, we believe, is not enough,'' Yacoub said, adding that he gave the patients regular drugs to treat heart failure, but at very high doses _ doses the diseased heart would not normally be able to handle if it also had to pump blood around the body.

As the heart recovers, it shrinks too much because its workload has been taken over by a pump. To prepare the heart to assume circulation duties again, Yacoub used another drug to build the heart muscle up to the right level.

``With that strategy, we have been able to explant two-thirds (remove two-thirds of the pumps) already ... and they are absolutely normal now for a period of up to two-and-a-half years,'' said Yacoub, a professor of cardiothoracic surgery at the National Heart and Lung Institute at Imperial College in London.

He weaned 10 of the 15 patients off the pumps. Although the average recovery time for the hearts was six months, one case took 1 1/2 years.

Those patients still take regular heart drugs.

The other five patients remain on pumps.

Yacoub said the strategy could be widely used but Dr. Mark Entman, scientific director of the DeBakey Heart Center at Baylor College of Medicine in Houston, said he believed the technique likely will pan out differently.

``It's unlikely that you will have large groups of these people where you will say, 'Go. Be well. You are cured,''' he said. ``That's probably not going to happen.''

He envisages the technique as an opportunity to regress heart damage a few years.

``While they may still have some problems, it's possible that this second time around you can treat them more intelligently,'' he said.

When mechanical heart pumps were introduced in the late 1980s, they were designed to take over the heart's work for a brief period until a suitable transplant organ could be found.

Studies have shown that the newer pumps can be left permanently in terminally ill patients. Some patients have survived with the HeartMate device for about two years.