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Allegheny General Hospital tests 'bridge' heartt

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Saturday, Feb. 23, 2013, 8:43 p.m.
 

Doctors in Pittsburgh are testing an implant that could replace a diseased or failing heart until a donor organ is found.

The SynCardia Total Artificial Heart has been used in two patients in Allegheny General Hospital in the North Side. Once implanted, it acts as a “bridge” to transplantation, restoring normal blood flow so the body can regain some health and strength lost to heart disease and be more likely to withstand the rigors of transplant surgery, said Dr. Raymond Benza, medical director of the hospital's Advanced Heart Failure, Transplantation, Mechanical Circulatory Support and Pulmonary Hypertension Program.

“A ‘bridge' is used in patients who are suitable for a transplant but are so ill that the likelihood of a successful transplant is very low,” Benza said. “The main purpose is to stabilize the patient until conditions improve.”

Though some patients can get by with a smaller pump assisting blood flow in one side of the heart, some people are sick enough that both sides are failing, said Dr. Stephen Bailey, director of the division of cardiac surgery in Allegheny General.

“The total artificial heart is another tool to get patients through the increasingly long time of waiting for an organ donor,” Bailey said. “It's a very, very good option for a small slice of the patient population, the sickest of the sick.”

Surgeons perform about 2,200 heart transplants across the United States each year, including about 25 in Allegheny General, he said.

UPMC, the largest hospital system in Western Pennsylvania, did 23 heart transplants last year, according to spokeswoman Jennifer Yates.

Dr. Robert Kormos, director of the artificial heart program at UPMC, said its hospitals have access to the SynCardia device but tend not to receive patients sick enough to require it.

“It depends on your patient profile,” he said. “We've been focusing on getting our referring physicians to send us patients before they reach that ‘crash and burn' stage.”

Kormos said he helps operate a database tracking about 8,000 patients since 2005 who have got implants to help pump blood. Only about 2 percent got total artificial hearts.

The first patient to receive the device in Allegheny General was a 62-year-old Pittsburgh native in February. With the artificial heart, his condition improved enough that was able to receive a donated heart, but he died in November from complications of the transplant, according to West Penn Allegheny Health System spokesman Dan Laurent.

A second patient, who received the artificial heart in April, died four weeks later as a result of a stroke.

The patients' families declined to be interviewed.

Since the earliest versions of the device were introduced in 1982, 475 patients have received total artificial hearts, almost all of them as a bridge to transplants, said SynCardia spokesman Don Isaacs.

To implant the device, surgeons remove almost all of the diseased heart, leaving the left and right atria, aorta and pulmonary artery intact. They attach a set of connectors and two mechanical pumps to what remains of the heart, with a pair of tubes connecting through the skin to a console that provides power and control for the system. The process takes five or six hours, Bentley said.

Benza said the Food and Drug Administration is evaluating a “portable” console, about the size of a rolling suitcase, that could allow patients to leave the hospital and wait at home for a donor heart or keep the artificial heart long term.

Allegheny General continues to seek candidates for the procedure. Benza said an ideal candidate would be someone in earlier stages of heart failure who might be more responsive to the implant than past patients.

Matthew Santoni is a staff writer for Trib Total Media. He can be reached at 412-380-5625 or msantoni@tribweb.com.

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