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A New Look to Heart Failure Treatment

Cardiologists reshape the heart to boost its strength

SUNDAY, May 16, 2004 (HealthDayNews) -- In an unusual strategy in the battle against one of America's leading killers, cardiologists are turning to experimental operations that aim to treat heart failure by reshaping ailing hearts into stronger organs.

The procedure isn't for everyone, and experts say it may only help a small percentage of heart failure patients. But considering that an estimated 300,000 Americans die of heart failure or related complications each year, any change in the death rate could lead to survival for thousands.

"This is now a new tool in the armamentarium of treating end-stage heart disease," said Dr. John Conte, director of heart and lung transplantation at Johns Hopkins University, which has been testing the operation. "I think it's something we'll do more and more as time goes on."

While it doesn't get as much attention as heart attacks, heart failure is a major health problem in the United States, striking an estimated 550,000 people each year. Patients typically develop heart failure while suffering from clogged arteries that prevent proper blood flow in and out of the heart.

Normally, the heart is small and elliptical, like an acorn. But as stress on the heart goes up, it becomes larger and more rounded, Conte said.

As the heart begins to fail, the circulatory system ceases its effective distribution of blood throughout the body. "Most commonly, people will develop fluid overload and shortness of breath with fluid in the lungs, fluid in the legs," Conte said. "Actually it's an insidious process you don't notice, depending on how bad your heart is, until a certain point."

Cardiologists treat heart failure with a variety of approaches, including drugs and heart transplants. But transplants aren't the panacea they may seem, Conte said.

Artificial hearts are far from being ready for prime time, while the number of available human hearts is limited to about 3,000 a year. The elderly, in fact, may be entirely out of luck.

"Certainly no one's going to transplant someone in their 80s, and most won't transplant anyone in their 70s," Conte said.

The reshaping operations, which only appeared on the scene within the past few years, are geared to help the neediest patients. Surgeons at several U.S. hospitals are testing the procedure.

Using a patient's height and weight measurements, the surgeons calculate how big the heart should be and try to form it into a football shape, rather than the damaged volleyball appearance. Some cardiologists insert mannequin-like devices into the heart and use them as guides during the reshaping procedure, said Dr. John D. Puskas, an associate professor of surgery at Emory University. In other cases, cardiologists eyeball the heart and use their own judgment about how best to return the heart to its proper shape, he said.

Often, cardiologists must cut away dead tissue to change the heart's shape. "This is a relatively new area and the techniques are evolving," Puskas said. "The results differ between different groups [of surgeons] with different levels of experience."

"By reshaping the heart and making it smaller without taking out tissue which is alive or viable, you're allowing the heart to perform much better with the same effort," said Dr. Eric Eichhorn, medical director of the Cardiopulmonary Research Science and Technology Institute in Dallas.

It's not clear how many patients will be helped by the new procedure. Conte estimated 10 percent, and Eichhorn said it may be lower. Even so, the number of heart-failure cases is on the rise as the average age of Americans goes up.

"If you added up breast, colon, lung and pancreatic cancer combined, they don't equal the number who will die from heart failure this year," Conte said. "It doesn't get as much press as cancer, but certainly it's a far greater health-care problem."

Even those who live with the health threat often suffer from "miserable" lives of congestive heart disease and shortened breath, Puskas said. "This [reshaping technique] is a response to try to offer a therapy for people who really don't have an alternative."

More information

Learn more about heart failure from the American Heart Association and the National Heart, Lung, and Blood Institute.

SOURCES: John Conte, M.D., director, heart and lung transplantation, Johns Hopkins University, Baltimore; John D. Puskas, M.D., associate professor, surgery, Emory University School of Medicine, Atlanta; Eric Eichhorn, M.D., staff cardiologist, Dallas Heart Group, and medical director, Cardiopulmonary Research Science and Technology Institute, Dallas
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