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Help for Heart Patients - 2001-08-23

People suffering congestive heart failure are unable to pump enough blood to meet the needs of their bodies. For years now, the only effective treatment for patients in the final stages of congestive heart failure has been heart transplant. But Dr. Joseph Rogers, of Washington University in St. Louis, Missouri, says that may change. He and his colleagues are testing a device that helps the heart's left ventricle pump blood to the rest of the body. "These devices have been designed to basically bypass that weakened chamber of the heart and supply a normal amount of blood flow," he said.

Since 1997, Dr. Rogers and his team have been implanting the left ventricular assist devices in very sick patients who are waiting for heart transplants. "The devices were originally tested as a bridge to transplant because we figured that they may not last a terribly long time, at the beginning," he said. "But we've come to find that this technology is so powerful that you can actually use it to treat people with heart failure who aren't transplant candidates or use it as their therapy that they have to treat their heart failure as long as the device would pump."

Dr. Rogers says it's important to find a substitute for heart transplant because there are more people needing healthy hearts than there are organs donated. Some researchers are studying the effectiveness of totally artificial hearts. But Dr. Joseph Rogers believes the left ventricular assist device may have some advantages over that technology.

"One is that you're not taking the native heart out," Dr. Rogers says. "So if the device would fail, you still have your own heart in there that would pump some amount of out-put of blood. With the total artificial heart, if it stops pumping, it's going to be a problem."

Dr. Rogers and his colleagues have implanted left ventricular assist devices into 27 patients since 1997. One patient lived with the device for nearly three years before deciding he was healthy enough not to need a heart transplant.

More than one million people worldwide suffer from chronic kidney failure, so their kidneys do not cleanse the bloodstream properly. The most common treatment is dialysis. There are two kinds: peritoneal dialysis infuses the abdominal cavity with a fluid containing glucose and salt. This mixture draws out toxins that can then be discarded. In hemodialysis, blood is removed from the body and pumped into a machine that filters toxic substances out and returns purified blood to the patient. In the United States, about two-thirds of dialysis patients receive the hemodialysis treatment. It requires them to spend several hours each week in hospitals or dialysis clinics. Kidney specialist Brent Miller, at Washington University in St. Louis, Missouri, says hemodialysis is very difficult.

"Most people come into a dialysis center three times a week for about three to four hours each time to do this for the rest of their lives or until they get a kidney transplant," he says. "And that's about a 20 hour a week commitment, so I tell people it's like a part-time job."

But now, groups in Toronto, Virginia, New York and Missouri are experimenting with home hemodialysis, allowing patients to receive their treatment at night while they sleep. Dr. Miller says patients need several weeks of training to learn to do the treatments at home. "They have to learn how to use a dialysis machine just like our dialysis technicians or nurses do. It takes about four to six weeks to train them," Dr. Miller says. "[We] Train them about twenty hours a week and then we do a test in the hospital the last week at night to make sure that they can do it for five nights before we send them home."

Dr. Miller estimates that, with proper training and support, up to 20 percent of hemodialysis patients would choose to take their therapy at home while they sleep.

(Sound courtesy of Washington University)