February 7, 2003
HOUSTON, TX - The Houston VA Medical Center (HVAMC) is one of only 30 sites in North America, and the only one in Texas, implanting a cardiac support device (like a net) around the hearts of patients with congestive heart failure.
"One of the defining characteristics of heart failure is progressive enlarging of the heart. This cardiac support device is based on the idea that if continuous dilation of the heart can be stopped, the relentless downward spiraling nature of the disorder may be significantly slowed, stopped, or even reversed," said Douglas Mann, M.D., a HVAMC staff physician.
The objective of the cardiac support device is to support the lower chambers of the heart in a way that effectively reduces the muscle stretch and wall stress resulting from the heart enlarging. Therefore, HVAMC physicians hope this cardiac support device might halt the progressive enlargement of the heart, improve its function, and encourage a reduction in size.
Heart failure is a progressive downward spiraling syndrome that results from any number of conditions, including coronary artery disease, long-standing hypertension, toxins, and idiopathic dilated cardiomyopathy. The initial onset can be so mild that little or no functional impairment is immediately apparent. But at some point, symptomatic heart failure is experienced, while a relentless process of damaging structural and functional changes to the heart continues.
People with dilated cardiomyopathy notice a decrease in ability to walk or perform even basic daily activities due to shortness of breath and fatigue. Current extensive drug regimens have been proven helpful in relieving symptoms of heart failure. However, many patients continue to do poorly despite optimal medical therapy.
"How to stop, if not reverse, such cascading deterioration remains the key to effective long-term treatment of the heart failure syndrome. The cardiac support device in this trial is intended to treat patients who are on optimal medical therapy," said Ernesto Soltero, M.D., chief, HVAMC cardiothoracic surgery section.
As the heart first experiences impaired function, the body responds with compensatory mechanisms that attempt to maintain adequate cardiac output and tissue perfusion. These early compensations work to achieve healthy equilibrium. But their prolonged activation eventually results in structural and functional changes that reduce heart function. Together, these changes are called ventricular remodeling. In other words, the heart becomes larger and larger as it strains, causing it to pump poorly.
Pre-clinical studies have demonstrated that this cardiac support device reduces heart size and improves heart function. Structural and functional changes at the cellular level appear to be the primary cause for these global improvements in heart muscle performance. These studies further indicate that the cardiac support device, by supporting the ventricle and reducing stress-mediated heart muscle stretch, can halt progressive remodeling and allow reverse remodeling, thus providing a promising new therapy and better quality of life for heart failure patients.
This trial is a Baylor College of Medicine Investigative Review Board approved research study. For more information, contact Trenda Lynch, RN, BSN, at the Houston VA Medical Center, (713) 794-8757.
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Point of Contact: VHAHOU Public Affairs04/21/04 08:25