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Center for Advanced Cardiac Care

Extending Life and the Quality of Life for End Stage Heart Failure Patients

Over five million Americans suffer from heart failure—a serious, chronic condition that occurs when the heart does not pump strongly enough to meet the needs of the body. If at least one chamber of the heart can not pump with adequate force, the body's tissues do not get enough oxygen. The heart has to work harder to make up for the inefficiency, and this in turn causes more damage.

Compared to a normal heart (left), the heart muscle of a patient with hypertrophic cardiomyopathy (right) is greatly thickened. CREDIT: Nancy Heim

Patients' symptoms depend on how weak the heart is and how well their heart failure is controlled. Many patients require several medications, including ACE Inhibitors to lower blood pressure and open the blood vessels; Vasodilators to lower blood pressure and relax the blood vessels; Diuretics to help expel extra water and salt; and Digoxin, which helps the heart pump better.

Although medical management is often successful in treating heart failure in earlier stages, end stage heart failure requires therapies beyond drugs. Previously, heart transplantation was the only hope for such patients. Founded over a quarter of a century ago, the heart transplant program at NewYork-Presbyterian Hospital/Columbia University Medical Center is the top cardiac transplant program in the United States by volume. In conjunction with this program, the Center for Advanced Cardiac Care (led by Medical Director Donna Mancini, MD, Division of Cardiology, Department of Medicine), provides the most advanced medical and surgical options to patients with heart failure. Moreover, in an effort to overcome some of the limitations of transplantation (in particular, the long waiting lists for donor organs), Columbia's surgeons have helped to spearhead the international effort to develop and implement cardiac assist devices, which provide mechanical support to failing hearts.

The Mechanical Circulatory Support Program, led by Yoshifumi Naka, MD, PhD, Director of the Cardiac Transplantation and Mechanical Circulatory Support Programs, was founded in 1990 to provide a "bridge-to-transplantation" for patients requiring heart transplants—supporting their lives until a suitable donor heart became available. Today, this program also offers assist devices as a "destination therapy" for patients with end stage heart failure who are not eligible for a transplant.

HEART FAILURE RESEARCH

Under Dr. Naka's direction, novel research is advancing new approaches to mechanical circulatory assistance. In particular, the center is investigating a range of new devices in an effort to provide patients with devices that are smaller, quieter, and more portable, fully implantable, or capable of providing biventricular support.

This builds on a long history of research in the field, a course that has been marked by outstanding progress.

• The landmark REMATCH trial, led by Eric A. Rose, MD, FACS, proved in 2001 that LVADs prolong the lives of patients with end stage heart failure. This led to Medicaid's historic decision in 2003 to cover the costs associated with LVAD implantation.
• In 2005, NewYork-Presbyterian/ Columbia was awarded a $17 million NIH grant to study the main problems associated with LVADs. Studies funded by this grant are leading to better understanding of, and methods to minimize, problems such as infection, bleeding, neurological problems, and device malfunction.

Patients who go on to have heart transplantation surgery will significantly benefit by research conducted by Mario C. Deng, MD, Director of Cardiac Transplantation Research in the Department of Medicine, Division of Cardiology. Instead of undergoing repeated endomyocardial biopsy (EMB), an invasive, uncomfortable, and potentially risky test for signs of organ rejection, heart transplant patients can now be routinely tested through a simple blood test. Only if the blood test shows definitive signs of organ rejection will patients need to undergo EMB. The development of this test was made possible by harnessing the knowledge gained by mapping the human genome. In other work, Dr. Deng and colleagues are investigating the relationship between the cardiovascular system and the immune system, and are examining the impact of mechanical circulatory support devices and heart transplantation on survival and quality of life.