HELPING THE FAILED HEART

The brilliant cardio-surgical team in Royal Brompton Hospital and Harefield Hospital, UK hasve again shown us an important fact, that a heart that has failed, resulting in severe heart failure, requiring cardiac transplantation, can recover. It used to be standard teaching that cardiac tranplantation is reserved for the very few, whose heart is so severe damaged, and failed, that they need a new heart. The problem is that there are not enough hearts for cardiac transplant needs, resulting in a long waiting list for cardiac transplantation.

The UK cardiac surgeons, led by the world famous, Sir Magdi Yacob, obviously had the same problem. They were obviously studying the role of left ventricular assist devices (LVAD) in this very sick population. In their recent publication in the New England Journal of Medicine, they reported their findings in 15 patients who were on the heart transplant waiting list. To keep them alive (they were so sick that anti-heart failure drugs were insufficient), they were given the left ventricular assist device (LVAD), which is often used as a bridge to surgery, while the patient awaits for a suitable donor.

To their surprise, they found that 11 recovered and 8 were still well after 4 years without the need for heart transplant, and were just on drugs without CCF. This is wonderful news for those awaiting heart transplantation. It is important to note that these patients were suffering from dilated cardiomyopathy and not from ischemic heart disease. This difference is important as ischemic heart disease usually results from infarcted heart muscle which can no longer function (all fibrous tissue). It would appear that in dilated cardiomyopathy, the heart muscle could be so weaken that they fail, but when they are given time to rest (the LVAD is doing the LV work), the cardiac sarcomeres can recover. I trust that this UK cardio-surgical team had chosen for heart transplantation, patients who had irreversible heart failure. This study findings certainly gives new hope for all who are awaiting heart transplantation.