Vol. 8 No. 1
March 1998

Insuring Quality Community Healthcare

Winthrop's Advance Directive Initiative

The Winthrop South Nassau University Health System Opens Homecare*America Superstore in Mineola

Winthrop Welcomes Three New Directors

Winthrop Opens a Second, Fully Monitored Neurosurgical Intermediate Care Unit

Winthrop's $12 Million New Life Center is on Track for July, l998

Winthrop's Long Island Regional Poison Control Center Observes Fifth Anniversary of Averting Danger, Saving Lives

Patient Unit is Dedicated to the Management of Chronic Obstructive Pulmonary Disease

Long Island's First Dual Chamber Defibrillator is Implanted in Winthrop's Electrophysiology Lab

Report from The Heart Institute at Winthrop: Third Cardiac Catheterization Lab is Authorized by State Department of Health

Winthrop's Artificial Heart Device Program: A Revolutionary Treatment for End-Stage Heart Disease Patients

Winthrop's Dialysis Centers Receive National Award for Patient Encouragement - One of Only Six Programs in the United States to be Recognized

Endoscopic Ultrasound: On The Forefront of Technology

Long Island Chapter of Impotents Anonymous Meets at Winthrop, Filling an Intimate Need ---Confidentially

Winthrop's Stem Cell Autologous Transplantation Therapy Program Saves a Life - And Can Save More!

Winthrop Adds Powerful New Radiological Intervention

Winthrop Auxilians Donate Service, Talent, and Creative Fundraising

Winthrop's Division of Reproductive Medicine Makes Parenthood Possible

Dialysis is technology...but caring is an art.

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Remember the riveting pictures of Dr. Barney Clark on the front pages of all the newspapers some 15 years ago? Dr. Clark had severe end-stage heart disease, and a transplant operation was not an option. Bedridden and frail, he became the first recipient of a mechanical heart. Tethered to a pump that resembled a refrigerator, Dr. Clark was sustained for 114 days, during which he was immobilized and gravely ill.

While congestive heart failure, or end-stage heart disease, continues to be a major public health problem with more than 400,000 new cases diagnosed every year, much has changed. Cardiac transplantation has been remarkably successful, with 60% of these patients surviving for five years or longer following transplantation. However, the limited supply of donor hearts makes cardiac transplantation an effective treatment for only about 2,000 patients annually.

The vast discrepancy between those who could benefit from transplantation and the number of suitable heart donors has spurred the successful development of a new generation of mechanical hearts, revolutionizing therapy for heart failure, and providing end-stage heart disease patients with hope and a better quality of life. Many recipients of the latest artificial heart device can now lead active, useful lives. Some work full-time and exercise - even playing tennis.

William C. Scott, MD, Chairman, Department of Thoracic and Cardiovascular Surgery, Winthrop-University Hospital, displays the HeartMate IP LVA, the implantable "artificial heart" device, now available at Winthrop.

Advanced "Artificial Heart" Technology at Winthrop
Affiliated with the Columbia University Transplant Program, Winthrop-University Hospital's cardiac surgeons have become skilled in the use of the most advanced "artificial heart" technology - the Left Ventricular Assist Device (LVAD). This mechanical pump, when implanted in the body, assumes the function of the left ventricle, the heart's most critical pumping chamber. It enables the body's own left heart to rest, while simultaneously supporting the body with normal, or near normal blood flow.

When implanted, the LVAD serves as a bridge, or intermediate step, to transplantation. In addition to postponing the infection, rejection, and cancer-producing effects of transplantation, these devices can be produced in the large numbers required by patients, who might otherwise die while awaiting suitable donor hearts for transplantation.

The first FDA-approved LVAD was the HeartMate IP, now available at Winthrop. The device consists of a pump driven by compressed air through a flexible drive line or tube, which comes out through the skin. Roughly the size of a man's palm, it is implanted in the abdominal cavity and connected to the heart at two points, so that blood is diverted from the left ventricle into the pump and then forced into the aorta and through the body. It is controlled by a connected computerized console. Patients can be very mobile with the LVAD, able to walk and exercise comfortably. A new, more portable drive console is currently being tested, and will be available in the near future.

Available on Long Island Only at Winthrop
To date, 129 centers worldwide have implanted 791 devices as bridges to transplantation, including 81 centers in the United States, two in the New York Metropolitan area, and only one on Long Island - Winthrop's Heart Institute. Results with this IP LVAD have been excellent. Of the 791 implants, 50 are still ongoing. The average age at implantation in the U.S. is 49; the average duration of support is 85 days; and the longest duration of support has been 726 days. Of these patients, 69% survived until a transplant or removal of the device, with recovery of the native heart. In the most recent experience, the success rate, after the early learning curve, has been 73%.

The primary indication for implantation of the HeartMate LVAD is in patients who are deteriorating with end-stage heart failure, while awaiting heart transplantation. All patients must be candidates for transplantation and evaluated prior to implantation. On occasion, there are very ill patients for whom formal evaluation is impossible. They may be considered for implantation with a rapid screening for transplantation suitability. Some patients undergoing conventional cardiac surgery, who are very high risks for poor heart function following surgery, may also be candidates for LVAD implantation, if they do not do well in the operating room with the conventional operation. These patients must be screened for cardiac transplantation preoperatively and can then have an LVAD on standby to be implanted, if necessary.

Because of the growing shortage of donors, only critically ill patients now receive cardiac transplants. The results of transplantation have been, therefore, somewhat less favorable than previously, reflecting the degree of deterioration of the recipients prior to transplant. A growing body of evidence shows that survival in these severely ill patients is better when LVAD is utilized prior to transplantation, compared to the survival in unstable patients who go straight to transplantation. In addition, preliminary evidence shows that some patients considered for transplantation with "irreversible" heart failure have improved after resting the heart with LVAD implantation, and may even be candidates for removal of the device later.

"As our experience with these devices grows, and as further refinements of these pumps are made, thousands of patients dying of end-stage heart disease, who are not transplant candidates, will benefit from LVAD implantation, with prolonged, meaningful survival becoming a reality," says William C. Scott, MD."Currently, an FDA-approved and HCFA-sponsored study is underway to evaluate the current LVAD for this use."

The indications for implantation continue to evolve and will be refined with experience. The Winthrop Heart Institute and End Stage Heart Disease Program, in affiliation with the Columbia University Transplant Program, are further refining this cutting edge technology and are continuing to provide the Long Island community with the most advanced care and technology for patients with heart disease.

For more information, call 516/663-2384.

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