Upgrade Opens Heart Therapy to More Patients

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MADISON—A therapy is only as good as the number of patients it can safely help.
That's why a new evolution in a device used to help patients with failing hearts has interventional cardiologists excited about the opportunity to use it on a wider spectrum of patients.
Physicians in UW Hospital and Clinics' cardiac catheterization laboratory recently became the first in Wisconsin to begin using a next-generation heart pump that takes over the job of pumping blood in very ill patients while they undergo complex cardiac catheterization procedures.
The primary difference between the new Abiomed Impela 2.5 and the CardiacAssist TandemHeart device UW Hospital has been using for the past four years is the size of the device inserted into the patient's arteries. The TandemHeart pumps have large tubes, which occasionally created an increased bleeding risk for certain patients.
"The main advantage of the new device is that it's a little bit smaller and easier to insert, so we think we can use it in a broader set of patients who have disease in their arteries, with fewer bleeding complications," says Dr. Matt Wolff, chief of cardiology for UW Hospital and Clinics. In the four years in which UW has been using percutaneous assist devices, Wolff and his colleagues have inserted more than 30 of them.
According to Wolff, the new model could double or even triple the number of patients who receive the therapy each year.
It won't be viable for every patient, however.
"There are still some situations where we would need more blood flow and would be willing to accept the larger tubes to achieve that," says Wolff. "We're constantly weighing the risks and benefits of these devices in procedures we're doing, but we believe this will broaden the number of patients we can help with this overall strategy."
The percutaneous cardiac-assist devices are different than the surgical versions that have primarily been used as a bridge to heart transplant for patients whose hearts are failing but for whom a donor heart is not yet available. The pumping mechanism in the Impella 2.5 lies within the catheter-based device, inserted through the femoral artery, and is designed to be a temporary tool to help doctors as they place stents into blocked arteries or perform complex angioplasties.
In clinical trials, the U.S. Food and Drug Administration has allowed percutaneous devices to remain active in patients for a longer period of time. These devices are used to preserve the heart muscle and preserve other end organs while allowing time for the heart to recover or while the patient awaits further surgery.
Since introducing the new device in June, UW physicians in the catheterization lab have used six Impella devices in heart patients. More than anything else, physicians are happy to have another tool in their treatment arsenal.
"It's tremendously exciting," says Wolff. "Other cardiologists don't have access to as wide a range of tools as we do. With the ability to use cutting-edge technology in a multidisciplinary environment, we're really able to treat and offer hope to the sickest of patients."

Date Published: 10/01/2008

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