The Texas Heart Institute at St. Luke's Episcopal Hospital Heart Failure Program has instituted programs to treat heart failure aggressively and has successful initiatives spanning the continuum of care. Referring physicians and their patients benefit from these programs, as do healthcare professionals who want to learn firsthand about optimal management approaches.
While remaining in the care of their referring physician, patients of the Heart Failure Program have access to specialty care as needed. Referring physicians can collaborate with a wide range of staff specially trained to care for patients with congestive heart failure, including cardiologists, cardiovascular surgeons, nurses, dietitians, rehabilitation therapists, social workers, and home health providers.
The Program's staff works with physicians to provide the following options to patients:
- State-of-the-art medical therapies including oral and intravenous vasoactive medications, continuous intravenous inotropes, and various investigational agents, if appropriate.
- Advanced surgical therapies including left ventricular assist devices, resynchronization therapy and cardiac transplantation
- Intensive inpatient therapies including nesiritide, dobutamine, milrinone, and intra-aortic balloon counterpulsation on specialized inpatient units
- Potential future therapies including myocyte transplantation, somatic gene therapy and the next generation total artificial heart
The Heart Failure Program offers patients:
- Individual follow-up and telemonitoring
- Individual and group education programs for symptom management, diet and exercise
- Specialized home nursing care
- Improved support for patients between scheduled appointments
This team approach offers advantages and alternatives for both patients and their referring physicians. Through the Heart Failure Program, patients remain in the care of their referring physician, who is kept informed of their patient's condition and progress at all times.
Treatment Options
Treatment for heart failure can include lifestyle changes and medicines. But in some cases, surgery may be necessary to more effectively ease the workload of the heart. Listed below are some of the methods practiced at Texas Heart Institute at St. Luke's Episcopal Hospital for treatment of heart failure.
Coronary Artery Bypass Graft
Coronary artery bypass graft operation (often abbreviated as CABG and pronounced "cabbage") improves the blood flow to the heart with a new route, or "bypass," around a section of clogged or diseased artery.
The surgery involves sewing a section of vein from the leg or artery from the chest or another part of the body to bypass a part of the diseased coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly. Doctors most frequently use a vein from the patient's leg or an artery from the chest or wrist. By attaching this vein or artery to the heart artery above and below an area that has been blocked or narrowed, the doctor creates a bypass around the blockage. Rerouting blood around the clogged arteries in this manner improves blood and oxygen flow to the heart.
Valve Surgery
Valve repair or replacement is another option for the treatment of heart failure. Repair may involve opening a narrowed valve by removing calcium deposits or reinforcing a valve that doesn't close properly. Repair may also be used to treat congenital defects and defects of the mitral valve. Replacement is used to treat any diseased valve that cannot be repaired. It involves removing a defective valve and stitching in its place a prosthetic valve. Prosthetic valves can either be mechanical (made from materials such as plastic, carbon, or metal) or biological (made from human or animal tissue). Mechanical valves increase the risk of blood clots forming on the new valve. Patients with mechanical heart valves will need to take blood-thinning medicines for the rest of their lives. Valve surgery is an open heart technique. This means that surgeons use a heart-lung machine, because the heart must stop beating for a short time during surgery.
Transmyocardial Laser Revascularization
Transmyocardial laser revascularization (TMLR) is a treatment option for patients with angina who are not suitable candidates for more conventional medical intervention or surgery. The laser creates anywhere from 10 to 50 channels to provide blood flow from the left ventricle -- the heart's main pumping chamber -- into the ventricular cavity in the area of the heart suffering from a lack of oxygenated blood.
The TMLR procedure is performed under general anesthesia. The surgeon begins with an incision in the patient's left chest then, with access to the heart, uses a laser to create multiple narrow channels through the wall of the left ventricle into the ventricular cavity in the area of the heart. The inside surface of the channels develop a smooth, permeable membrane that allows blood to flood to heart muscle. The exterior surface opening of the channel is sealed off as blood coagulates and scar tissue closes the hole. The TMLR procedure usually takes about two hours.
Sometimes, one part of the heart can be treated with bypass surgery while another part of the heart can be treated with TMLR. In these cases, TMLR and bypass surgery are done at the same time.
Recovery requires between three to four days in the hospital. After the procedure patients will have to rest and limit their activities. St. Luke's offers a cardiac rehabilitation program that many doctors recommend for their patients. Patients with an office job can usually go back to work in four to six weeks. Those who have more physically demanding jobs may need to wait longer.
Most of the time, the symptoms of coronary artery disease and angina get better after TMLR, but it may take three months or more to see improvement.
Heart Transplant
As the heart problem gets worse, the heart grows weaker and is less able to pump oxygen-rich blood to the rest of the body. Because the heart must work harder to pump blood through the body, it tries to make up for this extra work by becoming enlarged (hypertrophied). In time, the heart works so hard to pump blood that it may simply "wear out," and be unable to meet even the smallest pumping demands. Medicines, mechanical devices to assist the heart, and other therapies can sometimes help and even improve a patient's condition. But when those treatments fail, transplantation becomes the only option.
Implantable Left Ventricular Assist Device
Though transplants offer hope for approximately 2,000 advanced heart failure patients each year, more than 250,000 patients have no viable treatment option and are considered at high risk for repeated hospitalizations, severely diminished quality of life and limited life expectancy.The HeartMate II LVAS is a mechanical circulatory support device intended for a broad range of advanced-stage heart failure patients. A rotary, continuous-flow device, the HeartMate II is designed to provide long-term cardiac support. The device is implanted alongside a patient's native heart and is designed to take over the pumping ability of the weakened heart's left ventricle—it can pump up to 10 liters of blood per minute covering the full output of a healthy heart. It is designed for easier implantation, and with only one moving part, the HeartMate II is designed to provide exceptional reliability and improved patient quality of life. An external system controller regulates pump speed, and a power cable connects the device to a small monitor and power base unit. The device is designed to have a much longer functional life than the previous generation of devices and to operate more simply and quietly.
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