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BREAKTHROUGHS AND TECHNOLOGY
A heart transplant is typically the last option for a person with a failing heart, if the patient can survive long enough for a donor heart to be found. The good news is many patients are now able to experience a better quality of life—and often better health—as they await a transplant, thanks to advances in the field.
There are ongoing challenges too. The possibility of the immune system’s rejection of a donor heart hasn’t been totally eliminated. “We can’t stop rejection. But it’s now manageable and usually well controlled,” says J. David Vega, director of Emory
University Hospital’s Heart Transplant Program. “And like any other aspect of medicine, with time and continued education, new technologies, new drugs, and our experience, we’ve been able to do more to improve outcomes for heart transplant patients.”
LVADs, the implanted mechanical pumps that help the bottom left chamber of a failing heart move blood to the aorta, the body’s main artery, and then throughout the body, are an example.
First used in the mid1960s, the devices were once so large that they were only used in hospitals for short-term support.
Their size also meant that women were mostly excluded from being able to use an LVAD, says Wendy Book, director of the Emory Adult Congenital Heart Center. “Now they are so small they fit in the palm of your hand. In fact, they have been miniaturized enough that babies and children with heart defects who need transplants can benefit from these devices.”
Durable LVADs designed for long-term implantation are not only helping patients awaiting heart transplants, they also are used to improve heart function in people with advanced heart failure who aren’t candidates for transplant.
“We have a large of population of patients who have durable LVADs, and some people live five to 10 years with these implanted devices at home, leading relatively normal lives,” says Mani Daneshmand, director of the Emory Heart and Lung Transplantation program. Remarkably, the technologies used to support patients for transplants have resulted in some people improving so much they no longer need new hearts.
“One of the technologies we use to support people for transplants is a temporary mechanical support device known as the Impella 5.5,” Daneshmand says. “It is a pump we put in through the axillary artery that goes into the heart. The device supports the heart without patients undergoing major heart surgery.”
Extracorporeal membrane oxygenation (ECMO) is another groundbreaking technology used by the Emory Heart Transplant team. ECMO involves pumping blood outside of the body to a machine that removes carbon dioxide and sends oxygen-rich, warmed blood back through the body, allowing the heart to rest and heal.
Emory also has participated in a research study of the TransMedics OCS (organ care system) for use with hearts for donation after cardiac death, which describes hearts removed because they stopped naturally or because the patient was taken off life support. Last fall, the FDA approved the TransMedics OCS technology for commercial use, and it is expected to make more donor hearts available.
“The TransMedics OCS heart device allows us to evaluate hearts that are good but would have otherwise not been used for various reasons,” says Daneshmand. “For example, the heart might have been too far away, or based on an initial assessment, the heart might be deemed not good enough for transplant. But on the device, the heart can get stronger and better.” EHD