When it comes to hearts, Taneal Wilson won the lottery. A small pump implanted to keep the 31-year-old alive long enough for a heart transplant somehow helped Wilson's ravaged heart completely recover instead.
Only a lucky few are ever weaned off those implants, their rested hearts able to work on their own again. How to duplicate those successes is one of cardiology's biggest questions - as a new generation of the heart pumps begins US testing.
"Why his heart recovered and the next person's heart does not recover, we don't know," said Dr Steven Boyce, Wilson's surgeon at Washington Hospital Centre in the US capital. "We're waiting for the science to catch up to the art."
That science is beginning. Doctors have begun pairing heart pumps with high doses of cardiac medication in hopes that more aggressive therapy will shrink flabby enlarged hearts enough to avoid a transplant, or at least enable patients to survive longer without one.
Experts urge testing on 'less sick'
At a few hospitals in the US and Britain, they are also testing an experimental steroid-like drug on pump recipients that might spur heart muscle to rebuild.
Experts gathered by the National Institutes of Health recently urged testing heart pumps on patients who aren't quite as sick, instead of reserving them for the near-dead like doctors do today.
By that time, "we probably have lost our window of opportunity," said Dr Lyle Joyce of the University of Minnesota - part of the first study to see if the slightly less sick fare better using Ventracor's next-generation VentrAssist pump.
It's much-needed work. Heart failure is on the rise, with 5.3
million Americans and 20 million people worldwide whose hearts become weak and unable to pump properly due to age, damage from a survived heart attack or other problems. In half of all cases, doctors can't even find a cause - like Wilson, who went from healthy to near comatose in a matter of weeks.
Hope that new generation LVADs will last longer
Medications and certain pacemakers help, yet heart failure kills
57 000 Americans a year and contributes to many more deaths. Only about 2 100 patients a year receive a heart transplant. A few thousand more try to buy time with "left ventricular assist devices" or LVADs, that take over the left ventricle's job of pumping blood through the body, powered by special batteries worn in a waist pouch.
Early pumps were too big for many patients and wore out quickly, the longest lasting just over a year. Last spring, the Food and Drug Administration approved a mini-LVAD, Thoratec Corp.'s HeartMate II, deemed safer and, with fewer moving parts, expected to last longer.
Now comes a third generation of LVADs that doctors hope will last five years or longer because they have just one moving part. Among them: VentrAssist, which has begun US testing, and a pump by HeartWare Ltd. -to begin testing soon - designed to be even smaller and easier to implant.
Resting the heart can prove remarkably rejuvenating. About a third of LVAD patients have significant improvement in heart muscle function, making them better transplant candidates, says Dr. Simon Maybaum of New York's Montefiore Medical Centre, who led the best study to date of recovery.
But rarely do patients fare as well as Taneal Wilson - whose pump was surgically removed June 17, 10 months after its implant, because his heart is functioning like a normal 30-something's again. Between five and nine percent of LVAD recipients have been weaned off, some only to quickly relapse.
Adapting to life sustained by batteries
Boyce postponed Wilson's explant for months to be as sure as possible that his heart would beat unaided. "This is a second chance God gave me," says Wilson. "I told the doctors every day, 'I got two sons. I need to go home to them."'
Wilson was a school maintenance crew supervisor, used to physical labour, when he suddenly found it difficult to breathe. He spent weeks in intensive care before Boyce could implant the then-experimental HeartMate II, the only LVAD small enough to fit his chest.
Looking back, Wilson laughs about adapting to life sustained by a battery change every three to four hours. He initially made friends carry a heavy bag of eight extra batteries whenever he walked along Washington's streets. Then one day Wilson went to a grocery store for cake mix and carried just two extra batteries inside - only to worry the whole time that someone would steal his truck where he'd left the rest.
But he got confident enough to venture out to his former hangouts: "My buddies got the batteries. ... I'd just sit back and enjoy myself like everybody else."
Doctors can't yet predict which LVAD recipients will be lucky like Wilson, although so-called acute patients with abruptly damaged hearts have a better shot. More hospitals are learning how to dial back the pumps to test for recovery.
"If you don't look for it, you can't find it," says Maybaum, whose own hospital had two explants in the last year. – (Sapa, July 2008)
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