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Implantable Device to Help the Heart Pump
Each year thousands of Americans die while awaiting a new heart

Early in his career, Dr. Eric Rose, now associate dean for Translational Research and chair of the Department of Surgery at Columbia, saw heart transplant patients deteriorate and die while waiting to receive new hearts. Confronted with this reality, he was moved to commit his professional career as a cardiac surgeon to developing new methods, besides transplantation, to replace a heart.

"As the former director of Columbia's heart transplantation program for 10 years, I saw many patients die while awaiting a heart because of inadequate supply or who were not candidates for a new heart because of donor restrictions," said Dr. Rose. "There are only 2,000 heart transplants done per year in the United States and 250,000 deaths due to heart failure—the need is clearly much greater than the supply."

Research conducted with animals enabled the invention and testing of implantable heart pumps, called left ventricular assist devices (LVADs), which function as cardiac replacement therapy for patients with severe congestive heart failure. The devices assist in pumping oxygenated blood from the heart's left ventricle—the heart's major pump—to the aorta, where it travels to the rest of the body.

Early on the machines were primitive—they often occupied a large portion of an operating room and were connected outside the body. Later they were reduced to the size of a large grapefruit—enabling them to fit inside the chest cavity. Now they fit easily into the palm of a hand.

Today LVADs extend lives by years and improve the quality of life for many patients—those awaiting heart transplants and others with heart failure. The U.S. Food and Drug Administration and Medicare have both granted approval for permanent implantation. However, there are still challenges and potential complications, such as bleeding and infection.

Columbia's team, again led by Dr. Rose, is conducting new research with animal models in pursuit of new techniques to reduce infection and improve methods to prevent clots and bleeding. The team is developing a treatment for thinning blood that can also protect the mechanisms for clotting. Blood-thinning medications are traditionally given to patients on a heart-lung machine to prevent clotting. But if the medication is not reversed after the operation, a patient can bleed to death.

"The view has always been that you could never separate out the propensity for bleeding from the ability to block clotting," said Dr. Rose. "But we think that we can." Dr. Rose and his colleagues have developed a medication that selectively controls coagulation, allowing a patient's wounds to clot while preventing clotting in a heart-lung machine. The medication, now called TTP889, has been successful in animals and will soon be tested in human clinical trials.

Columbia's most advanced research in the area of heart transplants aims to perfect human cell transplantation to replace damaged parts of the heart, rather than replacing the entire organ or using LVADs. This would be yet another huge step toward reducing dependence on heart donors.
© 2005 Columbia University