Repairing, Restoring,

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Repairing, Restoring, Replacing Worn Hearts
University of Maryland School of
Medicine MINI-MED School

• Surgical Revascularization (Heart Bypass)
• Ventricular Remodeling (Reshape Heart)
• Gene Cell Rx (Regrow Hearts)
• Heart Transplant
• Mechanical Support (Implanted Pumps)

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Broadening Surgical Options Rx HF
CABG
LV Restoration
Tx
Organ
Destination Rx
Cell
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1985 -1st U.S. Jarvik TAH Bridge Pt.-HomeWe Have
More Options Now But 13 Yr Surival
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Heart Failure Rising in USA

• 550,000 new cases per year
• mortality
• 5 yr 50

Thousands of patients
year
Nat. Center for Heath Statistics
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HOW CAN WE TELL BYPASS WILL HELP ?
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LV Remodeling Post MI
infarct expansion hrs to days
acute MI (hrs)
global remodeling days to months
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After a Heart Attack The Heals with Scar LV
REMODELINGBAD
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Normokinetic or normal area not involved in
heart attack
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shrinkage fraction
30
()
-5
Akinetic or scar area
-10
4 days
4 weeks
6 months
1.5 years
3 years
Gaudron P., l993
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GUSTO IESVI and MortalityBIG HEARTS THAT
EXPANDED DID WORSE
ESVI ml / m2
Migrino RQ Circulation 1997
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Septal Exclusion
Akinesia without Scar
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EF 20 LVESVI 98 ml/m2
EF 38 LVESVI 57 ml/m2
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Plan for Cardiac Surgery _at_ UMM

• Key Considerations
• Recruit Team
• Quality
• Innovative Programs
• Research
• Access to Market
• Intramural assist in chief of
  cardiol. recruitment work closely with section
  heads (esp Mark Kelemen)
• In System -work with MGH NAH to
  capture referrals
• Region -one at a time Easton office
  selective cardiology recruits to Assoc Program
  

Eric Segal
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Surgically Rebuilding HeartsWorlds 1st for UMB
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CorCap External Restraint DeviceCORSET for the
HEART
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Cor Cap Ventricular Restraint
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HEART TRANSPLANTATION at UMMC

• Program revived 11/01
• 29 Procedures
• 88 absolute survival
• Medicare approved 6/03
• CMS select site Destination Rx 11/03
• New Immunosuppression

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Replacing the Heart

• Cardiac Transplantation
• since 1/02, 23/25 patients survive
• (1 late death from cancer)
• New Immunosuppression

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Heart Transplant Survival (ISHLT N52,195)
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Thoratec Heartmate LVAD BLOOD PUMP for LEFT SIDE
of HEART
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REMATCH, Jun 21, 2002 108 events p 0.00129
1.0 0.8 0.6 0.4 0.2 0.0
408 days
Pr alive
150 days
Med Rx
0 6 12 18 24 30 36
Time (months)Plot created Fri Jun 21 163802
EST 2002
O61 28 17 8 3 L68 41 35 23 9 2 1
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Jarvik2000 Small,Continous Flow,ThoracotomySlick
Platform for Repair or Recovery ?
UMM Implant 9/01
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Jarvik 2000..Small Format Vad
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Abiocorä Implantable Total Heart

• Smaller Market
• Large Pump
• L R Side Balance
• Remarkable Engineering
• Romantic Favorite
• UMMC approved

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CAN WE REGROW HEARTS ? You BetSoon !
Cell and collagen alignment?
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Injecting Myoblast Cells in HeartUMM
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Rebuilding Human Hearts from Cells Study _at_ UMB
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ES Wall Thickening
0
Delayed contrast-enhanced MRI (08/14/2003) MJP
Short-axis cine MRI (08/14/2003) MJP
Base Mid
Apex
Courtesy of C. Swingen, University of Minnesota
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