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New Therapy at OHSU Hospital Extends Heart Failure Patients' Lives

   Portland, Ore.

OHSU is only Oregon hospital and one of few in the country offering the therapy

The cardiac team at OHSU Hospital has given a Bend man a new lease on life thanks to its ability to provide treatment not available anywhere else in Oregon.

Lee Tomlinson of Bend, Ore., suffers from pulmonary hypertension and heart failure, but was too sick to receive a heart transplant and had only a few weeks to live. OHSU Hospital's cardiac surgery team implanted a ventricular assist device (VAD) into his heart, improving his quality of life and extending survival for one to two more years.

"It was touch and go. Now I'm taking walks, parking at the opposite end of store parking lots so I can walk more, and I've recently walked the course at the Grotto," said Lee, 62. The device is connected to two battery packs that sit in holsters on the sides of his belt.

VADs have been used for several years to help patients with heart failure survive until heart transplant or give their hearts a rest while healing after a severe heart attack. Within the last few months, selected cardiac teams around the country have been approved to implant the HeartMate left ventriclular device (LVAD), made by Thoratec, for destination therapy - long-term support for patients with severe heart failure. Heart failure is typically caused by heart attack, dilated cardiomyopathy, valve disease, other forms of heart disease or birth defects.

The LVAD is a blood pump that takes over almost all of the work of the failing left ventricle, the main pumping chamber, to supply oxygenated blood to the body. The device is implanted in the abdomen and is inserted into the left ventricle. The blood is pumped from the LVAD to the aorta, the body's main artery.

"It's exciting that we can now use the electric HeartMate to extend the survival of patients with advanced heart failure who may not qualify for heart transplant," said Ray Hershberger, M.D., director of OHSU Hospital's heart failure and cardiac transplant program, and professor of cardiology in the OHSU School of Medicine.

OHSU Hospital is the only center in Oregon and one of only about 70 in the country accredited by the Centers for Medicare and Medicaid Services to provide the new, life-extending therapy. An accredited center must be a Medicare-approved heart transplant facility and have implanted at least 15 VADs between Jan. 1, 2001, and Sept. 30, 2003, among other criteria. OHSU Hospital's cardiothoracic team has implanted 35 devices and cared for 42 patients with VADs. The only other CMS-approved heart transplant programs accredited to perform destination therapy in the region are located in Seattle and Spokane.

"What this means for these patients is time and improved quality of life. Patients are able to leave the hospital, spend time with family and do things that patients with end-stage heart failure would never be able to," said Matthew Slater, M.D., OHSU Hospital cardiothoracic surgeon and assistant professor of surgery (cardiothoracic surgery) in the OHSU School of Medicine. "We feel fortunate that we can offer this to our patients."

Pasala Ravichandran, M.D., surgical director of OHSU's heart transplantation program and assist device program and associate professor of surgery (cardiothoracic surgery) in the OHSU School of Medicine, performed the procedure with Slater's assistance. The team has well known interest in treating end stage heart failure and have the largest experience in left ventricular restoration procedure after severe heart attacks.

The cardiac team that cares for patients like Lee is extensive. Lisa Pickens, R.N., is OHSU Hospitals' VAD coordinator. It's her job to educate the patient's care providers on how to support Lee at home and when he needs medical care in Bend.

Lee is OHSU Hospital's first destination therapy patient. Patients who qualify for this therapy would have a life expectancy of less than two years and not be a candidate for a heart transplant. Hershberger said the team expects to help five to 10 patients a year. As VAD technology improves, this number is expected to increase substantially. An estimated 100,000 or more patients each year in the United States may qualify for this new therapy.

Previously, the only treatment available to sustain these patients was continuous intravenous medications to help keep the heart pumping. But that treatment limits the patients' mobility, reduces their quality of life and provides a shorter life expectancy.

The Food and Drug Administration approved Thoratec's HeartMate LVAD for use in destination therapy in November 2002 and is the only device approved for this treatment.

Lee is optimistic about his future. So what does Lee plan to do with his life now? "Do things I put off all my life. Mostly travel. I'm a curious guy. I hope one day I'll be eligible for a transplant"

OHSU Hospital's heart transplant team has performed more than 440 heart transplants since it started in 1985. It was Medicare certified three years later. As part of that team, the OHSU Heart Failure Treatment Program is able to develop new medical treatments for heart failure patients, allowing many to delay or eliminate the need for heart transplantation. OHSU Hospital is the sole hospital in Oregon that is part of the state's only health and research university.

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