Innovative Procedures Offer Hope for Patients with Severe Heart Disease
ATLANTA - Medication, lifestyle
changes and, when necessary, bypass surgery or angioplasty can help
many people with heart disease. But for some people with severe cardiovascular
disease, these options do not adequately relieve pain or help improve
the quality of their lives. In fact, traditional bypass surgery and/or
angioplasty may not even be attempted in some people with severe disease
because blood vessels are too small or their disease is too widespread.
So what can be done to help
those with serious coronary artery disease who have run out of medical
options? According to Emory Crawford Long Hospital (ECLH) cardiothoracic
surgeon Omar Lattouf, MD, PhD, there are new ways to help many of these
people -- including patients who have been told in the past that there
was no hope and no help available.
(TMR) and 'hybrid' TMR/bypasses are innovative surgical procedures available
now at ECLH that offer hope for many people with severe cardiovascular
disease -- and current research into gene therapy may also provide additional
ways to help them in the future," says Dr. Lattouf.
TMR surgery treats ischemia
(lack of oxygen to tissues) and the resulting pain known as angina by
using a YAG laser to punch small holes through diseased myocardium (the
muscular wall of the heart). These channels are believed to restore
blood flow and oxygen to the heart muscle, effectively relieving angina
pain in patients for whom conventional treatment is not indicated or
has been insufficient. "PET scans of patients who had signs of very
severe ischemia prior to TMR have documented reversal of ischemia after
TMR," says Dr. Lattouf, who is Director of the TMR Program at ECLH.
There are several hypotheses
about other ways TMR affects the heart. "Testing on hearts that have
TMR show that organized cells accumulate inside the created channels
and may be a precursor to angiogenesis (the growth of new blood vessels)
in the proximity of those channels," notes Dr. Lattouf. "It may also
modify nerve function in the heart, reducing pain."
A "hybrid" TMR/bypass procedure
can be used on patients who have one or two areas suitable for bypass,
but another region that is totally occluded and not bypassable. "We
maximize the blood supply to the new grafts in the area that can not
be grafted, using the TMR laser," Dr. Lattouf explains. "In addition,
TMR is an accepted indication to augment bypass in some patients who,
because of very small vessels or the diffuse nature of the disease in
the target vessel, may be at risk of grafts failing prematurely."
Approximately 70 patients
have been treated with TMR or the TMR/bypass hybrid procedure at ECLU.
"A number of them were turned down for angioplasty and bypass," says
Dr. Lattouf. "At follow-up, the great majority have gotten pain relief
and experienced improved exercise tolerance, some for as long as three
years so far."
Dr. Lattouf is also a principal
investigator in a multi-center national trial of recombinant gene therapy
that could provide yet another new therapy for severe heart disease
by triggering angiogenesis. The randomized double-blinded study involves
injecting an escalating dose of genes or a placebo into the target zone
of an ischemic myocardial region that is not suitable for a bypass at
the time of a current bypass operation. "Over the next five to ten years,
I believe cell therapy is going to be a major area of transition from
basic science and clinical research to clinical applications that provides
direct patient benefits," says Dr. Lattouf.
The Emory Heart Center
is comprised of all cardiology services and research at Emory University
Hospital (EUH), Emory Crawford Long Hospital (ECLH) Carlyle Fraser Heart
Center, the Andreas Gruentzig Cardiovascular Center of Emory University
and the Emory Clinic. Ranked in the top ten of U.S. News & World Report's
annual survey of the nation's best Heart Centers, the Emory Heart Center
has a rich history of excellence in all areas of cardiology - including
education, research and patient care. It is also internationally recognized
as one of the birthplaces of modern interventional cardiology.