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January 13, 2003


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.

"Transmyocardial revascularization (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.

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