Stavros Drakos, MD, PhD, a cardiologist at University of Utah Health, talks about a new procedure for saving dying hearts.
What is heart failure?
DRAKOS: Heart failure is when the heart gets weak and doesn’t pump the blood as it’s supposed to into the whole body. Patients that are in heart failure don’t feel well, are short of breath, cannot walk, are out of energy, and out of breath. It’s a miserable life.
You can treat it for a while with medication, but then what happens?
DRAKOS: That’s right. We have some very good medications, and this institution has been at the forefront of developing some of these medical therapies that we are using. But, unfortunately, some of these medications we see wear out, so the patients have symptoms again and don’t feel well. When this point arrives in the progression of the disease, this is when we need to employ other, more advanced therapies.
Has LVAD saved thousands of lives?
DRAKOS: Yes. LVAD, which is a fancy word to describe a cardiac-assist-device, or mini artificial heart, is a lifesaving intervention. It has saved tens of thousands of lives so far. We are proud in this institution because of our contributions over the decades to the development of the cardiac-assist-devices field. So, we’ve been using them over the years and in our institution here with hundreds of patients to save their lives.
Once you get on the LVAD, do you stay on it until you get a heart transplant?
DRAKOS: Yes, that’s absolutely right. Once you get the LVAD, the option would be there as a breach until a donor heart became available and you got a heart transplant. For patients that were not eligible for heart transplantation, the LVADs were serving as lifetime therapy, or permanent therapy. These were the two options.
Is it easy to live with an LVAD?
DRAKOS: I would say that is a fair statement. The LVAD needs to be plugged to the power and you need to recharge the batteries. There is a wire coming out of your belly, and this wire can be a source of problems. When you have something sticking out of your belly, which carries electricity, you may get infections. You cannot easily do things that you would like to do. And of course, you cannot go to the beach.
How do you think a heart that has been on an LVAD, which is diseased, could rebuild or revive itself?
DRAKOS: That’s a great question. How could somebody think that this is even possible? And to be honest, most people thought this was impossible. That’s why when the first observations began coming out as anecdotes from centers all over the country and the world, people initially considered this like coming back from the dead, like Lazarus. Miracles, as we know, don’t happen every day. So initially, people were looking at it with skepticism. But as we got more and more of these cases over the years, people began really looking into it very seriously. The idea is that the heart rests and reinvigorates in a way and recovers. That’s the word we are using.
How does it recover when the LVAD stops it from working?
DRAKOS: The LVAD takes over and removes the stress and the load from the heart, which is weak. The heart and self-repair mechanisms get activated. These resting periods give time for the heart to reboot. Like when we go to sleep then wake up a few hours later fresh, ready to go again. Think about it like that, but a little bit more complicated. When this happens, one of the major questions is how it happened and then how sustainable will this be. So, heart failure, or weakening of the heart, doesn’t come back quickly because then it’s not worth removing something that you will need again next week, and then you need another surgery to put it back. These are the questions that all of us were faced with initially. We are still faced in our effort to make this from an investigation of therapy to standard of care. These are the studies we are doing.
What are you seeing?
DRAKOS: What we’ve been seeing is that in selected patients, it can be a really cool option. What’s better than reviving and recovering your own heart and not having to go on the heart of a donor, which means immunosuppression and all these other things you need to do. Living back your life with your own heart also provides an emotional and psychological advantage to these patients.
Do you have any idea how it repairs itself other than just rest?
DRAKOS: I have to say what you just asked is probably the most interesting question. The impact of understanding exactly how it happens is that we may be able to activate these biological pathways and get this benefit even without having to go through these processes with a cardiac assist device and other things. If we can figure out how biology works in the heart muscle to get back to being strong again, then we may be able to do this in the future with pills or with other interventions that are less complex. This is one of our major focuses right now. We get tissue from the heart and blood from these patients as part of the operation to get the LVAD. That’s the beauty of this model. We take advantage of the tissue and blood and analyze it. We investigate how the gene and other protein expression change in the heart muscle. Then, when we remove the pumps and these assist devices from the ones that they recover, we take another piece and compare the changes. By doing that, we’re trying to figure out what is changing and what is driving these beneficial effects. We have had some cool findings that we’ve been publishing over the years to our scientific medical journals. We are very optimistic that down the road, we will be able to find and uncover some of the ways that the heart can rebuild, revive, and recover itself based on these findings.
And when you do that, you think about the millions of people who are suffering from heart disease. Could this be the biggest medical impact ever?
DRAKOS: Yes. That’s the dream, that’s the plan, that’s the vision. To impact all these millions of people. As you know, heart disease is the number one killer. Heart failure costs more than all heart attacks and all cancers combined. It’s a major public health issue. So, providing options to these patients to recover their weakened hearts is a major undertaking and something that inspires a lot of people in our field all over the country and the world. That’s why we’ve been working on it.
Why did you think Annie would be a good patient for this?
DRAKOS: Annie is unique and has this energy and optimism, even when she was sick. When you undergo things like this, you need to be committed. On top of that, she also had some factors that predispose you to recover. From the studies we’ve been doing and looking at people that recovered over the years, we figured out that younger female patients that have not been sick for years, and patients where their heart was weak but not very enlarged, were some factors that you were more hopeful that this patient may recover. Annie had those factors and we felt we had a good chance to achieve the remarkable result we achieved.
Well, Annie calls it a miracle all the way. You and God saved her, that’s what she says.
DRAKOS: Well, I would not take so much credit. First, it’s a teamwork, and our team here is the home of a great team. We are comprised of surgeons, cardiologists, nurses, coordinators, social workers, trainees, and medical students. All these people are part of a team that cares for these patients. When it comes to results like these, it’s when you realize that nothing would have been possible without the whole team working as one. We are proud of how seamless our team is when it comes to delivering health and healthcare to our patients.
Are you surprised at Annie’s outcome?
DRAKOS: I wouldn’t say that I’m surprised because of the factors that we described previously. I think it’s fair to say we are thrilled and extremely happy with the outcome and the fact that she has a sustainable recovery and she’s back now with her native heart strong again, living her life, taking care of kids, on vacation, working and enjoying life. That is the major reward that our team members can derive from cases like Annie’s.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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