Patients' symptoms depend on how weak the heart is and how well their heart failure is controlled. Many patients require several medications, including ACE Inhibitors to lower blood pressure and open the blood vessels; Vasodilators to lower blood pressure and relax the blood vessels; Diuretics to help expel extra water and salt; and Digoxin, which helps the heart pump better.
Although medical management is often successful in treating heart failure in earlier stages, end stage heart failure requires therapies beyond drugs. Previously, heart transplantation was the only hope for such patients. Founded over a quarter of a century ago, the heart transplant program at NewYork-Presbyterian Hospital/Columbia University Medical Center is the top cardiac transplant program in the United States by volume. In conjunction with this program, the Center for Advanced Cardiac Care (led by Medical Director Donna Mancini, MD, Division of Cardiology, Department of Medicine), provides the most advanced medical and surgical options to patients with heart failure. Moreover, in an effort to overcome some of the limitations of transplantation (in particular, the long waiting lists for donor organs), Columbia's surgeons have helped to spearhead the international effort to develop and implement cardiac assist devices, which provide mechanical support to failing hearts.
The Mechanical Circulatory Support Program, led by Yoshifumi Naka, MD, PhD, Director of the Cardiac Transplantation and Mechanical Circulatory Support Programs, was founded in 1990 to provide a "bridge-to-transplantation" for patients requiring heart transplantssupporting their lives until a suitable donor heart became available. Today, this program also offers assist devices as a "destination therapy" for patients with end stage heart failure who are not eligible for a transplant.
HEART FAILURE RESEARCH
Under Dr. Naka's direction, novel research is advancing new approaches to mechanical circulatory assistance. In particular, the center is investigating a range of new devices in an effort to provide patients with devices that are smaller, quieter, and more portable, fully implantable, or capable of providing biventricular support.
This builds on a long history of research in the field, a course that has been marked by outstanding progress.
Patients who go on to have heart transplantation surgery will significantly benefit by research conducted by Mario C. Deng, MD, Director of Cardiac Transplantation Research in the Department of Medicine, Division of Cardiology. Instead of undergoing repeated endomyocardial biopsy (EMB), an invasive, uncomfortable, and potentially risky test for signs of organ rejection, heart transplant patients can now be routinely tested through a simple blood test. Only if the blood test shows definitive signs of organ rejection will patients need to undergo EMB. The development of this test was made possible by harnessing the knowledge gained by mapping the human genome. In other work, Dr. Deng and colleagues are investigating the relationship between the cardiovascular system and the immune system, and are examining the impact of mechanical circulatory support devices and heart transplantation on survival and quality of life.
Learn more about heart failure, mechanical circulatory assist devices, and heart transplantation at www.columbiasurgery.org or by calling 201.346.7001.
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