Wally Wawro first noticed the symptoms in 1990, when he was 39. The Dallas television audio specialist was working a project in Palm Springs, California, when he came down with what felt like a nagging cold. Four months later, he found himself gaining weight, feeling constantly run-down, and short of breath. “I thought it was something like bronchial pneumonia,” he recalls. He decided to see his physician, who, with just one look at Wawro’s chest X-ray, had a diagnosis: congestive heart failure (CHF). Relatively obscure thirty years ago, CHF is a condition that used to affect some 250,000 people in the nation a year. But as our population has begun to live longer, that figure has more than doubled. And as millions more boomers approach their sixties, its incidence is set to increase another 40 percent by 2010. CHF is poised to become our next buzzword. Fortunately for us—and Wawro—some of the most promising innovations for treating the disease are right here in Texas.
Ticker trouble
Wawro didn’t know much about this pervasive yet little-understood condition, and neither do most Americans. Some variation of a heart attack, isn’t it? Not exactly. A heart attack is a sudden interruption: The organ radically slows or stops its pumping due to an abrupt deprivation of blood, which occurs when there are arterial blockages of plaque or an arrhythmia caused by a short-circuiting in the heart’s electrical system. Congestive heart failure, on the other hand, is a chronic condition in which the pumping mechanism gradually weakens and becomes misshapen. It develops when existing damage to the heart—caused by, say, long-term high blood pressure, hardened arteries, diabetes, or, in fact, a heart attack—prevents the organ from pumping the way it used to. Blood backs up into the lungs (hence the term “congestive”), causing shortness of breath, fatigue, and a long, cruel death not unlike suffocating over twenty years.
Curing heartbreaks
Thanks to advances in medical treatment, more people than ever before are surviving coronary crises like heart attacks and hypertension. What this means, however, is that many of us are headed into our golden years with severely weakened hearts—and an unprecedented risk for CHF.
The bad news? There is not yet a cure for a failing heart. But there are ways to manage it. Though the end goal of many CHF sufferers is a heart transplant, several options today can delay (and even help bypass) that kind of extreme surgery. The first is drug therapy—ACE inhibitors, beta-blockers, and so on—which greatly improves the pumping force and efficiency of a worn-out heart. The next course of action, especially for those with serious arrhythmias, is to implant a defibrillator or a pacemaker. A third option? To repair the heart through surgical techniques, the most intriguing of which is something called left ventricular restoration (LVR). Developed in Europe in the eighties, this procedure involves inserting an inflatable shaping device known as a mannequin into a patient’s left ventricle. By carefully calibrating the device’s inflation, the surgeon can restore the ventricle to its elliptical form (CHF tends to make it rounder) and normalize its pumping action. A patch is then sewn into the reshaped ventricle to help the organ hold its shape.
According to Michael Mack, the founder of the heart transplant program at Dallas’s Medical City and a pioneer of LVR use in Texas, this technique is now considered a desirable treatment for certain CHF patients. “Drug therapy is still a mainstay,” he says. “But ventricular reshaping is appropriate for a limited number of patients with localized damage after a heart attack.” It should also be said that it is, literally, not for the faint of heart: In one study of seven hundred patients who underwent LVR, death or major complications occurred in a third of the cases—a result that probably owes to the fact that such patients are pretty sick to begin with, may suffer from diabetes and high blood pressure, or may have had multiple heart attacks.
The last frontier
As soon as Wawro was diagnosed, he was placed on vasodilators to help with his blood flow. Then, in 1992, he had a defibrillator put in to control his arrhythmias. But neither of these was enough, nor was LVR an option in his deteriorating condition. Because of his relatively young age, and because of his heart’s increasing electrical problems (his defibrillator was “re-pacing” its rhythm several times a day, it seemed), he desperately needed a new heart. Yet there was no telling how long he’d have to wait for one.
His physicians referred him to Mack, and he was placed on a transplant list. In the meantime, Mack and his surgical team had one more trick up their sleeves to buy him time: a left ventricular assist device (LVAD). A battery-operated pump about the size of your thumb, an LVAD is the next-best thing to that holy grail of biotechnology, an artificial heart. It is implanted in the abdominal wall and connected to the heart by two tubes: One carries blood from the damaged ventricle to the pump; the other pushes blood up through the aorta and out to the body. A third tube with electrical wiring extends to the outside at the waist area, where a battery pack can be attached to a belt.
Mack’s team presently installs about fifteen LVADs a year, but with technology improving, that number will likely increase. Wawro received his in July 2006. “It made a huge difference in my life,” he told me. “Within three months, I had better circulation and an appetite.” It was also a mixed blessing. “It takes a strong person to be an LVAD patient,” Wawro said. “You’re aware of it 24/7. You constantly have to be aware of the power source and its batteries, which have to be replaced every four or five hours. And the entrance wound to the power pack must be kept clean.” Still, when a new heart finally became available eight months after his operation, he knew he probably wouldn’t have made it without the device.
Given the increasing longevity of our population, CHF may just be the next big frontier in heart disease: It is likely that more, not fewer, of us will be taking a journey similar to Wawro’s. There may come a day when we have all the cures for an ailing heart, but until then, we’ll need to follow our ticker’s beat ever more closely.
Cooley and DeBakey: Still deep in the heart of Texas.
Given the coronary bypass revolution they pioneered in the late sixties—earning Houston its Heart City nickname—it’s hardly surprising that Denton Cooley and Michael DeBakey have also contributed to the battle against CHF. Cooley, now 87, published the first report of a patient’s undergoing left ventricular aneurysmectomy (the removal of severely weakened ventricular muscle that causes heart failure) supported by a cardiopulmonary bypass machine in 1958. In 1989, following on the heels of South American and European heart surgeons, he refined his technique to include restoration of the ventricle’s normal shape. Meanwhile DeBakey, who is still professionally active at 99, has developed the DeBakey VAD with surgical partner George P. Noon, of the Houston biotech company MicroMed Cardiovascular. Though there are a handful of other LVADs available, DeBakey’s is considered state of the art because it contains only one moving part, which can pump up to ten liters of blood per minute. It is also alone in having a model for juvenile CHF sufferers.
