Is transmyocardial
revascularization(TMR), the investigational procedure that"drills" channels
through ischemic myocardium with a high powered CO2 laser, headed toward a position
as a viable third alternative to bypass surgery and angioplasty?
Despite being restricted to some of the most dismal extremes of coronary disease in patients who had been rejected from either by pass surgery or angioplasty, the TMR investigators from around the country described a series of highly encouraging findings on the first 61 American patients treated with the procedure as part of Phase I and II FDA approved protocols.
The TMR procedure is performed by drilling from 20-35 pinpoint holes through the ischemic mycardium (read injured tissue suffering from lack of oxygen Ed.) and into the left ventricle after access to the heart has been gained by a limited left thoracotomy (entrance through the ribs Ed.): after each firing, the outer surface of the epicardium generally seals spontaneously in minutes, but the rest of the channel seems to stay patent indefinitely, thereby restoring potentially significant flow to areas of little or no perfusion. The TMR concept relates to studies of the reptilian heart, in which 70 percent of the myocardial perfusion is achieved via a network of transmural channels supplied directly by the ventricles, rather than major coronary arteries. Investigators at the New Orleans meeting described a number of striking cases where formerly moribund patients with severe multiple-vessel disease, histories of failed bypass surgery andangioplasty, and past myocardial infarctions, often exacerbated by other concomitant diseases, were rendered angina free after the relatively brief TMR procedure.
"When I was first asked to participate in these trials, I replied that they should be asking the Department of Defense, because this was a Star Wars application," joked Lawrence Cohn, MD, of Boston's Brigham and Women's Hospital in describing how he insisted on convincing animal demonstrations of TMR's potential for increased reperfusion and improved contractility before agreeing to participate in clinical trials of the procedure.
"But we have seen patients in here who were as sick and infirm as you can get with coronary disease, bedridden and attached to IV bottles of nitroglycerin and heparin, and they are now functioning as individuals out in the community, with minimal to moderate anti-anginal medications."
After performing eight TMR procedures at the Brigham and Women's Hospital in conjunction with Keith Horvath, MD, Cohn said, "I have transformed my thinking about this. With the proper selection of the seriously ill patient with end-stage vascular disease, I'm cautiously optimistic that this is going to be something that you're going to deal with in increasing numbers in the very near future.
"Reviewing his experience in 10 cases with Bud Frazier, MD, at the Texas Heart Institute, Denton Cooley, MD, also called the results with the new procedure "very encouraging." He noted that TMR is "much more easily tolerated by the patient" than bypass surgery because it requires such a small, three-to four-inch incision, and is performed without interruption of the beating heart.
Overall the 46 patients in the Phase II study had an average NYS angina class of 3.55 prior to receiving TMR, with a number of Class IV patients bedridden (or wheel-chair ridden) on nitroglycerine drips. All told, 66 percent of the TMR patients had undergone a previous CABG (bypass surgery), and many had previous PTCA (angioplasty); all of these were considered to have exhausted the potential of medical therapy and to be beyond further interventions. One Milwaukee patient had even undergone seven angioplasties and one bypass surgery prior to TMR.
Remarkably, after TMR the average NYS angina class has dropped to 0.33 on a zero to four scale at discharge, and rose only to 1.0 at 3 months. Interestingly, at six months follow-up, the average angina class dropped again to 0.5. All patients showed increased activity after the procedure.
Surgeons appeared to be particularly interested in the long-term results at the San Francisco Heart Institute, which began a Phase I trial in 1990. Even though procedural efficacy and equipment has improved significantly since that study began, 10 of an original 15 cases have shown clinical improvements lasting more than two and onehalf years. In fact, Reinhold Jones, MD, noted that he had just completed a four-year follow-up evaluation on the longest surviving Phase I patient, who had been incapacitated with Class IV angina and considered inoperable prior to the procedure. According to Jones, this 86-year-old patient continues to be free of chest pain with "absolutely normal" thallium readings and is busy perfecting his fly fishing cast.
"One thing that should be stressed is that this procedure does work and is going to have great benefit for a subset of patients," the San Francisco thoracic surgeon remarked, while giving an overview of the significant improvements that have been made with ultrasound guidance and increasingly powerful TMR laser technology.
The most common complications of the procedure are difficulty achieving adequate laser penetration through areas of the epicardium that are covered with fat, and the need for suture closure of a small percentage of the laser holes, particularly those that are drilled through scar tissue.
However, surgeons are impressed by the technical ease of the procedure and the fact that the total time of TMR averages only 1 to 2 hours-or approximately half the time of bypass surgery.
"We are very pleased with the fact that we can do this procedure right now in little more than an hour, skin-to-skin," observed Dr. Jones. "I think that most surgeons who know how to open a chest and are competent are going to be able to do this."
Compared to bypass surgery, systemic blood loss during TMR has also been exceptionally low, averaging about 175 mils during the Phase II trial. The large majority of patients were discharged from the ICU in one day, and the average total hospital stay was seven days.
There have been five post-operative cardiac deaths in the Phase II study - generally, the investigators noted, in the oldest and sickest coronary patients with the lowest ejection fractions.
In the largest single-center experience, Mahmood Mirhoseini, MD, the originator of transmyocardial revascularization, reported that he has already performed the laser procedure on 24 Phase II patients at St. Luke's Hospital in Milwaukee.
Mirhoseini said that 16 of these patients had one or more prior CABGs (six of them had two prior bypasses; and one actually had three CABGs), and 16 had prior MIs; eight had congestive heart failure; 18 were on IV nitroglycerin; three had renal failure, and five exhibited concomitant carotid disease.
In this high risk population, Dr. Mirhoseini said that there were three postoperative cardiac deaths - one from a cardiac arrhythmia degenerating into cardiogenic shock, one from acute MI - and one late death from renal failure in an 80-year old. There were also two cases of late heart block requiring pacemaker insertion; three other patients developed late congestive heart failure, and two were rehospitalized for unstable angina and were returned to nitroglycerin therapy
."This procedure is not a panacea," Dr. Mirhoseini warned. "When you take on patients of such high risk, you are going to have some morbidity and mortality."
Based on his experience, he specifically warned about the risk of using TMR on patients with severe congestive heart failure.
The Milwaukee cardiac surgeon also presented a series of perfusion studies showing significant improvements at 3 months, with some fall off at 6 to 9 months, butrebounding perfusion levels after that.
"The numbers are so small that we simply cannot explain this," Dr. Mirhoseini commented about the intriguing late gains following TMR.
Wall motion studies, he noted, showed increased ejection fractions in nearly twothirds of the patients as well. The surgeon also showed exercise tests ranging from 3 to 4 METs prior to TMR and rising to 8 to 10 METs after the procedure.
In all but two patients, quality of life scores rose dramatically, from an average of around 30 on a scale of 100, prior to TMR, to numbers in the 80s and 90s after the procedure.
Most fundamentally to the patient, the elimination of, or significant reduction in, angina in nearly 90 percent of the Milwaukee patients reaching the one-year mark has left Mirhoseini enthusiastic about these results.
"I think this operation is definitely going to help patients who have acute coronary disease and have mn out of coronaries from previous surgeries or have had balloons do zilch. Also, in patients who have areas of the myocardium that are ischemic but devoid of functioning coronaties, you should consider adding this technique as an adjunct to your CABG armamentarium," Dr. Mirhoseini predicted about potential future applications when approved.
"Your object has to be total revascularization, and in those patients you cannot achieve total revascularization with surgery alone.
"Brigham and Women's Cohn agreed that the evidence on behalf of TMR's efficiency is growing steadily more solid.
"We are beginning to see more interest in TMR in our institution and elsewhere as we see objective evidence of increased perfusion in ischemic myocardium, and increased clinical performance in some really, really sick people," he noted.
TMR Clinical Reports, Vol. 2, Issue 1, Winter 1994
Calvin Miller,
Goshen, IN
Dear Don:
Your recent article about Transmyocardial Revascularization (TMR) should be of great interest to your heart transplant readers.
I received my new heart in March of 1987. Each year I would watch the annual angiogramwith great anticipation. On my 5thannual 1992, the right coronary artery was occluded. Anattempt was made with angioplasty, but entry was unsuccessful. I had no pain and realized I could still function, play golf, etc., without this artery.
My 1994 annual discovered the left descending and circumflex were also occluded. However, I had developed one collateralabove the occluded right coronary artery. The blood supply was not sufficient, and I had a heart attack in August, 1994. I also had shingles and pneumonia at the same time. I was in ICU for 2 weeksand left the hospital in heart failure.
During the time I was convalescing I saw a blurb on TVabout a new procedure being done in Europeand several centers in the United States. I asked my cardiologist to get more information on this procedure. After several months of callsand correspondence to three different centers, we chose Dr. Denton Cooley at the Texas Heart institute in Houston, Texas.
Dr. Cooley had been wanting to try (TMR) on hear transplants. I was scheduled for tests on January 4thand 5th, 1995, with surgery on January 9th.
By using a 1000 watt carbon dioxide laser theydrilled 28 one millimeter channels into the left ventricle. I was in ICU one day. The second day I was up walking, and they released me after 5 days.
Pre-testing showed a left ventricle function at 29%. My 6 month check-up it was at 42%. I amback playing golf and walking 2 miles a day.
I feel this procedure will extend the life of heart transplants that develop advanced atherosclerosis, whichwas evident in my case. I believe it will give additional time to develop collaterals around the rest of the heart. This procedure can only be done in the left ventricle because of the need for oxygen-rich blood.
Calvin Miller,
Goshen, IN
Guest Editorial- The Upbeat Organ Donation Plan lives!
Dear Emergency Room Guys:
If I get whacked in a car accident and end up flat-lined on a gurney with a piece of windshield sticking out of my brain...USE ME!
Start sawing away in there. Clip that liver out and ship it to some alcoholic in Georgia.
Crack open the chest and get Dr. Michael DeBakey on the phone. Snip out all the tissue you want. Yank out the eyeballs and make somebody see through 'em.
Take it all and do something with it. It changes people. It makes things better. I think it REALLY changed Mickey Mantle, for example. I can tell by just listening to him on TV.
What I don't understand is why people still have such a humongo problem with this. They did this study at the University of Pittsburgh to find out why we don't have more donors out there saving lives and you know what they found out?
When you ask people, "Would you agree to donate a family member's organs if he' s brain-dead?" 75 percent say, "Yes, indeedy, I would." But when the guy is lying there on the operating table, actually brain-dead, only 40 percent actually give the permission. Somebody's lying here.
What this says to me is that most people already agree that it's the right thing to do. But they just think somebody ELSE should actually do it. It gets worse. When we're talking about organs, 46.5 percent of families with a brain-dead relative give the permission.
When we're talking about tissue the figure drops to 34.5 percent. And when we're talking about corneas, it drops to 23.5.
In other words, they'll give the essential organs - the ones you can't live without - but they apparently don't think blindness is THAT BIG A DEAL!
Why they say no
The reasons they give for holding onto these body parts: God told 'em not to do it. They're afraid somebody'11 kill their relative on the operating table so the evil doctors can grab those organs while they're still warm. They don't give a flip about anybody else because their loved one just died.
Look, I've got an easy way to handle this. If you fill out the back of your driver' s license, volunteering your own organs, then you become eligible to RECEIVE organs. If you don't donate, then you don' t get any transplants for yourself. After all, if you don't think God wants people cutting the heart out of YOUR body, then you shouldn't think he wants a heart cut out of somebody else for your benefit.
Believe me, this system would require a WHOLE lot less hearts and livers and corneas. And the people who wanna hold onto those organs can hold onto 'em, right straight through to the graveyard.
Minneapolis Star Tribune,
11/30/95 From Tx
Anne M. Schoonover,
Rochester, MN
UpBeat was fortunate in reaching Mr. Briggs, author of the foregoing editorial. We forwarded a copy of our Sept. and Oct. 1995 editorials espousing the same concept to him for review. His response:
FROM: JOE BOB BRICKS,
TO: Don Marshall,
DATE: 12/23/95
Re: Great thinking!
Don,
Yes, I totally agree with everything you're saying about organ donation. Unfortunately, I think the medical community is too cowardly to accept something so commonsensical. I can already hear the objections:
Minorities will say it's discriminatory because the educational system in the inner city doesn't properly instruct 18-year-olds on the value of organ donation-and many 18-yearolds don't finish high school anyway.
The government that keeps the computer records will be afraid of lawsuits if they fail to enter someone's donation info correctly.
On and on and on .
Everyone these days has a reason they should be an exception to any rule.
But I STILL think we should try it.
Hang in there,
Joe Bob
Next time you're at one of those cocktail parties where the conversation
turns to organ transplants supposedly in order to keep you amused, try remarking
that "porcine organs will be used before long" and see how many of your
listeners nod their heads in dumb agreement, not having the slightest idea you mean
pig. Speaking of the above, as this is written the gentleman in California has just
received a bone marrow transplant from a baboon. Let us pray he is still around as
you read this newsletter. Already many jokes are beginning to appear, some fortunately
instigated by the gentleman himself. Yet this is a very serious matter. One of these
days, sooner than later, one of us heart recipients, who has developed TCAD, but
doesn't qualify for listing for further transplant or other procedure, will feel
compelled to ste p forward and volunteer to be the second xeno heart transplant recipient.
That too will be a very serious matter and involve some very brave and sacrificing
people. It will happen, and there will be set-backs, but there will never be failures.
Acute vascular rejection still poses a major hurdle in the efficacy of xenografts, but inroads are being made and will be overcome eventually, according to Jeffrey Platt, M.D., professor of experimental surgery, pediatrics and immunology at Duke University Medical Center, in a seminar sponsored by "Transplant News" October 16 on overcoming barriers to transplantation of animal organs into humans.
Hyperacute rejection, which destroys a transplanted organ within minutes or hours, is no longer a major problem, he told the audience, but scientists have considerable work ahead of them in preventing acute vascular rejection.
"It's not unsolvable," he said with cautious optimism. "It has been resolved in some cases."
Although cellular and chronic rejection also pose obstacles, their risk need not be eradicated before xenografts take place, he stated. Cellular and chronic rejection occur today in human-to-human transplants without posing sufficient threat to dissuade physicians from performing transplantations, he noted.
Duke University has made significant progress in combating hyperacute rejection with the development of transgenic pigs. In a separate interview, Platt described how his team had transplanted hearts from transgenic pigs into more than a dozen baboons thus far, with promising results.
Transgenic pigs carry a human gene for complement inhibitors. These complement inhibitors prevent the recipient's immune system from destroying the newly implanted foreign organ. Duke researchers, collaborating with researchers at Nextran of Princeton, N.J., developed transgenic animals by microinjecting the human gene constructs into fertilized pig eggs. Those pigs born with human DNA incorporated into their genone were considered transgenic. Those pigs were then bred, and those offspring were used as donors.
Hearts have been used primarily for the university' s experiments as opposed to other organs because of their simpler anatomical structure, their relative ease in monitoring rejection and the immediacy with which organ failure can be detected.
The hearts, smaller than human hearts because of the age and size of the recipients, were transplanted into the baboon's neck, where they could easily be observed. The donor hearts were transplanted not to determine their ability to restore circulatory function but rather to determine when and if the recipient would reject them. The baboon's native heart was not removed and continued pumping the primate's blood. When the donor hearts were removed, the baboons remained unaffected by the surgery.
"Our goal has been to see if rejection can be overcome," Platt stated. "And it can be. Our next objective is to use these organs in conjunction with other therapies to gain prolonged graft survival."
Platt told his audience in Washington, D.C., that he imagined xenografts being introduced gradually into the clinical arena, first as a temporary device for use outside the body, such as liver dialysis, then inside the body as a bridge toward allograft transplantation, then as a permanent replacement for a failed organ.
Platt was unable to give a time line for when the transgenic pig organs might be transplanted into humans, but when pressed suggested perhaps two to three years for the country's f~rst human trials.
With permission - UNOS Update, Volume 11, Issue 11, Nov. 1995 pp.20
SAN FRANCISCO,(UPI 12/18/95) -Calling it a dangerous risk, a public interest group asked federal regulators Monday for an official investigation into the circumstances that led to the approval of a controversial bone marrow transplant from a baboon into a human being. The group, Physicians Committee For Responsible Medicine, filed complaints with the National Institutes of Health's Office of Research Integrity and Office of Protection From Research Risks concerning last week's transplant into Jeff Getty, an AIDS patient at San Francisco General Hospital.
"Xenotransplantion has been inappropriately and unrealistically promoted by overzealous experimenters," said Dr. Neal D. Barnard, the committee' s president. "It is a dangerous procedure which, at best, kills both donor and recipient and, at worst, extends grave risks to the recipient's contacts and the general public."
The experimental procedure was initially set to take place last April, but the Food and Drug Administration intervened after some scientists raised concerns that mixing baboon and human cells could introduce new diseases into the human population.
After lengthy deliberations, an FDA panel approved the procedure in July, on condition the researchers take special precautions.
The scientists said the baboon donor has been extensively screened for a wide range of viruses, bacteria and parasites, but conceded some chronic infections are present in all baboons, and "we may not be able to avoid all of them."
At least 50 other xenotransplant protocols are currently on hold pending the outcome of this trial.
Meanwhile, hospital officials said Getty was undergoing an "uneventful" recovery. He has shown no signs of any adverse side affects and felt good enough Sunday night to order out for a pizza.
While encouraged by Getty's progress, doctors also remained cautious knowing that it was way too early to call the procedure a Success.
Doctors have restricted the number of visitors Getty can receive because he still remains at risk to infections. Not only is his immune system compromised by AIDS, but it has been further weakened by radiation and chemotherapy -- standard treatments for bone marrow transplant patients.
Getty, 38, fought for two years to receive the controversial treatment, which doctors hope will restore his immune system because baboons are immune to AIDS.
In the best possible outcome, the baboon cells will eventually take hold in Getty's system and kick up a stronger immune response. But doctors won't know if that is happening for several weeks or even months.
MADISON, Wis. (AP 12/20/95) -- A fire at an agricultural research station Wednesday killed 700 pigs, including some that had been used in a 20-year research project on cholesterol.
The cause of the fire at the swine center at the University of Wisconsin-Madison's Arlington Agricultural Research Station wasn't known.
"I think the toughest loss is in the number of years some of the scientists had invested in their research here," said David Jensen, research program manager for the Swine Research and Teaching Center. "These animals were indispensable to their work."
Jensen was the only person working at the building Wednesday and was away at lunch when a neighbor reported the fire. No injuries were reported. The building housed many long-term research projects on animal and human health, including a project involving 80 pigs that was looking into genetic factors involved in high cholesterol.
In addition to farm research, the center provided animals for university researchers perfecting organ transplant and other surgical techniques. Darwin Frye, agricultural project supervisor at Arlington, said the building, which was built for $1.5 million in 1984, was designed to be disease-free and isolated from outside elements.
[Further word indicated that enough pigs had been saved to continue with the cholesterol project. Ed.]
LOS ANGELES (AP 11/21/95)--"Eddie! Eddie!" Maria Aguirre called out as her son's squeals drowned out a telephone call.
"He' s watching 'Batman Forever,'" she explained to a caller, adding later, "He thinks he's Batman."
The noisy little boy is Eddie Anguiano, better known as "Baby Moses," a pseudonym to protect his family' s privacy when he underwent a pioneering infant heart transplant just four days after he was born in 1985. At the time, he was the youngest person to undergo successful heart transplantation. Ten years later, he is the oldest living survivor of an infant heart transplant.
The 10th anniversary of his surgery was celebrated Monday at Loma Linda University Children's Hospital, where one infant heart transplant was completed the same day and a second was under way.
Prior to Monday's two surgeries, Loma Linda surgeons had transplanted hearts into 195 babies under 6 months of age and 82 over 6 months. A total of 205 from both groups combined have survived.
Eddie's record as youngest infant heart transplant was eclipsed in 1987 by Paul Holc of Vancouver, who underwent the operation at Loma Linda three hours after being delivered by Caesarean section. But for many families with sick babies, Eddie remains the inspiration.
"He is the one that everyone looks to," said Anita Rockwell, spokeswoman for the hospital in Loma Linda.
Eddie' s mom agreed.
"It gives them hope," she said from her home in Fontana, about a 15-minute drive from the hospital.
She knows the families' anguish. Eddie was born Nov. 15, 1985, with hypoplastic left-heart syndrome, an underdevelopment of the left side of the heart that is fatal within days or weeks of birth. Her first baby had died of the same syndrome three days after being born.
"Back then it was very hard to look toward the future. We took it one day at a time. It was the most serious thing that ever happened to me," said Ms. Aguirre, whose marriage to Eddie' s father, Nicholas Anguiano, later ended in divorce.
Unlike the situation with her first child, however, Eddie was born just over a year after Loma Linda surgeon Dr. Leonard Bailey stunned the medical world by trans- planting a baboon heart into an infant known as "Baby Fae." Baby Fae survived only 20 1/2 days after her Oct. 26, 1984, transplant, but Ms. Aguirre saw a chance. She even wanted Bailey to try. another baboon transplant but he never did another one.
"I didn't care where the pump came from as long as it worked. I didn't want to see another child buried," Ms. Aguirre said.
The call came when Eddie was 3 days old. A human heart had been found.
"All we know it was from a family up north. I think it was Sacramento or San Francisco. It was a little boy and that' s about it," she said.
But hope mixed with uncertainty about how long Eddie would survive. Doctors now expect he will live to adulthood and "perhaps the normal lifespan," Rockwell said.
"At the time I had a lot of doubt .... It was just praying every day that it would get to 10 years or even five," Ms. Aguirre said.
Ten years have indeed passed, though not without scares and ongoing concerns about his health and development.
Two years ago, after five years without a heart rejection episode, he experienced an episode but overcame it.
He must regularly return to Loma Linda for medication and examinations, and his room, an optical technician, rushes him there if he gets sick.
His speech is not very clear and he has coordination problems, but he plays soccer and "loves to do anything that little boys like," his mother said.
Eddie attends fourth grade in a special education class at a regular school, and his mother is optimistic. "I just had a teacher conference Friday," she said. "He' s improving slowly but he's improving."
PITTSBURGH - Lung-transplant recipient Bob Solfanelli almost did not live to see his fingertips turn pink.
Before receiving the donor lungs that brought richer blood to his bluish hands, the 21-year-old college student spent five months in hospitals. The longer he waited for lungs, the nearer he came to the top of the list of hopeful candidates. Unfortunately, he also got weaker and sicker. Patients waiting for a heart or liver have the small comfort that as they come closer to the edge, their name will move up the waiting list.
But on the waiting list for lungs, criticality is not a factor. With lungs, the rule is first come, first served. As patients worsen, they are more likely to be rejected as too sick for transplantation.
"We have learned over the years, when they're put on a ventilator, the chances of them surviving a transplant are almost zero," said Brian Broznick, director of the Center for Organ Recovery and Education, the organ agency for western Pennsylvania.
This means that when a compatible pair of lungs becomes available, the patient in the intensive care unit could be passed over in favor of one just finishing a round of golf.
Doctors and organ procurers, many of whom helped the United Network of Organ Sharing in Richmond, Va, set the national policy, say there are many reasons for ignoring criticality. UNOS establishes allocation rules for all transplanted organs: lungs, livers, kidneys, pancreases and hearts.
Dr. Thomas Kirby, who chairs UNOS' thoracic committee and directs pulmonary transplantation at the Cleveland Clinic, said one reason is that lung diseases are varied and complex. For hearts or livers, only three or four diagnoses are treatable by transplant. But for lungs, a transplant may be indicated for 25 or 30 diagnoses, Kirby said, and the life expectancy is different for each one.
A patient with emphysema may live five years after becoming ill enough to reach the waiting list. A cystic fibrosis patient may have about two years.
Yet another diagnosis, adult respiratory distress syndrome - a complication in some cases of blood poisoning, pneumonia or trauma - may bring death within days.
Dr. George B. Mallory, Jr., director of lung transplantation at St. Louis Children's Hospital, believes if criticality were added to the list of factors in lung allocation, most donor lungs would go to hundreds of young adults each year who suffer this syndrome.
The added twist is, at least one-half of those patients quickly die from the failure of other organs.
"You transplant and- Oops ! The kidneys do fail and you've wasted an organ," Mallory said.
The science of lung transplantation is relatively young; 1992 was the first year that more than 1,000 lung transplants were performed nationally. In the same year, surgeons transplanted 3,911 hearts, 4,709 livers and 13,472 kidneys. With fewer operations to learn from, researchers have less data.
As more becomes known, UNOS adjusts its rules for allocating donor lungs. Already, the agency has modified its policies to reflect the urgency of pulmonary fibrosis, in which scar tissue quickly chokes the lungs. When the name of such a patient first goes on the lung list, he or she immediately gets credit for three months' wait.
"It tends to level the playing field until we establish the specialty of lung transplantation, "said Dr. R. Morton Bolman, vice chairman of UNOS' thoracic committee and chief of cardiothoracic surgery at the University of Minnesota Hospital and Clinics.
Bolman does not favor major changes now, preferring to observe the workings of the lung waiting list over time.
"Every time you give a certain group an advantage, you give another group a disadvantage," Bolman said. "We want to be fair to everybody on our waiting list."
As with all donor organs, the shortage is a patient's biggest hurdle.
Nationally last year, 290 people died waiting for lungs.
Dr. Bartley Griffith, chief of cardiothoracic surgery at the University of Pittsburgh Medical Center, could tell of many a patient who never reached the top of the list.
"I could have you in tears in minutes," Griffith said.
Lungs are particularly difficult to find because they are often damaged by smoking or pollution and easily contaminated from the digestive system.
For patients with the faster-acting illnesses, the window of time for a transplant is small. Having waited about a year, the patient may need a transplant before deteriorating much more.
Kalamazoo Gazette, 12/5/1995
Contributed by Dr. Don Marshall
TOKYO, (UPI 11/15/95)-- A well-known Ohio heart surgeon predicted Wednesday that heart surgery without scalpels will be a reality after the turn of the century via computer-generated, three-dimensional images of patients' pre-surgery hearts.
Dr. Floyd Loop delivered the keynote speech to the 12th Biennial Asian Congress on Thoracic and Cardiovascular Surgery, a gathering of Asian cardiovascular surgeons.
"Future heart surgeons will be able to practice complicated heart surgery using virtual-reality computers," said Loop, a noted coronary artery surgeon at the prestigious Cleveland Clinic Foundation in Cleveland, Ohio. Heart surgery in the 21 st century would be possible without scalpels using simplified techniques developed with threedimensional virtual- reality models and new drugs, predicted Loop, a pioneer in heart surgery techniques.
"Medical science is on the verge of developing an artificial heart and replacing traditional bypass surgery with new techniques," Loop told United Press International before delivering the keynote speech at the Tokyo conference. "Computer chips will be implanted in patients' chests to release drugs which will allow the heart to function normally," explained Loop. "Inserting catheters into heart chambers through the patient's veins or arteries will then replace the need for complex open chest surgery with scalpels."
Laser surgery will also be used to remove dangerous cholesterol deposits inside the heart's blood vessels using the catheter based techniques, he said.
"A single drug injected into the heart will accomplish the same thing as packing it in ice if surgery is required," explained Loop.
Loop praised the surgical training and expertise of Japanese heart surgeons, who he said were on a par with their counterparts in the United States. He noted, that young Japanese heart surgeons must serve as assistants to their seniors longer than the U.S.
A battery-powered wire that can push through clogged heart arteries may allow more people to benefit from balloon angioplasty, a new study suggests.
In many cases of clogged heart arteries, doctors use balloon angioplasty to treat the blockage. During that procedure, a tiny balloon is threaded into the artery and inflated, to flatten fatty plaque against the bloodvessel wall. But in some patients, doctors cannot properly insert the balloon, because the wire used to guide it into the artery cannot penetrate the obstruction, said Dr. Paul Rees of the Bristol Royal Infirmary in Bristol, England.
The new hand-held device vibrates the catheter at high frequency so it can wriggle its way through the blockage. In a study of 47 patients who had a total of 48 artery blockages - and in whom traditional angioplasty attempts failed because the catheter could not penetrate the blockages - the new technique successfully broke through 43 of the clogs, Rees reported this week in the medical journal The Lancet. Of the 43 blockages that were penetrated, angioplasty was successful in 33 cases. Angioplasty could not be performed in the other 10 instances for a variety of reasons, including failure to get the balloon into the clogged area, and blockages so hard that they could not be flattened against the vessel wall.
Not only does the battery-powered wire help patients avoid bypass surgery, it also prevents perforation of the blood vessel, which can occur if too much force is applied when the guide wire is manually pushed through a blockage, Rees said. In all of the patients in the study, the clogged area was completely blocking blood flow in the artery. Completely blocked heart arteries are a major problem, because they are extremely difficult to penetrate manually, according to Dr. John Bittl, director of interventional cardiology at Brigham and Women's Hospital in Boston.
ROME (Reuter 12/1/95) - Doctors and patients awaiting life-saving organ transplants in Italy gave a warm welcome on Friday to the passing of a new law by the upper house of parliament that could help end a severe shortage of donors.
The law establishes a principle of "tacit consent" that will mean Italians over the age of 16 will be assumed to have agreed to have offered their organs for transplant following death unless they specifically state otherwise.
It was passed in the Senate Thursday with cross-party support and must now move to the lower Chamber of Deputies for final approval. It will take effect one year after that. Italy has one ofEurope's lowest levels of organ donors according to official figures, and thousands of patients are on years-long waiting lists for transplants.
Millions of Italians were moved last year when the parents of a seven-year-old American boy shot dead while on holiday in southern Italy donated his organs for transplant and helped save the lives of seven Italians.
The parents of Californian boy Nicholas Green, killed in a motorway hold-up, have since campaigned in Italy for legislation to increase the number of organs available for transplant.
Heart and kidney sufferers groups also welcomed the Senate decision, which will give Italy legislation similar to that already in force in Austria, Denmark, Norway and Switzerland.
"Relatives will be relieved of the very heavy burden of having to decide and the decision will rest with the individual while that person is alive," said Marco Castagneto, director of Rome's Catholic University transplantcenter. "It will make it possible to increase the number of organs available for transplant in our country."
Critics argued that the law would rob Italians of freedom of choice.
"This mechanism means we will end up plundering corpses," said Luigi Roveda, a senator for the federalist Northern League, which gave its parliamentarians a free vote on the issue.
Dear Don,
On behalf of the University of California, Irvine Transplant Support Group, please accept the enclosed check for $150 to help continue the good work that you do by publishing your "UpBeat" newsletter.
We know that many people across the nation, just like we, have been educated, enlightened and yes, even entertained by your monthly publica tion. We also know that what you have chosen to do as your "new-life" work is too important to so many to just allow it to fade away because of financial restrictions.
We are therefore asking you to print this letter, and we ask that all who are now receiving "UpBeat" on a monthly basis, take the time to write a check to you to keep their subscription current. Additionally, we are issuing a challenge to all transplant support groups to match our pledge. We truly believe there is too much at stake here to allow this project to wither and die because of something that we can so easily fix.
It is our sincere hope that if individuals, and groups respond to this appeal, you will be able, metaphorically, to repeat the banner in your October "Biopsies" lead article; "Frozen Heart(s) Successfully Revived."
Thank you Don, for all that you do. We still believe in you!
UCI Medical Center
Tx Recipients and Families
[Editor's Note - l. Honest, I had nothing to do with this idea, but am somewhat entrapped into publishing the lettet 2. Gosh, doesn't someone write well?]
Disclaimer: The material in this document has been collected by Don Marshall
and friends. tf any of the views and opinions expressed here are taken the wrong
way, we can be nothing more than sorry. New ideas and materials are welcome all the
time. As a policy, UpBeat is sent upon request to heart and heart/lung transplant
recipients and other interested parties. Donations of $15 per year, or more, from
Tx recipients, if not a burden, are vital. From all others the donation is specifically
requested. The date shown after the name on the address label indicates the last
time a donation was received. Please make checks payable to Don Marshall, as we cannot
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Don Marshall
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