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It’s a dilemma for cardiologists: What do you do if your patient is too sick to survive the heart procedure that could save his life?
Until now, there were no good options for this scenario. But the cardiac catheterization lab at Northeast Georgia Medical Center recently began using the Impella Cardiac Assist Device (CAD), which takes some of the stress off a weak heart long enough for the patient to undergo treatment.
Dr. Prad Tummala, medical director of the hospital’s Ronnie Green Heart Center, said the device is helpful for patients who suffer from heart failure and also have several blocked arteries.
“The one-year mortality rate on these patients is over 50 percent,” he said. “They have no reserve of contractile strength, and the whole heart is weak because it’s not getting enough blood supply.”
Tummala said these patients are not candidates for open-heart surgery because the operation involves putting the patient on a cardiac bypass machine.
“We would not be able to restart their heart after taking them off the machine,” he said.
The alternative is to perform an angioplasty, in which a catheter is threaded from a vein in the groin up to the heart. The doctor can use a “balloon” device to open up a clogged artery, then insert a stent to prevent the blood vessel from re-closing.
But some patients are in such precarious condition that their heart won’t even withstand angioplasty. Last year, Tummala began searching for a way to help them.
“He brought the request for this device to us when it was still under clinical trials,” said Tom Edwards, director of cardiac services at the medical center. “But before we could enter the trials, the FDA went ahead and approved it.”
The CAD can bring hope to patients who otherwise would simply be waiting to die.
“I know this sounds dramatic, but it really is a life-saving device and a very useful tool,” Tummala said.
After a cardiologist pushes the CAD up through the catheter, he uses a tiny wire to guide the device into the heart’s left ventricle, then turns on its motor.
“It’s a mechanical pump. It’s kind of like an artificial heart in the way it works,” said Tummala. “It sucks blood out of the left ventricle and shoots it into the aorta. This helps support the heart so it doesn’t have to work as hard.”
If needed, the doctor can leave the device in place for several days, taking some of the burden off the patient’s heart during recovery.
Because the CAD is intended for a specific category of patients, Tummala used it only a couple of times during the first two months it was available at the hospital.
But for those two patients, it made all the difference. “Both of them came in with heart attacks. They had heart failure and all three arteries blocked,” Tummala said. “They had been in the hospital for a long time and no one wanted to do surgery on them.”
The main drawback of the CAD is that it’s expensive, about $25,000. Because the device is inserted inside a patient’s body, it cannot be reused.
But Tummala said Medicare does cover it, and the device is far cheaper than open-heart surgery.
Though the CAD is expensive and is only indicated for a small number of patients, Edwards said it was important for the hospital to acquire the technology.
“Cost is not what drives our decisions. We look at the clinical benefits,” he said. “We knew going in that we wouldn’t be using it on a lot of folks.”
Edwards said because every patient is different, a good cardiology department needs a full arsenal of “weapons” against heart disease.
“We have a whole menu of devices and procedures we can use,” he said. “We’ve got cutting catheters and a ‘roto-blader.’ We’ve got a laser that costs a lot of money. None of these things is used very often. But in some cases, if we didn’t have these devices, we wouldn’t be able to help the patient at all.
“If we are going to be the tertiary referral center for cardiology (in the Northeast Georgia region), we need to have these things on hand.”