Devices give injured hearts a rest

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Three years ago, after his heart stopped beating and he collapsed at a Wal-Mart store in Butler, Tim Kaczmarek, a schoolteacher and basketball coach, was kept alive by an implanted heart pump.

Annie O'Neill, Post-Gazette
Tim Kaczmarek talks to his students during class at Highlands Middle School. After seven weeks on a heart pump, he recovered and was taken off the pump. Although he has had to cut back on some activities, he has returned to full-time teaching.
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Doctors at the University of Pittsburgh Medical Center thought that Mr. Kaczmarek might need the pump, connected by a tube leading from his abdomen to a two-wheeled, backpack-sized unit, until he could receive a heart transplant. But after seven weeks, his heart recovered enough that the device was removed and he no longer had an immediate need for transplant surgery.

"It was quite miraculous," said Mr. Kaczmarek, 51, an eighth-grade history teacher at Highlands Middle School.

Mr. Kaczmarek, of Natrona Heights, is among more than 30 former patients who are expected to attend "Heart of Pittsburgh," a fundraising gala Saturday at Heinz Field to celebrate the 20th anniversary of UPMC's artificial heart program.

More than 650 people are expected to attend the sold-out event. Among them are television personality Regis Philbin, who is serving as entertainer and keynote speaker; Dr. Robert Jarvik, designer of the Jarvik-7 artificial heart; Jeffrey Romoff, UPMC's president; Dr. Kenneth Melani, Highmark's chief executive officer; Sy Holzer, president of PNC Bank; and political figures including Gov. Ed Rendell, Mayor Luke Ravenstahl and Allegheny County Chief Executive Dan Onorato.

The event will celebrate the successes of the past and look toward the future, including the potential of the devices to head off the progressive decline in cardiac function known as heart failure, said Dr. Robert Kormos, director of the artificial heart program and medical director of the McGowan Institute for Regenerative Medicine. The institute, established by the University of Pittsburgh and UPMC, investigates devices and other means of restoring the function of impaired tissues or organs.

"We're seeing some signs these devices, and the technology we have available to us now and will have in the near future, could possibly even prevent heart failure from progressing to the end stages that we currently see now," Dr. Kormos said.

More than 350 people have received the devices at UPMC since its artificial heart program began in 1985. Some are left ventricular assist devices, known as LVADs, that help failing hearts to pump.

The devices can be implanted permanently, but often have been used to maintain patients until a donor heart becomes available.

And some patients, like Mr. Kaczmarek, recover enough to have their devices removed. At UPMC, 17 patients have been weaned off the devices and have not required heart transplants.

Dr. Kormos hopes that technological advances will allow broader use of the devices, helping more hearts to recover after heart attacks and preventing heart failure.

That approach also could provide an ideal setting for use of stem cell therapies aimed at restoring heart function, he said, noting that early studies have shown promising results.

The shortage of donor hearts available for transplantation is a pressing reason for developing new therapies, he said.

The heart devices also are used in children, who particularly may benefit because they often lack diabetes or other health problems that affect many adults, said Dr. Peter Wearden, a cardiothoracic surgeon at Children's Hospital.

Dr. Tomislav Mihaljevic, a heart surgeon at the Cleveland Clinic, said numerous attempts are being made to develop heart assistance devices that are smaller and easier to use.

While that effort is unlikely to stem the rising tide of heart failure, "patients would benefit greatly if cardiologists were in a position to put in a smaller device that would help the heart to rest," he said.

Like Dr. Kormos, he said more research is needed. Artificial heart devices now in use have limitations, which can lead to complications such as infection and stroke.

"But in the past 20 years, we've come very far," Dr. Mihaljevic said. "We have come from experimental devices used on rare occasions in a very few centers around the country to established therapies for selected patients."

UPMC's artificial heart program has contributed to those advances.

The first device implanted in a patient at UPMC was the Jarvik-7. The surgery -- the world's second implant of the device as a bridge to transplant -- took place on Oct. 24, 1985.

After he was implanted with the device, Tom Gaidosh received a heart transplant a few days later, becoming the first patient to successfully undergo transplantation after being supported by an artificial heart. He went on to live for 12 more years.

In 1990, another UPMC patient was the world's first to be discharged with an implanted device to await organ transplantation outside the hospital.

The same year, a gift from MCI founder William McGowan, who had undergone a heart transplant at UPMC, established the McGowan Center for Artificial Organ Development.

The center became the McGowan Institute in 2001 as its mission expanded beyond artificial organs to tissue engineering "and other potential therapeutics that weren't on the radar screen" in the 1980s, said Dr. Harvey Borovetz, a deputy director at the institute and chairman of bioengineering at Pitt.

In 2000, UPMC experts traveled to Israel for the first implant of an LVAD known as HeartMate II, which was co-developed by McGowan researchers.

And in 2001, UPMC developed a bioengineering team, Vital Engineering, to provide support locally and nationally for patients on artificial heart devices.

That team has worked to simplify the complex technology for patients and their family members and also provided important assistance to clinicians, Dr. Borovetz said.

In another milestone, Dr. Amit Patel, director of cardiac stem cell therapies at the McGowan Institute, began leading a study last year that involves injecting stem cells from a patient's own bone marrow to see if they can rebuild weakened heart muscle. The study was believed to be the first of its kind approved by the Food and Drug Administration.

Nearly 10 years have passed since UPMC had its first patient whose heart recovered while using one of the devices. Mr. Kaczmarek considers himself fortunate that he has been among the small group of other cases that have since occurred.

A former girls basketball coach at Deer Lakes High School, Mr. Kaczmarek admits that his recovery has not been complete. He has had permanent heart damage and no longer coaches. He also has cut back on some of his other activities, such as shoveling snow and mowing his lawn.

But he is grateful that he has been able to return home to his family and to full-time teaching.

"I realize I can't do a lot of things I used to do, but I don't worry about it or dwell on it," he said. "I've already had three years of extra life."


Joe Fahy can be reached at jfahy@post-gazette.com or 412-263-1722.


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