It takes a measure of courage to venture down a path so few have tread before. But for J.E. “Betsy” Tuttle-Newhall, MD, forging a career as a female surgeon has been about following her own professional passions — while also pioneering new paths for those that would follow her.
|A 58-year-old male awaiting a cardiac transplant with Thoratec Ventricular Assist Device strolling Caroline Mall on the Saint Louis University Medical Center Campus.|
Thank you for your interest in the Mechanical Circulatory Support Program at Saint Louis University. Our program has a long, rich and innovative history of evaluating mechanical cardiac assist devices, both in the laboratory and clinically. It is internationally recognized having provided support to more than 350 adult and 120 pediatric patients with cardiogenic shock. To date, this program has published over 110 scientific manuscripts and presented information at hundreds of scientific sessions.
We utilize a number of ventricular assist devices that can be used to aid the failing heart. Patients may need left ventricular, right ventricular or biventricular support. Some may require pulmonary support as well. Several groups can potentially benefit from this technology, including patients who cannot be weaned from cardiopulmonary bypass after cardiac surgery, acute myocardial infarction shock patients, those who develop cardiogenic shock as a result of nonischemic cardiomyopathies and cardiac transplant candidates who deteriorate while awaiting location of a donor heart. Device selection depends on body size and type of heart failure.
Saint Louis University has employed the Thoratec ventricular assist device (Figure 1) since 1981 as a result of participation in a National Heart, Lung and Blood Institute multicentered trial to evaluate ventricular assist device support in patients with refractory shock. This device is an external, pneumatically driven pump. The advantage of using this reliable system is that it can be used for left, right or biventricular failure. We have supported 124 patients with the Thoratec pump for durations up to six months and are currently participating in a clinical trial evaluating a portable control console for this device. The Thoratec ventricular assist device was approved by the Food and Drug Administration in December 1995.
The Novacor left ventricular assist system (Figure 2) is also available. It is an electromechanical pump that is implanted in the abdomen. The system is operated by an external, portable, electronic controller which is powered by battery packs. The advantage of using this pump is that patients may be discharged from the hospital to wait for their heart transplant. It provides only left ventricular support and recipients must be large enough (> 140 pounds) to accommodate the device. Saint Louis University was one of the first three centers to clinically implant the Novacor and we have supported 28 patients with this device for intervals up to one year. The Novacor system was approved by Food and Drug Administration in September 1998.
|Figure 1||Figure 2|
|Thoratec ventricular assist device||Novacor implantable electrical left ventricular assist system|
The Abiomed biventricular support system, Biomedicus centrifugal pump and extracorporeal membrane oxygenation are short-term devices which are also available to our patients. Many cardiac surgery centers choose to implant their own short-term devices and transfer the patient to Saint Louis University for weaning or, if necessary, cardiac transplantation.
In the near future it is hoped that reliable permanent ventricular assist devices and total artificial hearts will be available. Mechanical circulatory support, along with cardiac transplantation, reparative cardiac surgery, cardiomyoplasty and ventricular volume reduction are complementary surgical procedures to treat chronic heart disease. Saint Louis University will continue assisting with the laboratory development and clinical application of these procedures to reduce the mortality and morbidity associated with end-stage heart failure.
We are always available for consultation. The cardiac surgeons, cardiologists and circulatory support staff can be reached at the following numbers. Please let us know if we can provide any further information.
Paul J. Hauptman, M.D.
After hours, page through Saint Louis University Hospital operator (314) 577-8000.