Thursday, February 02, 2012

‘Beating heart’ transplants could boost success rate

By Liz Kowalczyk,
Article originally appeared in The Boston Globe
Amy DeStefano was a single mother juggling family life and a full-time job three winters ago when she caught what at first was just a persistent February cold. Then it spiraled into pneumonia and spread to her heart.

By last January, DeStefano, at 39, was on the waiting list for a heart transplant at Massachusetts General Hospital.

Her wait ended late last month when the social worker from Portsmouth, N.H., became the first patient in New England to receive an experimental “beating heart’’ transplant.

Amy DeStefano of Portsmouth, N.H., part of the clinical trial, recovered… (WENDY MAEDA/GLOBE STAFF)

Cardiac transplant surgeons have high hopes for the technology, which is approved in Europe, believing it could improve survival rates for recipients because the donor hearts will be in better condition.

Typically, after surgeons remove the heart from a donor, they replace the blood with a salt-water solution and place the organ on ice in a chest resembling a picnic cooler. Racing the clock, surgeons have only about four hours to transport the heart and stitch it into the recipient before it becomes too damaged to transplant.

DeStefano is part of a clinical trial testing a machine that circulates blood in the donor’s heart, and keeps it beating in a transparent plastic case after removal. A computerized control system monitors the heart’s metabolism, blood pressure, and electrical state. More than 40 patients in the United States have participated in the trial so far.

Eventually, doctors speculate, the device, made by an Andover company, will keep hearts in good condition longer than four hours, meaning that they could be transported farther and that more donor hearts could be used. Now, about half of hearts from potential donors go unused, either because the donor is too far from a matching recipient or because of abnormalities in the heart.

“The moment we take that heart out of the donor’s body it is deteriorating,’’ said Dr. Bruce Rosengard, who is surgical director of cardiac transplantation at the hospital and who performed DeStefano’s transplant. “We hope to dramatically increase the number of transplants.’’

Yesterday, DeStefano, now 40, sat in a chair in her room at Mass. General, sipping water while nurses took vital signs and blood samples. She walks the floor and does leg-lifts for exercise and said she feels more energetic every day. A recent echocardiogram “shows excellent function,’’ similar to what one would see in an athlete, said Rosengard.

DeStefano said she did not have any reservations about participating in the trial and found the technology fascinating. “It made so much sense,’’ she said.

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