Success for Heart Failure: Connecticut's Only Destination VAD Center

Drs. Hammond and Wencker
Drs. Jonathan Hammond and Detlef Wencker

NEWS: Hartford Hospital Doctors First in U.S. To Implant Right Ventricular Impella Device

For more information contact the Heart Failure Rescue Program at (860) 545-1212

Hartford Hospital has created one of the state’s most comprehensive programs for managing congestive heart failure.

Hartford Hospital offers a range of options from outpatient care in our infusion center to the use of ventricular assist device technology and heart transplantation.

What sets Hartford Hospital's Heart Failure Rescue Program apart is its designation as a Ventricular Assist Device (VAD) Destination Therapy Center.

VADs have been used for many years to sustain patients who are candidates for heart transplant as they await a donor heart. With the development of lighter, more dependable VADS, it has become possible to consider the use of these devices not only as a "bridge to transplant," but as a stand-alone therapy for those with hearts too weak to function properly. Emerging research from Europe is beginning to suggest what was once thought impossible: Some VAD patients find that their hearts actually improve with help from these mechanical pumps.

As one of only two heart transplant centers in the state -- and and the birthplace of successful heart transplantation in Connecticut nearly 25 years ago -- Hartford Hospital is well-experienced in the use of VADs for potential transplant patients. This, despite the fact that average waiting times for donor hearts at Hartford Hospital are much shorter than the national average. Click here for more information about this program.

In addition to cutting-edge VAD options, Hartford Hospital’s new infusion center is changing the way today’s patients live with heart disease. This state-of-the-art outpatient treatment facility is dedicated to caring for patients at the advanced stage of heart failure. Intravenous administration of medications rapidly improves symptoms and restores normal fluid status.

One-on-one nutritional counseling also is available in the program This helps patients adhere to a complex medical regimen and a specialized low-sodium (salt) diet, while learning to recognize weight gain that signals fluid retention. Cardiac rehabilitation and individualized exercise plans strengthen the heart muscle to improve circulation and support the recovery process.

Understanding Congestive Heart Failure

When the weakened heart muscle loses its ability to pump efficiently, the life-threatening condition is called congestive heart failure (CHF). For nearly five million aging Americans, congestive heart failure brings frightening trips to the emergency room and recurrent hospitalizations.

In the United States, 550,000 new cases of CHF are diagnosed each year. The condition usually develops gradually as the result of a heart attack, uncontrolled high blood pressure, heart defect or viral infection.

During a heart attack, a sudden clot blocks a coronary artery, sometimes damaging the oxygen-starved heart muscle permanently. When the heart can’t pump forcefully enough, blood flow drops as the heart struggles to supply oxygen and nutrients to the brain and vital organs. The chambers of the heart stretch to hold more blood, but over time, the heart muscle walls weaken and pumping slows. The kidneys respond by causing the body to retain water and sodium. Blood backs up into the veins leading to the heart, excess fluid pools in the lower legs and ankles, and the belly becomes swollen and congested. Fluid fills the lungs, causing shortness of breath, especially when lying down.

When so much fluid accumulates that diuretics (water pills) no longer work, the usual treatment is hospitalization for intravenous (IV) administration of medications. In hospitals across the country, congestive heart failure is the leading cause of hospitalization for patients age 65 and over.

Detlef Wencker, MD “Repeated hospitalizations are a medical and financial burden,” says Detlef Wencker, M.D., who recently joined the Henry Low Heart Center as director of the Heart Failure and Transplant Center. “Nationally, the average stay for CHF patients is five to six days—and 50 percent are readmitted to the hospital within six months. Outpatient infusions have been shown to reduce hospital readmissions by as much as 91 percent.

“Patients do better when they stay out of the hospital,” says Dr. Wencker, “Our results show clearly that outpatient infusion with IV diuretics keeps heart failure patients mobile, which translates into better outcomes. Just being in bed for six days in the hospital worsens patients’ cardiovascular condition and outcomes. Although the expected mortality rate for acute decompensated CHF is about 30 percent at one year, we saw only about five percent in our patient population. Patients referred to us by a cardiologist can call and come directly to the infusion center, avoiding the emergency department and hospitalization.”

Not only does the infusion center provide therapy in a convenient setting, but patients also receive a complete blood work-up at every visit, which keeps tabs on blood volume, total body water, electrolyte levels, kidney function and other indicators. As part of Dr. Wencker’s research into the cellular mechanism of progressive heart failure in patients with endstage heart failure, Hartford Hospital patients who meet specific criteria may be eligible to enroll in several groundbreaking clinical trials.


Hartford Hospital Doctors First in U.S. To Implant Right Ventricular Impella Device

On Oct. 31, 2012, doctors at Hartford Hospital were the first in the United States to place a right ventricular Impella device (a "mini heart") in a patient in shock because of a right ventricular infarction. This device is currently being evaluated by the FDA, and this surgery has been performed only eight times worldwide.

The right heart Impella is designed to support patients with right ventricular dysfunction that is usually associated with an inferior wall marked cardial infarction. The presently available support devices including balloon pumps, Impella, and tandem heart are useful to support a failing left ventricle but provide no right ventricular support.

The right heart Impella is a catheter that is placed from the inferior vena cava through the right atrium, right ventricle and is positioned in the pulmonary artery. There is a pump within this catheter. It withdraws blood from the inferior vena cava and pumps into the pulmonary artery (thus taking over the function of the right ventricle).

The director of Structural Heart Disease, Dr. Ronan Margey, took the lead in procuring the device, receiving approval for implantation by Hartford Hospital's Institutional Review Board (IRB), and implanting the device in this patient. Drs. Dan Fram, Jeff Hirst, Fran Kiernan, Ray McKay, Immad Sadiq, and David Silverman were all involved to support this achievement.

 


 

The Hartford Hospital STEMI Team Sets a Record and Saves Lives

On January 17 2011, Alfred Cecchini, a 47 year old barber who lives in South Windsor, experienced a substernal chest pain after working out in the gym. He immediately called 911. Alfred was ultimately successfully treated for acute myocardial infarction in the HH Catheterization Laboratory. His blocked coronary artery was opened with a stent with a record door-to-balloon time of 26 minutes.