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Fighting Heart Failure

Innovation for safer treatment

Jai Raman, MD

Heart care has come a long way since the 1950s, when the first cardiac surgeries took place. But until recently, one thing hadn't changed: After performing a procedure, cardiac surgeons would close the patient's breastbone, or sternum, with wire.

Then, a few years ago, a team of experts including Jai Raman, MD, PhD, a cardiac surgeon at Rush University Medical Center, set out to develop a new technique. Their goal: to minimize the pain and wound-related problems that can arise after wire closure, which carries a small but potentially devastating risk of infection because it may not allow complete healing and fusion of the two sides of the bone.

Their solution: thin titanium plates and screws that close the sternum and fix it more securely, dramatically decreasing the risk of wound infection after cardiac procedures ranging from minimally invasive valve replacement to heart transplantation.

Raman says this simple approach, available at only two Chicago hospitals including Rush, is one of many ongoing developments that promise to improve the lives of people with heart failure.

Efforts in prevention

Of course, the best way to fight heart failure — a chronic condition that occurs when the heart cannot pump enough blood to the rest of the body — is to prevent it. Heart failure usually stems from heart disease and can result directly from heart attack.

As a result, the same practices that help prevent heart failure's underlying causes can also stave off the condition itself. Important preventive measures include not smoking, avoiding salt and exercising as directed by a doctor.

For clinicians, Raman explains, they also include finding new ways to identify people at risk for developing heart failure. For example, he plans to work with colleagues at Rush in a long-term effort to improve techniques for determining which patients are likely to experience diastolic heart failure.

This type of heart failure is common in older adults and those with high blood pressure. But it can be difficult to diagnose because it results from stiffening of the heart muscle, a problem that is harder to measure and to see in images than constricted coronary arteries or abnormal valves.

New and improved devices

After diagnosis, people with heart failure can benefit from an increasing array of treatment options. In addition to medication, these include new and improved devices to help the heart pump better.

For example, Raman says, "Twenty years ago, there was only one device to treat left-sided heart failure," a type of heart failure that comprises 70 percent of severe cases. "Now, more and more are appearing."

These left ventricular assist devices (LVADs), artificial pumps that a surgeon connects to the heart with tubes, have in recent years become significantly smaller and easier to tolerate, making them available to a broader range of people.

For those with severe, end-stage heart failure, LVADs can increase life expectancy from about 8 percent to more than 50 percent over the course of a year. They can also serve as a bridge treatment that keeps the heart pumping while a heart failure patient waits for a transplant.

Varieties of innovation

Whether he has just implanted a ventricular assist device or conducted a minimally invasive valve replacement, Raman closes any separation of the breastbone with the plate-and-screw method he helped pioneer. But he points out that such groundbreaking innovation doesn't always involve new technology.

"It's often the simplest things that have the greatest impact," Raman says.