Mark S. Slaughter on New Options for Patients with Severe Heart Failure

New Hot Paper Commentary, July 2011

Mark S. Slaughter

Article: Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device

Authors: Slaughter, MS;Rogers, JG;Milano, CA;Russell, SD;Conte, JV;Feldman, D;Sun, B;Tatooles, AJ;Delgado, RM;Long, JW;Wozniak, TC;Ghumman, W;Farrar, DJ;Frazier, OH;HeartMate II Investigators
Journal: N ENGL J MED
Volume: 361, Issue: 23, Page: 2241-2251, Year: DEC 3 2009
* Univ Louisville, Div Thorac & Cardiovasc Surg, 201 Abraham Flexner Way,Suite 1200, Louisville, KY 40202 USA.
* Advocate Christ Med Ctr, Oak Lawn, IL USA.
(Addresses have been truncated)

Mark S. Slaughter talks with and answers a few questions about this month's New Hot Paper in the field of Clinical Medicine.

SW: Why do you think your paper is highly cited?

Our paper "Advanced heart failure treated with continuous-flow left ventricular assist device" was very important and now frequently cited for several reasons. This publication clearly demonstrated the improvements and superiority of the new continuous flow technology compared to the earlier pulsatile flow technology that we had been using. Equally important, the improved survival rates now are not only statistically significant but clinically relevant compared to optimal medical therapy for treating advanced heart failure.

Both of these issues were acknowledged by Dr. Jim Fang in his accompanying editorial in which he states that patients with advanced heart failure should all be referred for evaluation and possible treatment with a LVAD.

SW: Does it describe a new discovery, methodology, or synthesis of knowledge?

CDKs and the cell cycle. Schematic representation of some of the mammalian CDKs involved in progression throughout the different phases of the cell cycle. Some of these kinases are required for DNA replication (S-phase) whereas other participate in the preparation for chromosome segregation during mitosis. Their therapeutic validation, however, requires proper analysis of this basic version of the cell cycle in different cell types and under different oncogenic backgrounds in vivo.
View PDF file with More figures and descriptions.

The paper was the next step in demonstrating the consistent and progressive improvement in device technology to treat advanced heart failure.

SW: Would you summarize the significance of your paper in layman's terms?

Our paper provides the evidence that there are new options for patients with severe heart failure that are not eligible for a heart transplant.

SW: How did you become involved in this research, and how would you describe the particular challenges, setbacks, and successes that you've encountered along the way?

I have a background in engineering and thus have always been looking for ways to apply engineering principles to help solve medical problems. If we can send a man to the moon safely it seems as though we should be able to make a mechanical pump to help or replace a failing human heart.

Over time, many of the challenges that were encountered with early pump design have been improved or solved. This has been accomplished by teamwork and collaboration between physicians, surgeons, engineers, and basic scientists. It has been an incredible journey which has now resulted in the improved survival and quality of life for many patients that had no options.

SW: Where do you see your research leading in the future?

The future for this technology is very exciting. There will continue to be improvements in pump design, miniaturization, and overall performance. We are now starting to use these devices to recover failing hearts. The new LVADs will be used in conjunction with cell therapy to improve and/or grow new heart muscle. This will ultimately allow for the device to be removed when the heart is strong again. Also, with improvements in pump design and performance, it is possible that it will replace or be an equal substitute for a heart transplant. This way patients will not have to wait months or years to receive treatment for severe heart failure that is not responding to medical therapy.

SW: Do you foresee any social or political implications for your research?

At this time, treatment with a LVAD for advanced heart failure is an expensive therapy. Like all new devices, the cost will be reduced when there is more competition from device manufacturers and an increase in the number of devices sold. However, with the ongoing efforts to contain health care costs, we will need to continue to look for new ways to make the devices more cost competitive and better identify which patients will receive the most benefit from this advanced treatment option.End

Mark S. Slaughter, MD
Professor and Chief
Division of Thoracic and Cardiovascular Surgery
Director Mechanical Assist Device and Heart Transplant Program
Associate Medical Director Cardiovascular Innovation Institute
University of Louisville
Louisville, KY, USA




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