Heart Failure:  Advanced Cardiac Support and Transplantation Center

What is congestive heart failure?

CNN Headline News interviewed Samer Najjar, MD, medical director, Heart Failure, Heart Transplantation, and Mechanical Circulatory Support Programs, about the use of ventricular assist devices for patients with congestive heart failure. One of Dr. Najjar's patients was also interviewed. To watch the report, click on the link.

Congestive heart failure (CHF) can often be a confusing and frightening term.  In order to understand congestive heart failure, it is important to remember that the heart works as a pump, and propels blood throughout the circulatory system. 

The heart squeezes blood through the circulatory system, and also to relaxes and accepts blood as it returns from the body and the lungs.  Any disruption in the heart’s ability to either squeeze (systolic dysfunction) or relax (diastolic dysfunction) can lead to “failure” of the heart to adequately perform. 

As a result, the heart compensates by working at a higher pressure within its chambers.  Higher pressures inside the heart can lead to substantial symptoms.

Click on one of the following items to learn more about: Symptoms Treatment Options Ventricular Assist Devices Research See a list of clinical trials for heart failure

George Ruiz, MD, with his fellows, who are studying more effective ways to treat heart failure.

What are the symptoms of heart failure?

• Decline in exercise capacity
• Shortness of breath
• Chest discomfort
• Fatigue
• Swelling

There may be several reasons why the mechanics of pumping may be altered.  Part of the challenge of caring for patients with heart failure is to decipher what might be causing the problem. 

Learn more about heart failure.

See more videos on heart failure.  

Experienced Team
At MedStar Heart Institute at MedStar Washington Hospital Center, our cardiologists and cardiac surgeons have created an integrated heart failure program that offers treatment for all forms of heart failure, no matter how severe.
 
How will treatment help me?

1. Medicine.  Our physicians maximize and tailor medical therapy, to ensure that patients get the most out of the prescribed medical regimen.  We integrate an aggressive medical regimen with the most advanced devices to support heart function.
    
2. Advanced technological devices.  Our CHF specialists work closely with our arrhythmia specialists to provide implantable defibrillators (ICDs) as well as bi-ventricular pacing/defibrillator systems (Bi-V/ICD). 
   
   If heart function is not getting better despite these strategies, we offer advanced mechanical support, in the form of ventricular-assist devices (implantable heart pumps that help support heart function), also known as VADs, and ultimately, cardiac transplantation. 
   
   As the need for more advanced cardiac support (VADs/cardiac transplantation) arises, we provide a comprehensive approach to care that includes social work, mental health, peer-to-peer support and a wide range of clinical and patient support services.

Learn more about Left Ventricular Assist Devices.

Thorough Evaluation Process
Patients with heart failure are evaluated thoroughly by our physicians, including a dedicated team of cardiologists who are experts in providing advanced support. Treatment plans are individualized to address the specific needs and circumstances that patients face.  Our group believes that advanced cardiac support demands complex medical decision-making, delivered in a partnership between the physician and the patient and family.

VIDEO GALLERY: Finding Balance - Our Team Approach to Managing Heart Failure
Introduction What is Heart Failure? Symptoms of Heart Failure MedicinesExercise NutritionConclusion View All Chapters

Treatment Options
Both medication and surgery may play a role in the management of patients with CHF.  Given how effective they may be, medications are often considered the first line of therapy for patients with CHF.  Medication used to improve the heart’s function and the patient’s ability to function normally includes:

• Ace inhibitors
• Beta blockers
• Aldactone
• Hydralazine/isordil
• Diuretics

Our inpatient management of cardiac dysfunction also includes the use of intropic medication (medications that increase the squeezing capacity of the heart), as well as ultrafiltration for fluid removal.

As our physicians manage patients through various treatment strategies, we depend heavily on an integrative approach to managing CHF.  CHF specialists rely on a diverse team that routinely brings together expertise from various fields.  Our team is comprised of:

• Cardiologists who cover the fields of heart failure transplantation, imaging, congenital heart disease, vascular disease and pulmonary hypertension.
• Cardiac surgeons with vast experience in revascularization, valve repair and replacement, as well as advanced mechanical support (VADs) and transplantation.
• Heart failure nurses and nurse practitioners
• Dieticians
• Physical therapists
• Research coordinators
• Social workers

Surgical options for treatment
If coronary artery disease is contributing to the heart’s dysfunction, the team may consider coronary bypass surgery (CABG).  If prior heart attacks have damaged key walls of the heart, surgical reconstruction or new devices may be also be used to improve heart function.  If one or several of four heart valves are exacerbating the heart’s dysfunction, surgical or percutaneous valve repair or replacement may be considered.

A Ventricular Assist Device device is so small, it can fit in the palm of your hand.

Ventricular Assist Devices
In some cases, despite aggressive therapies, the heart muscle cannot adequately sustain the body’s circulation.  In those situations, advanced cardiac support, in the form of ventricular assist devices (VADs) or transplantation, may be considered in appropriate candidates. 

VADs can be used as a bridge to support patients awaiting heart transplantation, or as “destination therapy” for some select patients who are not candidates for cardiac transplantation.  VADs often allow patients to regain much of the functional capacity that they have lost to heart failure.  MedStar Washington Hospital Center’s VAD program offers several advanced-mechanical support options, including:

• Heart mate XVE
• Heart mate II (continuous for pump)
• Heartware™.  The newest generation of left ventricular assist device.  Cardiac surgeons at MedStar Washington Hospital Center were the first group to implant this pump in North America. 
• Levitronix CentriMag Devices – used for the acute rescue of patients with severe and sudden heart dysfunction.

Research
Our physicians perform research in the areas of investigational drugs for systolic and diastolic heart failure patients, as well as new drugs that may repair the heart muscle.  CHF specialists are involved in the development and testing of new devices designed to improve the symptoms and outcomes of patient’s with heart failure. 

Clinical Trials
Our participation in clinical trials means that we offer the newest technologies and approaches to the management of our patients. 

Clinical trials we participate in include:

1. ASCEND.  Trial evaluating the role of Natrecor in addition to standard intravenous diuretics in expediting fluid removal.
2. TOPCAT.  Investigation studying use of Spironolactone in patients with diastolic dysfunction.
3. BALANCE.  Studying use of Lixiviptan in patients with low sodium and CHF.
4. CARRESS.  National Institutes of Health (NIH) trial of ultra filtration in patients with fluid build-up not responsive to diuretics.
5. ASTRONAUT.  Trial for hypertension drug Tekturna to study its role in CHF patients.
6. EVOLVE.  Study of new third generation left ventricular assist device.
7. HEART MATE 2 DESTINATION.  Giving patients an option of left ventricular assist device if not eligible for heart transplant.
8. HARPS.  Currently evaluating if advanced heart failure patients with VAD support can recover sufficient myocardial function to allow device removal.

For further information about heart failure clinical trials, please contact:
Ravjyot Chawla, MD or Linda Matuskey, RN 
202-877-8085

A New Lease on Life for Roger-Guy Folly Roger-Guy Folly had to stop his daily walks and his once powerful voice grew hoarse as his heart failure symptoms got worse. But when his visits to the emergency room became almost a weekly occurrence, he knew his time was running out. As a patient at MedStar Washington Hospital Center, he found that he was a candidate for a new type of investigational cardiac assist device. Mr. Folly was implanted with the device this past summer and talks about his experience.